MRI Helps Assess Complications Following Sex-Reassignment Surgery

Magnetic resonance imaging following sex-reassignment surgery helps clinicians assess post-operative anatomy and complications that may occur.

Magnetic resonance imaging allows clinicians to assess post-operative anatomy and complications following sex-reassignment surgery, according to a study published in the British Journal of Radiology.

Researchers from Italy sought to determine the role of MRI in evaluating the new female anatomy and complications in male-to-female sex reassignment surgery. Seventy-one patients participated in the study. The subjects’ age ranged from 21 to 63 years, with a mean age of 37 years. Forty-seven patients underwent MRI to rule out early post-operative complications, 40 after gender conversion, six after vaginoplasty, and one after remodeling of the labia majora. In 27 patients, MRI was performed from one to 20 years after surgery for late post-operative complications, pain or dysuria, inflammatory changes or poor cosmetic outcome. Three patients had MRI both before and after the operation.

The results showed using MRI allowed clinicians to investigate the new female anatomy in all cases. A small amount of blood was identified in all patients around the neoclitoris, urethral plaque, and labia. Post-operative complications were:

·       Clinically significant fluid collections in five patients;

·       Labial abscesses in two patients;

·       Severe cellulitis in three patients;

·       Partial neovaginal prolapse in three patients;

·       Focal necrosis and dehiscence of the vaginal wall in two patients; and

·       Hypovascularization of the neoclitoris in one patient.

After ileal vaginoplasty, three patients developed clinically insignificant hematomas, one a large rectovaginal fistula with dehiscence of the intestinal anastomosis and bowel perforation after ileal vaginoplasty. In the 27 patients investigated one to 20 years after the surgery, MRI demonstrated cavernosal remnants in 10 patients, spared testis in one patient, neovaginal strictures in eight patients, fistulas and abscesses in three patients, and prolapse in two patients. Three of these patients also had fibrotic changes. In the remaining three patients, no pathological features were identified.

The researchers concluded MRI is a useful tool to help clinicians assess post-operative anatomy and of post-operative complications following genital reconfiguration.