Background: The objective of this study is to determine the incidence of adverse events associated with rectovaginal fistula (RVF) repair surgery and compare the incidence of adverse events by route of surgery.
Transmasculine people are assigned female at birth but identify as male. These patients often are prescribed testosterone therapy as part of their transition. This treatment can affect ovulation and stop menstrual periods. Endometriosis is a common condition that causes pelvic pain in some people born with female pelvic organs. Not a lot is known about transmasculine people and how often endometriosis affects them. Testosterone should help treat if not reduce the incidence of endometriosis. This commentary looks at the current literature in order to help clarify existing knowledge gaps. Transmasculine patients who present for hysterectomy as a surgery to help them affirm themselves in their self-identified gender sometimes report pelvic pain symptoms as well. There are many reasons why patients report pain before surgery, and this can be related to endometriosis, even though this diagnosis is less expected in this group. Providers caring for transmasculine patients should be aware of this.
We present the rationale for and the design of a prospective trial to evaluate the role of preoperative frailty and mobility assessments in older women undergoing surgery for the treatment of pelvic organ prolapse (POP) as a planned prospective supplemental trial to the ASPIRe (Apical Suspension Repair for Vault Prolapse In a Three-Arm Randomized Trial Design) trial. The Frailty ASPIRe Study (FASt) examines the impact of preoperative frailty and mobility on surgical outcomes in older women (≥65 years) participating in the ASPIRe trial. The primary objective of FASt is to determine the impact of preoperative age, multimorbidity, frailty, and decreased mobility on postoperative outcomes in older women (≥65 years old) undergoing surgery for POP. The selection of the preoperative assessments, primary outcome measures, and participant inclusion is described. Frailty and mobility measurements will be collected at the preoperative visit and include the 6 Robinson frailty measurements and the Timed Up and Go mobility test. The main outcome measure in the FASt supplemental study will be moderate to severe postoperative adverse events according to the Clavien-Dindo Severity Classification. This trial will assess impact of preoperative age, multimorbidity, frailty, and decreased mobility on postoperative outcomes in older women (≥65 years old) undergoing surgical procedures for the correction of apical POP. Information from this trial may help both primary care providers and surgeons better advise/inform women on their individual risks of surgical complications and provide more comprehensive postoperative care to women at highest risk of complications.
Abstract Background Many providers require cessation of gender-affirming hormone therapy (GAHT) for transgender patients prior to undergoing masculinizing chest surgery (MCS) due to concerns about increased adverse events in the presence of exogenous hormones. Evidence has suggested that continuation of GAHT for certain patients may be safe for gender-affirming procedures. Objectives The aim of this study was to compare adverse event rates for GAHT cessation vs GAHT continuation in patients undergoing MCS. Methods This multicenter, retrospective study included patients at the Cleveland Clinic and MetroHealth System who underwent MCS between 2016 and 2020. Results There were 236 patients who met the inclusion criteria. Of these, 172 (72.9%) discontinued testosterone GAHT prior to surgery and 64 (27.1%) continued the therapy. Mean [standard deviation] age at surgery was 25 [8] years, and mean BMI was 29.5 [6.6] kg/m.2 The median duration of testosterone therapy was 18 months (range, 0-300 months). There was no significant difference in tobacco use (P = 0.73), diabetes (P = 0.54), thrombophilia (P = 0.97), or history of thromboembolism (P = 0.39). Most patients underwent the double-incision free nipple graft technique (77.9%). There was no significant difference in surgical time (P = 0.12), intraoperative complications (P = 0.54), or postoperative complications (P = 0.34). The most common complication was postoperative bleeding/hematoma (7.2%). Other complications included seroma (2.1%), infection (1.3%), and nipple graft failure (0.4%). There were no thromboembolic complications. Conclusions There is no significant difference in the incidence of perioperative adverse events for patients who continue GAHT preoperatively vs patients who stop GAHT prior to MCS. Level of Evidence: 4
Background: Feminizing genioplasty warrants chin modification to achieve feminine characteristics. This study compared female and male facial skeletal dimensions and shape to guide feminizing genioplasty. Methods: Skulls stored at the Cleveland Museum of Natural History were analyzed. Sex, age, and race were documented. Heights and widths of the face and chin were measured, normalized, and compared. Results: Forty-three male (43.58±12.52-y-old) and 43 female (40.48±12.04-y-old) skulls were included. Within each group, 25 skulls were of African American (AA) origin and 18 were of Caucasian (C) origin. Absolute chin heights were larger in AA and C males compared with females ( P <0.05). After normalization to lower facial height, there was a trend toward greater chin height in AA males compared with females ( P =0.07). Parasagittal chin width in AA males was significantly larger than AA females ( P =0.0006). Interforaminal chin width in C males trended toward being significantly larger than females ( P =0.08). Following normalization of chin widths, no significant sex-based differences were noted for AA skulls except for the interforaminal/intergonial ratio, which was smaller in AA males ( P =0.04). For C skulls, most normalized ratios were significantly smaller in males ( P <0.05). C females had wider angles at the point of maximum chin projection ( P =0.007) and wider symphyseal inclinations ( P <0.0001). These differences were not present in AA skulls ( P >0.05). Regardless of race, male chins appeared square, whereas female chins were round. Conclusions: While chin width reduction is not needed for most patients, height reduction could be considered. Chin contouring is the most central component of feminizing genioplasty.
In Brief OBJECTIVE To determine the safety and usefulness of a home-based pulmonary rehabilitation program for patients with very severe chronic obstructive pulmonary disease (COPD) who receive long-term treatment with oxygen. METHODS A randomized prospective study that included 50 patients with very severe COPD undergoing long-term treatment with oxygen. At the start of the program and after 12 months, the following evaluations were performed: pulmonary function tests, submaximal exercise capability, and quality of life. The rehabilitation program lasted for 1 year, with periodic home visits by a physiotherapist and included respiratory reeducation training of the respiratory muscles and muscular training. RESULTS Forty-two patients completed the study (27 in the rehabilitation group and 15 in the control group). There were no initial differences between the 2 groups. No complications arising from the performance of the exercises were observed. The rehabilitation group showed a clinically significant increase in the distance covered in the 6-minute walk test (313 ± 72 m vs 392 ± 82 m, P = .0001) and a clinically significant reduction in the St George's Respiratory Questionnaire score (55.3 ± 15.0 vs 40.5 ± 13.8, P = .0001). No significant changes were found in any of the parameters studied in the control group. CONCLUSION A home-based pulmonary rehabilitation program for patients with very severe COPD under long-term oxygen treatment is safe and useful, as it achieves an improvement in exercise tolerance, reduces dyspnea after effort, and improves quality of life without causing any complication arising from the performance of the exercises. To determine the safety and usefulness of a home-based pulmonary rehabilitation program for patients with chronic obstructive pulmonary disease who were receiving long-term oxygen treatment, a randomized prospective study was conducted. The rehabilitation group showed improvements in functional capacity and quality of life. A home-based pulmonary rehabilitation program for this patients group is safe and useful.
