Comparison of two male-to-female sexual reassignment surgery techniques - experience with 59 consecutive cases

Despite recent expansion and standardization of therapies for transgender people, the scientific evidence related to these treatments, including surgical ones, is still improving.

To compare the complication rates between two male-to-female (MtF) techniques of sex reassignment surgery (SRS): penile inversion with positioning of the glans at the bottom of the vaginal canal (VG) and penile inversion using the glans to make the clitoris (VC).

This is a retrospective observational cohort that included 59 transgender women who underwent sex reassignment surgery with VG (group I, n=25) and VC (group II, n=34) techniques, operated on between 2015 and 2019. We compared groups by age, weight, height, body mass index, length of hospital stay, death, and types of complications, such as urinary tract infection, vaginal canal conformation, vaginal canal lining, fistulas, intestinal perforations, vulvar volume on sexual stimulation, vulvar appearance, thromboembolic events, and need for reoperation. We used the Student's t, the Fischer's, and the Pearson's tests for statistical analysis.

The groups did not differ in terms of age, weight, BMI, and length of hospital stay. There were also no differences regarding complications such as infection/dehiscence (p=0.569), fistulas (p=0.71), rectal perforations (p=0.424), increased vulvar volume during sexual stimulation (p=0.122), vulvar aspect (p=0.630) and thromboembolic events (p=0.302). The groups differed as to the conformation of the urinary canal (p=0.020) and vaginal canal (p=0.002), neovaginal lining (p=0.011), and need for reoperation (p=0.006), with lower complication rates in the VC group. There were weak correlations between the complication pairs urinary complaints and increased vulvar volume during sexual stimulation (ρ=0.462), small lesions of the vaginal canal and fistulas (ρ=0.482), small lesions of the vaginal canal and the need for surgical reintervention (ρ=0.477), and increased vulvar volume during sexual stimulation and the need for reintervention (ρ=0.494). All other Pearson tests showed no or very weak correlations between variables.

The comparison of the two SRS techniques performed in the same service allows us to affirm that the VC technique has advantages, with lower rates of some types of complications.

This is the first known publication comparing two types of SRS in trans women, performed in the same service. However, this is a retrospective review of patients initially operated with the glans technique at the bottom of the vaginal canal (VG) followed by the group operated with the VC technique, which may generate bias.

The VC technique had a lower incidence of urinary complications, conformation of the vaginal canal, and vaginal lining and, consequently, less need for surgical reinterventions than the VG technique.