Rates of Urinary Tract Infection in Transgender Women Postvaginoplasty vs Cisgender Women: A Retrospective Cohort Study in a Large US Health Network

David Gilbert; Aishwarya Gautam; Tomasz Tabernacki; Stephen Rhodes; Megan McNamara; Swagata Banik; Rachel Pope; Shubham Gupta; Kirtishri Mishra

doi:10.1016/j.urology.2024.04.004

Rates of Urinary Tract Infection in Transgender Women Postvaginoplasty vs Cisgender Women: A Retrospective Cohort Study in a Large US Health Network

Urology. 2024 Apr 23:S0090-4295(24)00264-4. doi: 10.1016/j.urology.2024.04.004. Online ahead of print.

Authors

David Gilbert¹, Aishwarya Gautam², Tomasz Tabernacki², Stephen Rhodes³, Megan McNamara⁴, Swagata Banik⁵, Rachel Pope³, Shubham Gupta², Kirtishri Mishra⁶

Affiliations

¹ Case Western Reserve University School of Medicine, Cleveland, OH; University Hospitals, Urology Institute, Cleveland, OH. Electronic address: dtg26@case.edu.
² Case Western Reserve University School of Medicine, Cleveland, OH; University Hospitals, Urology Institute, Cleveland, OH.
³ University Hospitals, Urology Institute, Cleveland, OH.
⁴ Cleveland VA Medical Center, Cleveland, OH.
⁵ Baldwin Wallace University, Berea, OH.
⁶ Case Western Reserve University School of Medicine, Cleveland, OH; University Hospitals, Urology Institute, Cleveland, OH; MetroHealth Cleveland Medical Center, Cleveland, OH.

PMID: 38657871
DOI: 10.1016/j.urology.2024.04.004

Abstract

Objective: To describe urinary tract infection (UTI) risk 3-month postvaginoplasty (VP) in transgender women (TW) compared to cis women (CW).

Methods: Using TriNetX (TriNetX, Inc, Cambridge, MA), we built cohorts of 2041 TW and 48,374,745 CW. Outcomes were ≥1 instance of UTI or Cystitis, and assessed from 3-6, 3-12, 3-36months, and 3months-10years post-VP. TW and CW were age-cohorted (18-39, 40-59, 60-74) and compared at each time interval. Kaplan-Meier was used to account for loss to follow-up, along with hazard ratios and log-rank tests to determine significance (P <.05).

Results: For all time intervals and age ranges, TW had a significantly (P <.0001-P = .0088) higher probability of developing a UTI compared to CW. The largest difference was ages 40-59 ten-year post-VP. In this analysis, CW and TW had a 12.96% and 29.34% cumulative outcome incidence, respectively. Cox proportional hazard analysis demonstrated increased hazard for TW compared to CW. Hazard ratios between CW and TW ranged from 1.363 (ages 18-39 at 10years, 95%CI: 1.119,1.660) to 3.522 (ages 60-74 at 12months, 95%CI: 1.951,6.360).

Conclusion: We found a significantly higher probability of TW developing UTIs compared to age-cohorted CW. Contributing factors may include difficulties with neovaginal perineal hygiene, lack of commensal bacteria and vaginal mucosa, larger urethral meatus, high rates of meatal stenosis, and nonnative bacteria introduced through dilators and douching. These findings may help improve quality of postoperative care in TW.