Long-Term Follow-Up of Individuals Undergoing Sex-Reassignment Surgery: Somatic Morbidity and Cause of Death

INTRODUCTION:

Studies of mortality and somatic well-being after sex-reassignment surgery (SRS) of transsexual individuals are equivocal. Accordingly, the present study investigated mortality and somatic morbidity using a sample of transsexual individuals who comprised 98% (n = 104) of all surgically reassigned transsexual individuals in Denmark.

AIMS:

To investigate somatic morbidity before and after SRS and cause of death and its relation to somatic morbidity after SRS in Danish individuals who underwent SRS from 1978 through 2010.

METHODS:

Somatic morbidity and mortality in 104 sex-reassigned individuals were identified retrospectively by data from the Danish National Health Register and the Cause of Death Register.

MAIN OUTCOME MEASURES:

Somatic morbidity and cause of death.

RESULTS:

Overall, 19.2% of the sample were registered with somatic morbidity before SRS and 23.1% after SRS (P = not significant). In total, 8.6% had somatic morbidity before and after SRS. The most common diagnostic category was cardiovascular disease, affecting 18 individuals, 9 before and 14 after SRS, and 5 of those 14 who were affected after SRS had cardiovascular disease before and after SRS. Ten individuals died after SRS at an average age of 53.5 ± 7.9 years (male to female) and 53.5 ± 7.3 years (female to male).

CONCLUSION:

Of 98% of all Danish transsexuals who officially underwent SRS from 1978 through 2010, one in three had somatic morbidity and approximately 1 in 10 had died. No significant differences in somatic morbidity or mortality were found between male-to-female and female-to-male individuals. Despite the young average age at death and the relatively larger number of individuals with somatic morbidity, the present study design does not allow for determination of casual relations between, for example, specific types of hormonal or surgical treatment received and somatic morbidity and mortality.

Full article at:   http://goo.gl/5x35ba

By:  Simonsen RK1, Hald GM2, Kristensen E3, Giraldi A3.

• 1Department of Sexology, University Hospital of Copenhagen, Copenhagen, Denmark. Electronic address: rikke.kildevaeld@regionh.dk.
• 2Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
• 3Sexological Clinic, Psychiatric Center Copenhagen, Copenhagen, Denmark. 
• Sex Med. 2016 Mar;4(1):e60-8. doi: 10.1016/j.esxm.2016.01.001.

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Male-to-Female Genital Reassignment Surgery: A Retrospective Review of Surgical Technique and Complications in 60 Patients

Below:  Preoperative surgical markings and an iodinate vaginal dilator in place

Below:  Penile disassembly

Below:  The glans and urethra are positioned through two small skin holes in their new position

Below:  Immediate postoperative neovagina

We conducted a retrospective study of 60 patients who underwent genital reassignment procedure for male-to-female GD at our department between November 2008 and August 2013 with a minimum follow-up of 1 year. Data were collected on surgical technique, postoperative dilations protocol, complications, and functional and aesthetic outcomes. We describe and critically evaluate the surgical technique used in our department.

Follow-up ranged from 14 to 46 months. Two patients developed late neovaginal stricture, and two patients experienced rectovaginal fistulae (one required surgical revision with dermal porcine graft placement). Minor complications occurred in 13 patients and included urethral stenosis, partial wound dehiscence, and minor bleeding. Secondary aesthetic revision surgery was performed in 13 cases.

GRS can provide good functional and aesthetic outcomes in patients with male-to-female GD. However, despite a careful planning and meticulous surgical technique, secondary procedures are frequently required to improve the function and appearance of the neovagina.

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