Gender-Affirming Surgery Complications: What Urologists Need to Know

What is it about?

This article presents a narrative review of postoperative complications that can occur after gender-affirming surgery (GAS). The most common surgery for feminizing GAS is vaginoplasty, which can result in wound healing complications, voiding dysfunction, postoperative bleeding, vaginal stenosis, acute vaginal prolapse, and graft loss, among others. For masculinizing GAS, metoidioplasty and phalloplasty are the most common procedures, with complications including urethral strictures, urethral fistulae, and urethral diverticula. Also, penile implants may accompany phalloplasties and can have complications like infection, erosion, migration, and mechanical failure. The article emphasizes the need for improved education and training programs to identify and manage postoperative complications, as well as broader cultural changes to ensure a safe and gender-inclusive environment for all patients.

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Why is it important?

This research is important as it provides a comprehensive narrative review of postoperative complications in patients who have undergone gender-affirming surgery (GAS). It highlights the most common complications, their management, and the importance of improved education and training programs to identify and manage these complications. Improved access to follow-up care is also essential to ensure optimal outcomes for patients who have undergone GAS. Key Takeaways: 1. Vaginoplasty is the most common feminising genital GAS, with penile inversion vaginoplasty being the most common approach. 2. Wound healing complications, voiding dysfunction, postoperative bleeding, vaginal stenosis, acute vaginal prolapse, graft loss, rectovaginal fistula, and urethrovaginal fistula are common postoperative complications of genital GAS. 3. Improved education and training programs are essential to identify and manage postoperative complications, and broader cultural changes are necessary to ensure a safe, gender-inclusive environment for all patients.