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Surgical Results
Surgical Results The aim of this procedure is to produce female external genitalia which is both cosmetically and functionally acceptable to the patient. However ,whilst this is obtainable in most cases the technique does have its limitations and patients must realistically acknowledge these before undergoing the procedure. Patients must also understand and accept the potential morbidity of the operation and the requirement for a secondary procedure in up to 20% cases in the long term. In most cases such secondary procedures are minor and performed as day-case surgery. In about 5 % of patients the vagina may be too short or stenosed and require the fashioning of a neovagina from a segment of bowel , usually the sigmoid colon.
The six week surgical outcomes of the Leicester series is audited prospectively. We have retrospectively studied the long-term surgical outcomes from both a case note review and telephone enquiry.
Of 222 case notes reviewed patients were of a median age of 43 years (range
19-76) and operated on between 1994 & 2004. The following complications were
recorded :
At six week review 148/197 (82.2%) had adequate vaginal depth with a measured median depth of 13cm (5-15 cm) in 103 patients.158/183 (86.3%) patients had a sensate clitoris which 4 (2.2%) judged to be hypersensitive and uncomfortable. 36/197 (18.3%) had some degree of urethral stenosis which resolved with out-patient urethral dilatation in 28 and day-case meatotomy in 8 cases.
A telephone survey of post-operative results demonstrated this to be a nomadic group of patients with only about 70 patients contactable at a median follow-up of 36 months ( range 9-96 ). 63/64 patients had a sensate clitoris of which 48% were able to achieve clitoral orgasm. Median vaginal depth was 13.5 cm (2.5-18cm ). 4 (6%) has developed a vaginal prolapse. Overall cosmetic result was acceptable in 76% and 80% reported that the surgery met with their pre-operative expectations.
In summary, about 80% of patients are globally happy with the technique and the majority of complications were correctable by a simple secondary procedure. However vaginal stenosis requires a new vagina made from a bowel segment which is clearly a further major procedure. Since 2005 our technique has been refined to include plication of the urethral stump to reduce the likelihood of post-operative urethral swelling, greater spatulation and interrupted suturing of the urethral meatus to reduce the incidence of stenosis and formation of a clitoral hood at the initial surgery using a more robust technique to minimise wound breakdown/scarring. Most importantly , we believe in the value of rigorous pre-operative patient counselling and post-operative support as inevitably a minority of patients will be disappointed to varying degrees with their operative outcome.
PicturesPatient A at 6 months
Patient B at 18 months
Patient C at 3 years