PURPOSE: There is an increased need for evidence-based practices in male to female transgender (MtF) vaginoplasty. While there are a multitude of surgical techniques, there is a paucity of data comparing these procedures. A systematic review of retrospective studies on the outcomes of MtF vaginoplasty was conducted to minimize surgical complications, and improve patient outcomes for transgender patients.
METHODS: Applying the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA), a comprehensive search of several databases from 1985 to November 7th, 2017 was conducted. The databases included PubMed, Ovid MEDLINE Epub Ahead of Print, Ovid Medline In-Process & Other Non-Indexed Citations, Ovid MEDLINE, Ovid EMBASE, Ovid Cochrane Central Register of Controlled Trials, and Web of Science. The resulting publications were screened, and those that met our specified inclusion/exclusion criteria were analyzed. The DerSimonian and Laird random effects model was used to pool complications and patient-reported outcomes.
RESULTS: A total of 471 articles were initially identified, of which 46 met our eligibility criteria. A total of 3716 cases were analyzed. Overall incidence of complications included 2% (95% CI 1% to 6%) fistula, 14% (95% CI 10% to 18%) stenosis and strictures, and 1% (95% CI 0% to 6%) tissue necrosis, and 4% (95% Cl 2% to 10%) prolapse. Patient reported outcomes included a satisfaction rate of 93% (95% Cl 79% to 100%) with overall results, 87% (95% Cl 75% to 96%) with functional outcomes, and 90% (95% Cl 79% to 98%) with aesthetic outcomes. Ability to have orgasm was reported in 70% (95% Cl 54% to 84%) of patients. The regret rate was 1% (95% Cl 0% to 3%). The length of the vaginal cavity was 12.5 cm (95% Cl 6.3 cm to 14.4 cm).
CONCLUSION: Multiple surgical techniques have demonstrated safe and reliable means of male to female vaginoplasty with low overall complication rates, and with a significant improvement in patient’s quality of life. Studies utilizing different techniques in a similar population and standardized patient-reported outcomes are required to further analyze outcomes among the different procedures and to establish best-practice guidelines.