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Complications Following Gender-affirming Penile-inversion Vaginoplasty: An Administrative Claims Analysis Of Over 1400 Patients
Caleb Haley, MD, Kumaran Arivoli, BS, Zachary Eisner, BS, Megan Lane, MD, William Bruce, MD, Jennifer Hamill, MPH, Jessica Hsu, MD, PhD, William Kuzon, MD, PhD.
University of Michigan, Ann Arbor, MI, USA.
Purpose: Penile-inversion vaginoplasty (PIV) is the most requested genital gender-affirming surgery (GAS). Previous studies examining complications following PIV have been limited by small sample sizes or single-institution data. We aimed to evaluate the frequency of complications and revisions following PIV in a national administrative claims dataset.
Methods: We utilized the PearlDiver database, containing administrative claims records from over 165 million patients from 2010-2022. Using CPT codes, we identified a subset of patients who underwent PIV from a sample of gender-diverse individuals. Basic demographic information in addition to complication rates and revision procedure rates were collected for patients who underwent PIV (Table 1).
Results: Of the 1449 PIV patients, 510 (35.2%) experienced at least one complication. Minor complications were common, with vaginal stenosis (10.4%), UTI (9.2%), and pain complications (9%) being most frequent. Major complications were less common, with hemorrhage (1.8%), urethrovaginal fistula (1.2%), and VTE (1%) being most frequent. 0.8% of patients experienced rectovaginal fistula. 11.7% of patients underwent revision within 1-year of PIV.
Conclusions: This study demonstrates PIV has a moderate risk of minor complications and lower risk of major complications. Surgeons can use this data when counseling patients preoperatively. However, given that not all complications are captured in claims datasets, the incidence of complications, especially minor complications, is likely underestimated. Thus, future work should prospectively assess complications following PIV across multiple centers.
Table 1: Frequency of Complications following Penile-Inversion Vaginoplasty (PIV) | | |
| Postoperative Outcomes (Time from PIV) | n | % (N=1449) |
| Total complications | 510 | 35.2% |
| Minor complications | 493 | 34.0% |
| Surgical site infection (180 days) | 35 | 2.4% |
| Pain complications (1 year) | 131 | 9.0% |
| Sensory complications (1 year) | 38 | 2.6% |
| Wound healing difficulties (1 year) | 103 | 7.1% |
| Stenosis (1 year) | 151 | 10.4% |
| Urinary difficulties (1 year) | 111 | 7.7% |
| UTI (6 months) | 133 | 9.2% |
| Major complications | 68 | 4.7% |
| Hemorrhage (30 days) | 26 | 1.8% |
| Urethrovaginal fistula (1 year) | 17 | 1.2% |
| Rectovaginal fistula (1 year) | 12 | 0.8% |
| VTE (90 day) | 14 | 1.0% |
| Revision procedures | 169 | 11.7% |
| Clitoroplasty (2 years) | 82 | 5.7% |
| Labiaplasty (2 years) | 69 | 4.8% |
| Urethral revision (2 years) | 33 | 2.3% |
| Introital revision (2 years) | 25 | 1.7% |
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