To evaluate the presenting complications of patients to reconstructive urologists after masculinizing gender affirming genital reconstructive surgery (GRS) performed elsewhere.

We identified patients who underwent revision surgery by one of the co-authors for sequelae of masculinizing GRS. We reviewed patient demographics, medical history, details of prior GRS, and complications from GRS. Specific attention was paid to the presence of the following: suprapubic tube (SPT) dependence, vaginal remnant, urethrocutaneous fistula (UCF) within the fixed urethra (pars fixa), UCF in the phallic urethra, phallic urethral stricture, meatal stenosis, and anastomotic urethral stricture. Statistical analysis was performed using Fisher’s exact test to determine differences in presenting symptoms by GRS.

55 patients who had reconstructive surgery for complications from masculinizing GRS from September 2004 to September 2017 were identified. The median age at surgical correction was 33 years. Fifteen (27%) patients had prior metoidioplasty and 40 (73%) had prior phalloplasty. The median time from date of GRS to presentation to a reconstructive urologist was 4 months. Urethral strictures (n=47, 86%) were the most common indication for subsequent surgery, followed by urethrocutaneous fistulae (n=31, 56%) and vaginal remnant (n=26, 47%). The majority of patients presented with two or more simultaneous complications (n=40, 73%).

There are several common presenting urologic complications after masculinizing GRS. Patients may present to reconstructive urologists early after GRS performed elsewhere. The long-term outcomes of GRS deserve further study.

Urology. 2019 Jun 20 [Epub ahead of print]

Geolani W Dy, Michael A Granieri, Benjamin C Fu, Alex J Vanni, Bryan Voelzke, Keith F Rourke, Sean P Elliott, Dmitriy Nikolavsky, Lee C Zhao

Department of Urology, New York University., Department of Epidemiology, Harvard T.H. Chan School of Public Health., Department of Urology, Lahey Hospital and Medical Center., Department of Urology, University of Washington., Division of Urology, Department of Surgery, University of Alberta., Department of Urology, University of Minnesota., Department of Urology, SUNY Upstate Medical University., Department of Urology, New York University. Electronic address: .