Prevalence and risk factors of post vaginectomy lower urinary tract symptoms in transgender male patients

This study describes the prevalence of postoperative lower urinary tract symptoms (LUTS) following gender-affirming total vaginectomy. Transgender assigned female at birth individuals who had a vaginectomy by a FPMRS-surgeon between August 1st, 2010 – July 1st, 2021 were invited to complete the following questionnaires: AUA Symptom Score (AUASS), Quality of Life (QOL), Incontinence Symptom Severity Index (ISI), Urogenital Distress Inventory Short Form (UDI-6), Incontinence Impact Questionnaire Short Form (IIQ-7), and Pelvic Pain Urgency/frequency scale (PUF). Chart review was conducted for demographics, pre-operative characteristics, intraoperative events, and post-operative outcomes. Clinically significant LUTS was defined based on validated instrument criteria: >25 for UDI_6, AUASS >7, ISI >2, IIQ-7 >34 and >3 for PUF. We performed descriptive analyses, comparing demographics, clinical, and perioperative characteristics between those with and without postoperative LUTS. Values were given median (IQR) or numbers and percentages. Non-parametric tests were performed as appropriate; Two-sided P<.05 was accepted as the degree of significance. Of the 53 patients contacted, 36 returned questionnaires (68%). Median age was 29 (IQR 26-39), median BMI was 27.1 (IQR 24.3 – 29.5), population was majority white (77.8%). Most patients underwent concurrent hysterectomy with bilateral salpingo-oophrectomy (n = 30, 83.3%). A minority of patients underwent concurrent urethral lengthening (n = 4, 11.1%). Median EBL was 380mL (IQR 150 – 650). LUTS were present in 19 participants (52.7%). Patients with post operative complications (n=14) and those undergoing a concurrent hysterectomy (n = 18) were more likely to experience LUTS (both p = 0.02) (Table 1). There was a trend that patients with LUTS had longer use of testosterone compared to patients without LUTS (p = 0.053) (Figure 1). Over half of patients undergoing gender-affirming vaginectomy experience clinically significant LUTS postoperatively. Patients should be counseled regarding possible LUTS, particularly for those undergoing concurrent hysterectomy at time of vaginectomy. Additional screening preoperatively could be considered to identify patients who may be at an increased risk of postoperative LUTS, such as length of testosterone use. Future studies elucidate duration of symptoms and identify modifiable risks for LUTS.Tabled 1Patient CharacteristicsCharacteristicsYes LUTS (n=19)1No LUTS (n=17)1p value2Concurrent Hyst18 (95%)11 (65%).02Concurrent BSO18 (95%)12 (71%).052EBL at vaginectomy (mL)500 (175-650)300 (135-650).56Post Op Complication314 (74%)6 (35%).02Time from operation(m)432 (18-42)23 (13-45).471. n(%); median(IQR) 2. Chi-Square; Fisher's Exact test; Wilcoxon rank test 3. Blood transfusion, infection, return to OR, VTE, Fistula 4. Operation to study (months). Open table in a new tab