101. Role of Allogeneic Placental Tissues in Penile Inversion Vaginoplasty

BACKGROUND: The role of allogeneic placental tissue in genital-affirming surgery is poorly understood. The most successful procedure, penile inversion vaginoplasty (PIV), oftentimes results in tissue healing or wound-related complications. Postoperative outcomes may include scarring and neovaginal stenosis. Surgical reoperation and revision vaginoplasty are common. METHODS: The authors performed a retrospective analysis of consecutive adult patients undergoing primary PIV performed during a 6-year period (September 1, 2014, to September 1, 2020). Cohort designation was based on the intraoperative application of an allogeneic placental tissue (APT) biomaterial to the dissected neovaginal canal space, the neovaginal canal lining, and to external genitalia incisions. Subjects undergoing primary PIV without APT were classified as the conventional group. Postoperative outcomes—with particular focus on wound healing morbidity and reoperation—were compared between groups. Short- and long-term complications were classified using Clavien-Dindo. RESULTS: A total of 182 primary PIV cases were reviewed (115 conventional PIV; 67 PIV-APT). The postoperative follow-up time for the population averaged 12.7 months. All-cause and wound related complications were significantly lower amongst PIV-APT patients when compared to conventional PIV (p =.0005 and p =.002, respectively). The rate of long-term complications was also identified as significantly lower in PIV-APT subjects: prolonged pain (p =.001), prolonged swelling (p =.047), and neovaginal stenosis (p <.0001). The PIV-APT group also required significantly less reoperation for vaginal depth enhancement (p =.007). CONCLUSION: Though its use in urogenital reconstruction has been limited, this study indicates that the placement of APT significantly lowered the risk of complications associated with poor wound healing, which aligns with previous literature describing the role of allogenic placental tissues in surgical procedures.