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Plast Reconstr Surg Glob Open
Plast Reconstr Surg Glob Open
GOX
Plastic and Reconstructive Surgery Global Open
2169-7574
Lippincott Williams & Wilkins Hagerstown, MD

GOX-D-24-00774
00008
10.1097/01.GOX.0001063840.50135.0b
3
PSTM Abstract Supplement
PSTM Top Abstracts/Posters 2024
Predictors of Postoperative Dilation Difficulty in Gender-Affirming Vaginoplasty Patients
Shamamian Peter Jr BS 1
Karim Subha BS 1
Wang Anya BS 1
Wang Carol BA 1
Montalmant Keisha MD, MPH, MB 1
Oleru Olachi MD 1
Seyidova Nargiz MD 1
Laarakker Avra MD 1
Zoghbi Yasmina MD 1
Henry Pang John MD 1
Avanessian Bella MD 1
Ting Jess MD 1
Horesh Elan MD, MPH 1
Icahn School of Medicine at Mount Sinai, Division of Plastic and Reconstructive Surgery; Mount Sinai Center for Transgender Medicine and Surgery
9 2024
18 9 2024
12 Suppl 6Copyright © 2024 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons. All rights reserved.
2024
https://creativecommons.org/licenses/by-nc-nd/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

OPEN-ACCESSTRUE
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pmcINTRODUCTION: A necessary component of postoperative care in gender-affirming vaginoplasty is consistent dilation of the neovaginal canal. The process of dilation is time-consuming and requires significant patient instruction and understanding. Patients can experience pain and difficulty with dilation, decreasing compliance and causing distress. This, in turn, can cause inconsistent dilation, leading to partial or complete closure of the neovaginal canal, and necessitate revisional surgery. This study sought to evaluate many patient and intraoperative factors that may contribute to dilation difficulty in patients, from social determinants of health indicators to operative characteristics.

METHODS: After approval from the Institutional Review Board at the Icahn School of Medicine, a retrospective review of patients undergoing gender-affirming vaginoplasty between January 2016 and December 2021 at The Mount Sinai Center for Transgender Medicine and Surgery was carried out. Demographics, comorbidities, preoperative genital characteristics, intraoperative details, postoperative complications, and follow up information was collected. National and state Area Deprivation Index (ADI) scores, reclassified by quintiles, were collected for each patient. ADI represents a multifaceted evaluation of a region’s socioeconomic conditions, which have been linked to health outcomes. The primary outcome was the presence of consistent dilation difficulty reported during follow-up clinic visits for any reason, including discomfort, pain, or understanding of instructions. Pearson’s Chi Square and Fisher’s Exact Tests were used for categorical values, and Student’s T-tests were carried out for continuous variables. Multiple logistic regression was carried out to identify significant predictors of dilation difficulty. Statistical significance was set at p<0.05.

RESULTS: Four hundred twenty-seven (427) patients were included in the study, 325 (72.7%) patients had no dilation difficulty, and 98 (22.9%) had dilation difficulty. Mean follow-up time was 12.3 months. On univariate analysis, Medicare insurance status (p<0.001), unemployment (p=0.007), any psychiatric diagnosis besides gender dysphoria (p=0.049), longer preoperative penile length (p=0.041), prior pelvic surgery (p=0.035), peritoneal vaginoplasty (p<0.001), longer operative time (0.023), and any unplanned readmission (p=0.004) were associated with postoperative dilation difficulty. Follow-up time was significantly longer in the dilation difficulty cohort (p<0.001), and significantly more patients with dilation difficulty required revision surgery (p<0.001). Multiple logistic regression revealed higher odds of dilation difficulty in patients with Medicare (OR 6.35, CI 1.55-26.07, P=0.010), in the fourth quintile of state-level ADI (OR 4.56, CI 1.30-15.98, p=0.018), with a history of keloids (OR 4.59, CI 1.42-14.85, p=0.01), with any non-gender dysphoria psychiatric diagnosis (OR 2.0, CI 1.11-3.58, p=0.021), and who received a peritoneal vaginoplasty (OR 5.01, CI 1.68-14.95, p=0.004). Lower odds of dilation difficulty were associated with patients in the second quintile of national-level ADI (0.356, 0.138-0.918, p=0.033), and in employed patients (OR 0.443, CI 0.221-0.930, p=0.031).

CONCLUSIONS: This is one of the first studies to examine the impact of sociodemographic, preoperative, and intraoperative factors on postoperative dilation difficulty in a large cohort of gender-affirming vaginoplasty patients. The risk of dilation difficulty may be associated with multiple aspects of the care spectrum, including social factors, psychiatric comorbidity, and operative technique. Understanding these risks are crucial for early intervention and ensuring patient postoperative dilation success.
