Variant genital gender‐affirming surgery: a systematic review

IF 3.7 2区 医学 Q1 UROLOGY & NEPHROLOGY BJU International Pub Date : 2024-08-30 DOI:10.1111/bju.16513
Wietse Claeys, Dylan T. Wolff, Alexandra Zachou, Piet Hoebeke, Nicolaas Lumen, Anne‐Françoise Spinoit
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Abstract

ObjectiveTo review the available literature on variant genital gender‐affirming surgery (GGAS), including the reasons for performing it, the surgeries themselves and their outcomes.MethodsA systematic review on the performance of variant GGAS was conducted (International Prospective Register of Systematic Reviews [PROSPERO] identifier: CRD42022306684) researching PubMed, Embase, Web of Science and Cochrane databases from inception up to 31 December 2023. Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines were followed, and risk of bias was assessed for each study using the five‐criteria quality assessment checklist.ResultsIn total 23 case series were included, of which 17 on masculinising and six on feminising surgeries. Patients mainly choose these surgical procedures out of personal desire to avoid risk of complication or because they do not have dysphoria about certain parts of their genitalia. Complications in masculinising surgeries primarily arose from the extended urethra, which could be mitigated through primary perineal urethrostomy. Both phalloplasty and metoidioplasty carried a higher risk of urethral complications when the vagina was preserved. In feminising surgeries, risk of visceral damage and requirement for lifelong self‐dilation could be avoided when vulvoplasty was performed without vaginal canal creation. All studies had a high risk of bias.ConclusionThis review highlights the importance of variant GGAS and acknowledges the preferences of transgender and gender‐diverse individuals. Patients should be informed about the risks and benefits of each step in these procedures.
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变异生殖器性别确认手术:系统综述
目的综述有关变异生殖器性别确认手术(GGAS)的现有文献,包括实施手术的原因、手术本身及其结果。方法对变异生殖器性别确认手术的实施情况进行系统综述(系统综述国际前瞻性注册[PROSPERO]标识符:CRD42022306684):对 PubMed、Embase、Web of Science 和 Cochrane 数据库进行了研究(国际前瞻性系统综述注册[PROSPERO]标识符:CRD42022306684),研究时间从开始至 2023 年 12 月 31 日。研究遵循了系统综述和荟萃分析首选报告项目(Preferred Reporting Items for Systematic Reviews and Meta-Analyses,PRISMA)指南,并使用五项标准质量评估清单对每项研究的偏倚风险进行了评估。患者选择这些手术主要是出于个人意愿,以避免并发症的风险,或者是因为他们对自己生殖器的某些部位没有恐惧感。男性化手术的并发症主要来自尿道的延长,这可以通过初级会阴尿道前列腺切除术来缓解。在保留阴道的情况下,阴茎成形术和阴道成形术出现尿道并发症的风险较高。在女性化手术中,如果外阴成形术不创建阴道管,则可避免内脏损伤和终生自行扩张的风险。结论本综述强调了变性 GGAS 的重要性,并承认了变性者和性别多样化者的偏好。患者应了解这些手术每个步骤的风险和益处。
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来源期刊
BJU International
BJU International 医学-泌尿学与肾脏学
CiteScore
9.10
自引率
4.40%
发文量
262
审稿时长
1 months
期刊介绍: BJUI is one of the most highly respected medical journals in the world, with a truly international range of published papers and appeal. Every issue gives invaluable practical information in the form of original articles, reviews, comments, surgical education articles, and translational science articles in the field of urology. BJUI employs topical sections, and is in full colour, making it easier to browse or search for something specific.
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