Gender‐affirming care in urology: Emergency care of the gender affirming surgical (GAS) patient ‐ What the primary urologist needs to know
Yonah Krakowsky, Gresha Shah, Anna‐Lisa V. Nguyen, Alex G. Kavanagh, Emery Potter, Taylor Remondini, Yulia Wilk Goldsher, Alexandra Millman- Urology
Objective
To present a narrative review of fundamental information needed to manage postoperative complications in patients who have undergone gender‐affirming genital surgeries.
Methods
A narrative review was performed using the following keywords: “gender‐affirming surgery”, “complications”, “emergency”, “post operative”. Articles were included after being reviewed by two primary authors for relevance. Four clinicians with significant experience providing both primary and ongoing urologic care to patients post gender‐affirming surgery were involved in article selection and analysis.
Results
The most common feminizing genital gender‐affirming surgery performed is a vaginoplasty. The main post‐surgical complications seen by urologists include wound healing complications, voiding dysfunction, postoperative bleeding, vaginal stenosis, acute vaginal prolapse and graft loss, rectovaginal fistula, and urethrovaginal fistula. The most common masculinizing genital gender‐affirming surgery options include metoidioplasty and phalloplasty. Complications for these surgeries include urethral strictures, urethral fistulas, and urethral diverticula. Penile implants may also accompany phalloplasties and their complications include infection, erosion, migration, and mechanical failure.
Conclusion:
Genital gender‐affirming surgeries are increasing, yet there are still many barriers that individuals face not only in accessing the surgeries, but in receiving follow‐up care critical for optimal outcomes. Improved education and training programs would be helpful to identify and manage postoperative complications. Broader cultural level changes are also important to ensure a safe, gender‐inclusive environment for all patients.