Overactive Bladder after Gender Affirming Vaginoplasty

Abstract

Objective: To assess overactive bladder symptoms and identify risk factors for worsened symptoms after vaginoplasty in transgender women.

Methods: This was a retrospective longitudinal study examining changes in OAB symptoms of transgender women undergoing vaginoplasty. All participants completed the 19 question Overactive Bladder Questionnaire Short-Form (OAB-q SF) to assess urinary symptoms before and after vaginoplasty. Medians of OAB-q SF scores, including Symptom Bother and Health-Related Quality of Life (HRQL) sub-scores, were measured. Changes in scores were compared using Wilcoxon signed-rank tests. Data were further stratified by factors such as age at time of surgery and type of vaginoplasty performed.

Results: 53 transgender women undergoing vaginoplasty were evaluated. Median time from surgery to post-operative questionnaire was 29 weeks. 53% underwent peritoneal flap vaginoplasty (PFV), 21% penile inversion vaginoplasty (PIV), 15% minimal depth vaginoplasty (MDV), and 11% sigmoid vaginoplasty (SV). For all patients, statistically significant HRQL declines were noted post-operatively (96.9/100 vs 93.8/100, p=0.020). When stratified by age, the oldest quartile of patients (44 to 71 years old) experienced the largest worsening of Symptom Bother (6.7/100 vs 20/100, p=0.020) and HRQL (96.9/100 vs 90.8/100, p=0.008). When stratified by vaginoplasty type, PFV had a significant decrease in HRQL (96.9/100 vs 93.8/100, p=0.023).

Conclusions: Patients undergoing vaginoplasty can experience worsening of overactive bladder symptoms affecting their quality of life, which in our series was more pronounced in older individuals and those undergoing PFV. However, the clinical significance of these symptom changes are unclear, suggesting that overall effects of vaginoplasty on OAB symptoms are limited.