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Urinary symptoms after genital gender-affirming penile construction, urethral lengthening and vaginectomy
Transgender and non-binary (TGNB) individuals are seeking penile reconstruction in greater numbers; many pursue urethral lengthening surgery with a goal of voiding while standing. Changes in urinary function and urologic complications—i.e., urethrocutaneous fistulae and urinary stricture—are common....
Autores principales: | , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
AME Publishing Company
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10251104/ https://www.ncbi.nlm.nih.gov/pubmed/37305627 http://dx.doi.org/10.21037/tau-22-675 |
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author | Fascelli, Michele Sajadi, Kamran P. Dugi, Daniel D. Dy, Geolani W. |
author_facet | Fascelli, Michele Sajadi, Kamran P. Dugi, Daniel D. Dy, Geolani W. |
author_sort | Fascelli, Michele |
collection | PubMed |
description | Transgender and non-binary (TGNB) individuals are seeking penile reconstruction in greater numbers; many pursue urethral lengthening surgery with a goal of voiding while standing. Changes in urinary function and urologic complications—i.e., urethrocutaneous fistulae and urinary stricture—are common. Familiarity with presenting symptoms and management strategies for urinary complaints after genital gender-affirming surgery (GGAS) can improve patient counseling and outcomes. We will describe current gender-affirming penile construction options with urethral lengthening and review associated urinary complications that present as urinary incontinence. The incidence and impact of lower urinary tract symptoms after metoidioplasty and phalloplasty are poorly characterized due to limited post-operative follow-up. Post-phalloplasty, urethrocutaneous fistula is the most common urethral complication, ranging in incidence from 15–70%. Assessment of concomitant urethral stricture is necessary. No standard technique exists for management of these fistula or strictures. Metoidioplasty studies report lower rates of stricture and fistula, 2% and 9% respectively. Other common voiding complaints include dribbling, urethral diverticula and vaginal remnants. History and physical exam in the post-GGAS evaluation require understanding of prior surgeries and attempted reconstructive efforts; adjuncts to physical exam include uroflowmetry, retrograde urethrography, voiding cysto-urethrogram, cystoscopy, and MRI. Following gender-affirming penile construction, TGNB patients may experience a host of urinary symptoms and complications that impact quality of life. Due to anatomic differences, symptoms require tailored evaluation which can be done by urologists in an affirming environment. |
format | Online Article Text |
id | pubmed-10251104 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | AME Publishing Company |
record_format | MEDLINE/PubMed |
spelling | pubmed-102511042023-06-10 Urinary symptoms after genital gender-affirming penile construction, urethral lengthening and vaginectomy Fascelli, Michele Sajadi, Kamran P. Dugi, Daniel D. Dy, Geolani W. Transl Androl Urol Review Article on Surgical Management of Stress Urinary Incontinence in Men Transgender and non-binary (TGNB) individuals are seeking penile reconstruction in greater numbers; many pursue urethral lengthening surgery with a goal of voiding while standing. Changes in urinary function and urologic complications—i.e., urethrocutaneous fistulae and urinary stricture—are common. Familiarity with presenting symptoms and management strategies for urinary complaints after genital gender-affirming surgery (GGAS) can improve patient counseling and outcomes. We will describe current gender-affirming penile construction options with urethral lengthening and review associated urinary complications that present as urinary incontinence. The incidence and impact of lower urinary tract symptoms after metoidioplasty and phalloplasty are poorly characterized due to limited post-operative follow-up. Post-phalloplasty, urethrocutaneous fistula is the most common urethral complication, ranging in incidence from 15–70%. Assessment of concomitant urethral stricture is necessary. No standard technique exists for management of these fistula or strictures. Metoidioplasty studies report lower rates of stricture and fistula, 2% and 9% respectively. Other common voiding complaints include dribbling, urethral diverticula and vaginal remnants. History and physical exam in the post-GGAS evaluation require understanding of prior surgeries and attempted reconstructive efforts; adjuncts to physical exam include uroflowmetry, retrograde urethrography, voiding cysto-urethrogram, cystoscopy, and MRI. Following gender-affirming penile construction, TGNB patients may experience a host of urinary symptoms and complications that impact quality of life. Due to anatomic differences, symptoms require tailored evaluation which can be done by urologists in an affirming environment. AME Publishing Company 2023-03-01 2023-05-31 /pmc/articles/PMC10251104/ /pubmed/37305627 http://dx.doi.org/10.21037/tau-22-675 Text en 2023 Translational Andrology and Urology. All rights reserved. https://creativecommons.org/licenses/by-nc-nd/4.0/Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0 (https://creativecommons.org/licenses/by-nc-nd/4.0/) . |
spellingShingle | Review Article on Surgical Management of Stress Urinary Incontinence in Men Fascelli, Michele Sajadi, Kamran P. Dugi, Daniel D. Dy, Geolani W. Urinary symptoms after genital gender-affirming penile construction, urethral lengthening and vaginectomy |
title | Urinary symptoms after genital gender-affirming penile construction, urethral lengthening and vaginectomy |
title_full | Urinary symptoms after genital gender-affirming penile construction, urethral lengthening and vaginectomy |
title_fullStr | Urinary symptoms after genital gender-affirming penile construction, urethral lengthening and vaginectomy |
title_full_unstemmed | Urinary symptoms after genital gender-affirming penile construction, urethral lengthening and vaginectomy |
title_short | Urinary symptoms after genital gender-affirming penile construction, urethral lengthening and vaginectomy |
title_sort | urinary symptoms after genital gender-affirming penile construction, urethral lengthening and vaginectomy |
topic | Review Article on Surgical Management of Stress Urinary Incontinence in Men |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10251104/ https://www.ncbi.nlm.nih.gov/pubmed/37305627 http://dx.doi.org/10.21037/tau-22-675 |
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