Assessment of Patient-reported Urologic Function Outcomes Post Vaginoplasty

PURPOSE: As transgender medicine and access to care continues to expand, the number of patients undergoing gender affirming surgery (GAS) continues to rise.1,2 Accompanying this increase has been an emphasis on better understanding the surgical implications/complications of this procedure, which may include abnormal voiding, overactive bladder symptoms, incontinence, and more.3 Previous studies assessing bladder function after GAS utilized institution-specific questionnaires or relied on retrospective provider documented chart information.4,5 The primary objective of the present study was to determine the optimal time post vaginoplasty surgery to administer the AFFIRM survey in order to achieve the most reliable information on postoperative outcomes and complications. METHOD: An AFFIRM-validated survey,3 a multi-institutional patient questionnaire was used to capture the genitourinary (GU) complications following vaginoplasty surgery, and was distributed to patients preoperatively, and then postoperatively at two weeks(n= 111 patients), 6 months(n=61), and 12 months(n=47). Survey questions aimed to assess postoperative changes to urinary frequency, urgency, nature of the urinary stream, urinary leakage (across a variety of contexts), occurrence of urinary tract infection (UTIs), and if/how these changes have impacted quality of life. Responses to the survey were collected for each patient and linear mixed-effect models were performed to assess whether responses significantly differed (p<0.05) at various time points. RESULTS: A total of 309 unique patients were included in the study. Most patients identified as white (74%) and non-Hispanic (69%). Survey responses demonstrated a significant decrease in urologic function before and after vaginoplasty for 7 out of 12 questions. When the 2 week survey response was set as the reference group, 4 out of 14 questions demonstrated significant difference in responses at different postoperative time points. Responses at later time points showed that patients had significantly more normal urine stream rates and less frequency of hematuria and UTIs than at the 2 week post op time point. Only 1 out of 14 questions had significantly different responses at 6 months vs 12 months. CONCLUSION: As expected, the survey responses demonstrate a significant difference in preoperative and postoperative bladder function. This finding is consistent with current literature.4,5 However, our study also reveals robust evidence that the AFFIRM survey distributed at the 6 month time point provides a reliable basis for assessing postoperative urologic function. REFERENCES: 1. Selvaggi G, Bellringer J. Gender reassignment surgery: an overview. Nat Rev Urol. 2011;8(5):274-282. 2. Winter S, Diamond M, Green J, et al. Transgender people: health at the margins of society. Lancet. 2016;388(10042):390-400. 3. Huber S, Ferrando C, Safer JD, et al. Development and Validation of Urological and Appearance Domains of the Post-Affirming Surgery Form and Function Individual Reporting Measure (AFFIRM) for Transwomen following Genital Surgery. J Urol. 2021;206(6):1445-1453. 4. Hoebeke P, Selvaggi G, Ceulemans P, et al. Impact of sex reassignment surgery on lower urinary tract function. Eur Urol. 2005;47(3):398-402. 5. Stites J, Bernabé KJ, Galan D, et al. Urinary continence outcomes following vaginoplasty in patients with congenital adrenal hyperplasia. J Pediatr Urol. 2017;13(1):38.

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