REVIEW   Free access

Minerva Urologica e Nefrologica 2019 October;71(5):479-86

DOI: 10.23736/S0393-2249.19.03407-6

Copyright © 2019 EDIZIONI MINERVA MEDICA

language: English

Systematic review of studies reporting perioperative and functional outcomes following male-to-female gender assignment surgery (MtoF GAS): a call for standardization in data reporting

Andrea COCCI ¹ ✉, Davide FREDIANI ², Giovanni E. CACCIAMANI ³, Gianmartin CITO ¹, Michele RIZZO ⁴, Carlo TROMBETTA ⁴, Francesca VEDOVO ⁴, Simone GRISANTI CAROASSAI ¹, Augusto DELLE ROSE ¹, Valeria MATTEUCCI ⁵, Francesco ROSI ², Piero BUCCIANTI ⁵, Cristina CECCARELLI ⁵, Giorgio I. RUSSO ⁶, Gaia POLLONI ⁷, Sergio SERNI ¹, Mauro GACCI ¹, Marco CARINI ¹, Andrea MINERVINI ¹, Girolamo MORELLI ²

¹ Department of Urology, Careggi Hospital, University of Florence, Florence, Italy; ² Department of Urology, University of Pisa, Pisa, Italy; ³ Department of Urology, University of Verona, Verona, Italy; ⁴ Department of Urology, University of Trieste, Trieste, Italy; ⁵ Department of General Surgery, University of Pisa, Pisa, Italy; ⁶ Department of Urology, University of Catania, Catania, Italy; ⁷ Private Practitioner, Como, Italy

INTRODUCTION: The aim of this study is to accomplish a systematic review on the surgical techniques available for male-to-female gender assignment surgery (MtoF GAS) published in the last 15 years, from January 2002 to May 2017, assessing advantages and disadvantages.
EVIDENCE ACQUISITION: A specific search on MEDLINE, Scopus and Web of Science databases included vaginoplasty for gender exchange. Preoperative (age, gender, body mass index, prior surgery), intraoperative (mean operating time, intraoperative complications, transfusion rate, conversion rate), postoperative (hospital stays, readmission rate, early and late complication rate), postoperative sexual activity, subjective satisfaction, vaginal depth, and long-term outcomes (vaginal stenosis, prolapse, dyspareunia and labial abscess) data of vaginoplasty for sexual exchange were collected. 29 articles were included (2.402 patients).
EVIDENCE SYNTHESIS: Out of the 29 papers, 19 studies assessed penile skin inversion and 10 evaluated intestinal vaginoplasty. No comparative studies were found. Penile skin inversion vaginoplasty reported slightly shorter operative time compared to intestinal vaginoplasty (109-420 vs 145-420 minutes). Intraoperative complications for penile skin inversion vaginoplasty not exceeded an incidence of 10%. No significant differences in terms of postoperative complications or hospitalization time were reported. Intestinal vaginoplasty provides a deeper neovagina. Female Sexual Function Index score was significantly higher in patients undergoing intestinal vaginoplasty.
CONCLUSIONS: A standardized data collection may allow a better understanding of effectiveness and outcomes of different techniques.

KEY WORDS: Gender dysphoria; Sex reassignment procedures; Reconstructive surgical procedures