"Prostatectomy after gender-affirming vaginoplasty for a transgender woman with prostate cancer"

Abstract

We present the case of a 75 year old transgender woman 18 months post gender-affirming vaginoplasty found to have unfavorable, intermediate risk prostate cancer. She elected a robotic radical prostatectomy with bilateral pelvic lymph node dissection. Postoperatively, the patient resumed neovaginal dilation without difficulty, and had improvements on International Prostate Symptom Score when compared to post-vaginoplasty, pre-prostatectomy. Incontinence measured by Revised Urinary Incontinence Scale remained mild. Robotic prostatectomy can, under appropriate circumstances, allow preservation of the neovaginal vault, but requires considerable experience and multidisciplinary intraoperative collaboration.

Keywords: Gender-affirming surgery; Health services for transgender persons; Prostate cancer; Prostatectomy.

Fig. 1

Pre-Surgical Lesion on Imaging Fig. 1 Legend. T2 Axial view of the prostate depicts a PRADS-4 lesion in the left posterior medial peripheral zone at mid gland level (yellow arrow). (For interpretation of the references to colour in this figure legend, the reader is referred to the Web version of this article.)

Fig. 2

Pre-Surgical Relation of the Neovagina to Prostate Fig. 2 Legend. T2 Sagittal view of the prostate (outlined in green) abutting the neovagina (outlined in blue). (For interpretation of the references to colour in this figure legend, the reader is referred to the Web version of this article.)

Fig. 3

Neovaginal Vault Defect During Apical Prostatic Dissection Fig. 3 Legend. Defect in neovaginal vault (within blue circle), created during release of the apical prostate (outlined in green) from the anterior wall of the neovagina (outlined in yellow). (For interpretation of the references to colour in this figure legend, the reader is referred to the Web version of this article.)