{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T15:34:25Z","timestamp":1790350465093,"version":"4.1.0"},"reference-count":29,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2022,2,23]],"date-time":"2022-02-23T00:00:00Z","timestamp":1645574400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Surg."],"abstract":"<jats:sec><jats:title>Objectives<\/jats:title><jats:p>Numbers of PIV are rising. The aim of this study is to analyze the surgical learning-curve (LC) on the grounds of perioperative complications.<\/jats:p><\/jats:sec><jats:sec><jats:title>Patients and Methods<\/jats:title><jats:p>108 PIVs, performed by a single surgeon between 2015 and 2018 have been analyzed. Learning-curve analysis was based on three factors: operating time, vaginal depth and complications.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The median FU was 6.3 months. Median age at surgery was 36 years, median time of hormone treatment was 36 months. The median CI was 0.3 and the median BMI was 25 kg\/cm3. Median CCI\u00ae was 8.08. 40.7% of the patients developed short-term complications, more than half of which were Clavien I. Overall only 1.9% had Clavien IIIb complications. There were no Clavien IV or V complications. 17.6% of patients had wound infections, 13% wound dehiscence, 9.3% introitus strictures, 13.9% suffered from atrophy of the neovagina, i.e. loss of depth or width, and 8.3% from meatus urethrae strictures. Duration of hormonal therapy, BMI and CI had no impact on surgical outcome. Age had a significant impact on CCI\u00ae, as younger patients had a higher risk for complications. Use of scrotal skin and surgeries performed had a significant influence. LC analysis <jats:italic>via<\/jats:italic> CUSUM analysis showed that after 32 surgeries, the PIV is performed safely.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The PIV is a safe GAS-technique, associated with minor complications leading to low rates of revision surgery. Younger age, the use of scrotal skin and surgeon's experience has significant impact on complications. Duration of hormonal therapy, circumcision and BMI has no impact on complications.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fsurg.2022.836335","type":"journal-article","created":{"date-parts":[[2022,2,23]],"date-time":"2022-02-23T10:20:47Z","timestamp":1645611647000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":19,"title":["Penile Flap Inversion Vaginoplasty in Transgender Women: Contemporary Morbidity and Learning-Curve Analysis From a High-Volume Reconstructive Center"],"prefix":"10.3389","volume":"9","author":[{"given":"Valentin","family":"Maurer","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marian","family":"Howaldt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Inga","family":"Feldmann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tim","family":"Ludwig","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Malte W.","family":"Vetterlein","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philipp","family":"Gild","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sylvia","family":"Weis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Phillip","family":"Marks","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Armin","family":"Soave","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian P.","family":"Meyer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Margit","family":"Fisch","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roland","family":"Dahlem","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Silke","family":"Riechardt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2022,2,23]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"125","DOI":"10.1080\/26895269.2020.1753136","article-title":"Epidemiological considerations in transgender health: A systematic review with focus on higher quality data","volume":"21","author":"Zhang","year":"2020","journal-title":"Int J Transgender Health."},{"key":"B2","doi-asserted-by":"publisher","first-page":"412","DOI":"10.1016\/S0140-6736(16)00684-X","article-title":"Global health burden and needs of transgender populations: a review","volume":"388","author":"Reisner","year":"2016","journal-title":"Lancet."},{"key":"B3","doi-asserted-by":"publisher","first-page":"1787","DOI":"10.1016\/j.jsxm.2020.05.032","article-title":"Retrospective cohort study evaluating surgical aptitude over time in a new male-to-female penoscrotal vaginoplasty program","volume":"17","author":"Whynott","year":"2020","journal-title":"J Sex Med."},{"key":"B4","doi-asserted-by":"publisher","first-page":"504","DOI":"10.1111\/bju.12197","article-title":"Measuring the surgical \u2018learning curve': methods, variables and competency: Measuring the surgical \u2018learning curve'","volume":"113","author":"Khan","year":"2014","journal-title":"BJU Int."},{"key":"B5","doi-asserted-by":"publisher","first-page":"433","DOI":"10.1093\/intqhc\/12.5.433","article-title":"The use of the Cusum Technique in the assessment of trainee competence in new procedures","volume":"12","author":"Bolsin","year":"2000","journal-title":"Int J Qual Health Care."},{"key":"B6","doi-asserted-by":"publisher","first-page":"201","DOI":"10.1097\/01.JU.0000556095.66857.7c","article-title":"MP40-03 OMTFSFI: operated male to female sexual function index. 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