Revista do Colégio Brasileiro de Cirurgiões
https://app.periodikos.com.br/journal/rcbc/article/doi/10.1590/0100-6991e-2026004325
Revista do Colégio Brasileiro de Cirurgiões
Artigo Original

Comparação de duas técnicas de cirurgia de adequação sexual do masculino para feminino - experiência com 59 casos consecutivos

Comparison of two male-to-female sexual reassignment surgery techniques - experience with 59 consecutive cases

Rodrigo Itocazo Rocha; Wilson Cintra Junior; Odair Gomes Paiva; Amanda Vitiello Pereira Brosco; Sidney Glina

http://dx.doi.org/10.1590/0100-6991e-2026004325 RCBC, vol.53, e2026004325, 2026
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Resumo

Introdução: Apesar da recente expansão e padronização das terapias para pessoas transgênero, as evidências científicas relacionadas a esses tratamentos, incluindo os cirúrgicos, ainda estão em processo de aprimoramento.

Objetivo: Comparar as taxas de complicações entre duas técnicas cirúrgicas de redesignação sexual (CRS) de homem para mulher: inversão peniana com posicionamento da glande no fundo do canal vaginal (VG) e inversão peniana utilizando a glande para confecção do clitóris (VC).

Método: Trata-se de uma coorte observacional retrospectiva que incluiu 59 mulheres transgênero submetidas à cirurgia de redesignação sexual utilizando as técnicas VG (grupo I, n=25) e VC (grupo II, n=34), operadas entre 2015 e 2019. Os grupos foram comparados por idade, peso, altura, índice de massa corporal, período de internação, óbito e tipos de complicações, como infecção do trato urinário, conformação do canal vaginal, revestimento do canal vaginal, fístulas, perfurações intestinais, volume vulvar à estimulação sexual, aspecto vulvar, eventos tromboembólicos e necessidade de reoperação. A análise estatística foi realizada utilizando o teste t de Student, o teste de Fischer e o teste de Pearson.

Resultados: Os grupos não apresentaram diferença quanto à idade, peso, IMC e período de internação. Também não houve diferenças em relação a algumas complicações, como infecção/deiscência (p=0,569), fístulas (p=0,71), perfurações retais (p=0,424), excesso de volume vulvar durante a estimulação sexual (p=0,122), aspecto vulvar (p=0,630) e eventos tromboembólicos (p=0,302). Houve diferença entre os grupos em relação à conformação do canal urinário (p=0,020) e vaginal (p=0,002), revestimento neovaginal (p=0,011) e necessidade de reoperação (p=0,006), com menores taxas de complicação no grupo VC. As complicações mostraram correlação fraca ao comparar queixas urinárias com volume vulvar durante a estimulação sexual (ρ=0,462); pequenas lesões do canal vaginal com fístulas (ρ=0,482); pequenas lesões do canal vaginal versus necessidade de reintervenção cirúrgica (ρ=0,477) e excesso de volume vulvar na estimulação sexual versus necessidade de reintervenção (ρ=0,494). Todos os outros testes de Pearson mostraram correlação nula ou muito fraca entre as variáveis.

Implicações Clínicas: A comparação das duas técnicas de cirurgia de redesignação sexual (CRS) realizadas no mesmo serviço permite afirmar que a técnica VC apresenta vantagens, com menores taxas de alguns tipos de complicações.

Pontos Fortes e Limitações: Esta é a primeira publicação conhecida a comparar dois tipos de CRS em mulheres trans, realizadas no mesmo serviço. Porém, trata-se de revisão retrospectiva de pacientes operadas inicialmente com a técnica da glande no fundo do canal vaginal (VG) seguidas pelo grupo operado com a técnica VC, o que pode gerar viés e esta é uma limitação do nosso estudo.

Conclusão: A técnica VC apresentou menor incidência de complicações urinárias, de conformação do canal vaginal e do revestimento vaginal e, consequentemente, menor necessidade de reintervenções cirúrgicas do que a técnica VG.

Palavras-chave

Disforia de Gênero; Pessoas Transgênero; Genitália; Procedimentos Cirúrgicos Urogenitais; Procedimentos de Redesignação Sexual

Abstract

Introduction: Despite recent expansion and standardization of therapies for transgender people, the scientific evidence related to these treatments, including surgical ones, is still improving.

Objective: To compare the complication rates between two male-to-female (MtF) techniques of sex reassignment surgery (SRS): penile inversion with positioning of the glans at the bottom of the vaginal canal (VG) and penile inversion using the glans to make the clitoris (VC).

Methods: This is a retrospective observational cohort that included 59 transgender women who underwent sex reassignment surgery with VG (group I, n=25) and VC (group II, n=34) techniques, operated on between 2015 and 2019. We compared groups by age, weight, height, body mass index, length of hospital stay, death, and types of complications, such as urinary tract infection, vaginal canal conformation, vaginal canal lining, fistulas, intestinal perforations, vulvar volume on sexual stimulation, vulvar appearance, thromboembolic events, and need for reoperation. We used the Student’s t, the Fischer’s, and the Pearson’s tests for statistical analysis.

Results: The groups did not differ in terms of age, weight, BMI, and length of hospital stay. There were also no differences regarding complications such as infection/dehiscence (p=0.569), fistulas (p=0.71), rectal perforations (p=0.424), increased vulvar volume during sexual stimulation (p=0.122), vulvar aspect (p=0.630) and thromboembolic events (p=0.302). The groups differed as to the conformation of the urinary canal (p=0.020) and vaginal canal (p=0.002), neovaginal lining (p=0.011), and need for reoperation (p=0.006), with lower complication rates in the VC group. There were weak correlations between the complication pairs urinary complaints and increased vulvar volume during sexual stimulation (ρ=0.462), small lesions of the vaginal canal and fistulas (ρ=0.482), small lesions of the vaginal canal and the need for surgical reintervention (ρ=0.477), and increased vulvar volume during sexual stimulation and the need for reintervention (ρ=0.494). All other Pearson tests showed no or very weak correlations between variables.

Clinical Implications: The comparison of the two SRS techniques performed in the same service allows us to affirm that the VC technique has advantages, with lower rates of some types of complications.

Strengths and Limitations: This is the first known publication comparing two types of SRS in trans women, performed in the same service. However, this is a retrospective review of patients initially operated with the glans technique at the bottom of the vaginal canal (VG) followed by the group operated with the VC technique, which may generate bias.

Conclusion: The VC technique had a lower incidence of urinary complications, conformation of the vaginal canal, and vaginal lining and, consequently, less need for surgical reinterventions than the VG technique.

Keywords

Gender Dysphoria; Transgender people; Genitalia; Urogenital Surgical Procedures; Sex Reassignment Procedures

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