"Modified" Penile Inversion Vaginoplasty: First Case Series of a Turkish Single Center

Area of Science:

• Surgical techniques
• Gender-affirming surgery
• Urology

Background:

• Penile inversion vaginoplasty (PIV) is a common procedure for male-to-female gender affirmation.
• Modifications to PIV aim to improve outcomes, such as vaginal depth and lubrication.

Purpose of the Study:

• To report outcomes, complications, and management of a modified penile inversion vaginoplasty (PIV) technique in transgender individuals.
• To present the first case series from a single center in Turkey using this modified PIV approach.

Main Methods:

• A cross-sectional study of adult transgender cases undergoing male-to-female gender-affirming surgery between January 2015 and December 2019.
• Application of a modified PIV technique incorporating the spatulated urethra into the penile skin flap.
• Prospective collection of demographic data, medical history, and follow-up complications.

Main Results:

• Thirty cases were included, with a mean age of 31.03 years and a mean hospitalization of 10.13 days.
• Mean vaginal depth was 14.2 cm at 1-year follow-up, with 80% reporting satisfactory neovaginal moistening.
• Complications occurred in 63.4% of cases, including intraoperative rectal injury and postoperative issues like meatal stenosis and vaginal narrowing. Overall satisfaction was 81.84%.

Conclusions:

• The modified PIV technique demonstrates high satisfactory outcomes, including achievable lubricity and vaginal width/depth.
• This technique is particularly suitable for cases with limited penile skin or prior circumcision.
• The modified PIV offers a viable option for gender-affirming surgery with good functional results.