Combined Mastectomy and Laparoscopic Hysterectomy with Salpingo-Oophorectomy in Transgender Men: a Cohort Study

There are few data on complications with gender affirming surgery. The aim of this study was to assess peri- and postoperative complications of laparoscopic hysterectomy and mastectomy performed in a single sitting in transgender men. Assessment of intra- and postoperative complications in a series of 65 transgender men (mean age 27, range 18–47) undergoing concomitant mastectomy and laparoscopic hysterectomy with salpingo-oophorectomy. Mean operating time was 292 ± 47 min. Thirty-four (52%) patients experienced complications: 28 (41%) DINDO grade I, 0 DINDO grade 2, 6 (11%) DINDO grade III. The six grade 3 complications consisted of 5 hematomas requiring evacuation after mastectomy and 2 vaginal tears requiring transvaginal repair. Three patients were readmitted within 30 days, all for postoperative bleeding/hematoma. In transgender men, performing laparoscopic hysterectomy and mastectomy at a single sitting has a modest rate of perioperative complications, and may improve resource utilization.

Comparison of Transvaginal Repair of Vesicovaginal Fistula with and without Martius Flap

Background: Different approaches and techniques have been adopted to repair Vesicovaginal Fistula (VVF) successfully. However, role of tissue interposition in success of VVF repair is still controversial. Objective: To compare the outcomes of transvaginal repair of Vesicovaginal fistula (VVF) with and without martius flap in terms of success rate and recurrence. Study Design: Randomized control study. Settings: Department of Urology Lahore General Hospital, Lahore Pakistan. Duration: One year and six months from January 01, 2019 to June 30, 2020. Methodology: Total 40 patients with VVF were included in the research, malignant, radiation induced and complex fistula are excluded. 40 patients of transvaginal repair of VVF, split into two groups, randomized by serial number technique each consisting of 20, group A repaired with martius flap and group B with simple repair without martius flap. After 2, 4 and 8 weeks all the patients were assessed for recurrence or any other complication. The data was collected in a specially designed proforma. Results: 40 patients fulfilling the inclusion criteria were included, 20 patients in each group. Mean age of group A patients was 36.70±5.16 and of that group B was 37.10±4.58. 33 (85.5%) patients have supra-trigonal fistula, while 7(14.5%) had trigonal fistula and mean fistula size was 1.96cm ±1.0. The success rate was 100% (20/20) in group A, while in group B, 95 % (19/20) with recurrence in one case. Chi square analysis was employed for comparison of adequacy of both the techniques. p-value was found to be 0.311 which suggests that the difference between the efficacies of two techniques was not statistically significant. Conclusion: Both the techniques of transvaginal repair of simple benign Vesicovaginal fistula are successful with equal success rate in martius inter positional flap repair and simple bilayer repair without flap.

A Midurethral Sling to Reduce Incontinence After Vaginal Prolapse Repair

This chapter summarizes the results of the Outcomes Following Vaginal Prolapse Repair and Midurethral Sling (OPUS) trial, in which women without stress urinary incontinence undergoing prolapse surgery were randomized to a midurethral sling or no concomitant midurethral sling. The OPUS trial found that women randomized to undergo prophylactic concomitant midurethral sling at the time of transvaginal repair for pelvic organ prolapse had lower rates of urinary incontinence at 3 and 12 months but also experienced higher rates of adverse events such as bladder perforation, major bleeding, and urinary tract infections.