2: Tranexamic Acid Is Associated With Decreased Intraoperative Blood Loss And Wound Healing Complication Rate In Penile Inversion Vaginoplasty

PURPOSE: Penile inversion vaginoplasty (PIV) is the most common gender affirming genital procedure for transfeminine patients. The purpose of this study was to investigate the impact of tranexamic acid (TXA), an antifibrinolytic, on bleeding and bleeding-related complications in vaginoplasty surgery. METHODS: Retrospective chart review was performed on patients undergoing PIV from February 2018 through March 2020 by the senior author (K.G.) at the University of Wisconsin Hospital and Clinics. Patients who received TXA received a combination of topical and intravenous TXA. Data collected includes patient demographics (age, body mass index, race, comorbidities, and tobacco and illicit drug use), intraoperative data (duration of surgery, estimated blood loss, fluid administration, TXA use and dose, and complications), and postoperative data (drain output, complications within 30 days, and revision surgery). Subgroup analysis on the effect of TXA was performed using independent sample t-test. RESULTS: Seventy-four patients were included in this study with 56 patients receiving TXA and 18 patients who had surgery prior to initiation of TXA protocol. There were no thromboembolic events observed in the TXA or the non-TXA group. Ninety percent of all complications were Clavien-Dindo Grade 1 and did not require intervention. There was a significantly lower EBL in the TXA group compared to the no TXA cohort (299.1 ± 64.3 vs. 347.2 ± 84.8, p=0.013). Patients who received TXA had significantly fewer wound related complications than those who did not receive TXA (21.4% vs. 66.7%, p<0.0001). Similarly, there were fewer neo-vagina skin graft failures in the TXA group, though this did not reach significance (0.0% vs. 11.1%, p=0.057). There was no significant difference in drain output between the two groups. CONCLUSION: No thromboembolic events were observed with intravenous and topical tranexamic acid use in transfeminine patients undergoing penile inversion vaginoplasty surgery. TXA was also associated with lower intraoperative blood loss as well as fewer wound healing complications. Further research is needed to further study its use in gender affirmation surgery.