Vaginoplasty for gender dysphoria and Mayer–Rokitansky–Küster–Hauser syndrome: a systematic review
Notice bibliographique
Résumé
Objective: Vaginoplasty is performed on approximately 20% of Dutch patients with male-to-female Gender Dysphoria (GD) and Mayer–Rokitansky–Küster–Hauser Syndrome (MRKHS). Various procedures are available, but comparisons of technique outcomes are lacking. The investigators aim to aid well-informed decision making by highlighting information gaps, weaknesses, and strengths. Evidence Review: A systematic search in PubMed, EMBASE, Web of Science, and Scopus until October 7, 2022, by Population, Intervention, Comparator, Outcomes method and prospectively registered systematic reviews registration. Original retrospective studies on complete neovaginal creation were included. Inclusion criteria were original, peer-reviewed articles, ≥10 adult patients with MRKHS or transfeminine, ≥6 months postvaginoplasty, and report at least one outcome (anatomy, complications, complaints, satisfaction, sexual function, or quality of life [QoL]) with 5 patients with MRKHS or transfeminine needed as isolated patient population. Exclusion criteria were merged results of patient types (with control groups) and/or vaginoplasty techniques, unspecified vaginoplasty techniques, combined treatments, or vaginoplasty as secondary procedures. Methodological quality and potential bias were assessed by the Newcastle–Ottawa Scale and the National Institutes of Health Quality Assessment Tool. Outcome assessed anatomy, QoL, satisfaction, sexual function, complications, or complaints. Results: Our search yielded 52 studies with 9 different vaginoplasty techniques. In total, 35 GD and 17 MRKHS studies were eligible. Mean vagina length was 8.3–16.2 cm and 7.6–16.4 cm, respectively. In patients with GD, hemorrhage (mean 0%–43.9%), necrosis (mean 0%–25.7%), prolapse (mean 0%–7.7%), stenosis (mean 0%–73.8%), gastrointestinal complications (mean 0%–8.3%), revisions (mean 3.2%–63.2%), pain (mean 3.1%–13.6%), discharge (mean 3.2%–6.7%), regret (mean 0%–6.5%), and fecal- (mean 3.2%–17.3%) and urinary issues (mean 1.3%–46.2%) were reported. Patients with MRKHS reported necrotic (mean 0%–16.7%) and stenotic complications (mean 0%–13.0%), discharge (mean 0%–100%), and prolapse (mean 0%–3.7%). Both patients with GD and MRKHS showed a high variation of Sexual activity (mean GD = 31.1%–86.7% and MRKHS = 21.2%–100%) and Dyspareunia (mean GD = 1.6%–50% and MRKHS = 0%–41.7%). Patients with MRKHS were more satisfied with anatomy (mean GD = 72.2%–100% and MRKHS = 100%). Conclusion: For patients with GD and MRKHS, multiple vaginoplasty techniques improve QoL and self-image with low rates of complications/complaints and high satisfaction. However, the heterogenicity of outcome-measuring methods reflects the need for standardized validation tools. Direct technique comparisons per patient cohort and exploration of tissue-engineering methods are critical for future surgical advancements and well-informed decision making. This first systematic review on 9 vaginoplasty techniques in patients with MRKHS and GD provides useful insight for patients and physicians and might aid well-informed decisions and manage realistic surgical expectations.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,001 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,001 |
| Méta-épidémiologie (sens large) | 0,004 | 0,001 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».