Abstract
BACKGROUND : About 430,000-1,000,000 Gender Dysphoria- and
Mayer-Rokitanksy-Küster-Hauser-patients undergo vaginoplasty each year.
Various surgical procedures are available, but direct comparisons are
lacking. This inhibits well-informed decision making by patients and
healthcare professionals.
OBJECTIVES : Highlight information gaps, weaknesses and
strengths of todays vaginoplasty techniques.
SEARCH STRATEGY : A systematic search in Medline, EMBASE, Web of
Science and Scopus until March 8, 2022 was conducted, by PICO method and
PROSPERO registration.
SELECTION CRITERIA : Original retrospective studies on complete
neovaginal creation in adult Gender Dysphoria- and
Mayer-Rokitanksy-Küster-Hauser-patients and discussing anatomical
outcome, Quality of Life, satisfaction, sexual function, complications
and/or complaints.
DATA COLLECTION AND ANALYSIS : Data was extracted and
methodological quality and potential bias were assessed. The 95%
confidence intervals were calculated with DerSimonian and Laird
random-effects.
MAIN RESULTS : A total of 47 articles were eligible. Surgery
took 198 minutes with 10.2 cm vaginal length. Major complications
included 5% hemorrhage, 1% gastrointestinal complications, 1%
prolapse, 3% tissue necrosis and 6% stenosis, leading to 31%
revisions. Patients reported 25% excessive discharge, 6% pain, 11%
fecal- and 17% urinary issues and one case of hair growth. Patients
also reported 95% aesthetic- and 93% anatomical satisfaction, 10%
overall dissatisfaction and 1% regret. Reports showed 75% sexual
activity, 13% dyspareunia, 87% sensation and 84% overall functional
satisfaction.
CONCLUSIONS : Multiple vaginoplasty techniques demonstrated safe
and acceptable outcomes, with significant improvement of Quality of Life
and self-image. However, standardized validation tools are needed for
well-informed decision-making. Direct technique comparisons with similar
cohorts and exploration of tissue-engineering methods are critical for
future surgical advancements.
KEYWORDS : Gender Dysphoria / Mayer-Rokitansky-Küster-Hauser
syndrome / vaginoplasty / patient-reported outcomes / complications
FUNDING
None.