Transperineal Ultrasound Evaluation of Pelvic Floor Anatomy in Transgender Women After Penile Inversion Vaginoplasty: A Pilot Study
Anna Carmona Ruiz, Mar Pallarols Badia, Eva Huguet Galofré, Beatriz Oteros Rodríguez, Xavier Urquizú, Oriol Porta Roda, Jordi Cassadó GarrigaABSTRACT
Aims
Penile inversion vaginoplasty is the most commonly performed gender‐affirming surgery in transgender women and results in the creation of a neovaginal canal while preserving several pelvic structures, including the urethra, prostate, and elements of erectile tissue. However, postoperative pelvic floor anatomy in transgender women has not been well characterized using functional imaging techniques. The aim of this study was to describe pelvic floor anatomy on transperineal ultrasound in transgender women after penile inversion vaginoplasty and to evaluate the feasibility and interobserver reproducibility of selected ultrasound measurements.
Methods
This pilot cross‐sectional study included transgender women who had undergone penile inversion vaginoplasty at least 6 months prior to evaluation. Participants underwent a standardized transperineal pelvic floor ultrasound. Anatomical landmarks, including the urethra, bladder, prostate, residual erectile tissue, neovagina, anal canal, and levator ani muscle, were identified in the midsagittal plane. Measurements included urethral length and thickness, urethral angle, bladder neck position, rectal ampulla position, detrusor thickness, postvoid residual volume and neovaginal parameters. Ultrasound volumes were analyzed offline by two independent observers blinded to clinical data. Interobserver reproducibility was assessed using intraclass correlation coefficients (ICC).
Results
Ten participants were included. Pelvic floor structures were consistently identifiable on transperineal ultrasound in all participants. The urethra, prostate, neovaginal canal, and residual erectile tissue could be reliably visualized in the midsagittal plane. Quantitative measurements demonstrated good to excellent interobserver reproducibility for most parameters (ICC: 0.72–0.99). The spatial relationship between the neovagina, urethra, and rectum could be clearly assessed, allowing characterization of the postoperative pelvic floor configuration.
Conclusions
Pelvic floor ultrasound is a feasible and reproducible imaging modality for the evaluation of pelvic floor anatomy in transgender women after penile inversion vaginoplasty. This technique enables detailed visualization of the neovagina and adjacent pelvic structures and may represent a useful tool for postoperative anatomical assessment and for the investigation of lower urinary tract and pelvic floor symptoms in this population.
Clinical Trial Registration
Not applicable. This study is an observational pilot study and was not registered as a clinical trial.