Cargando…

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....

Descripción completa

Detalles Bibliográficos
Autores principales: Fascelli, Michele, Sajadi, Kamran P., Dugi, Daniel D., Dy, Geolani W.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: AME Publishing Company 2023
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
_version_ 1785055881768992768
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
work_keys_str_mv AT fascellimichele urinarysymptomsaftergenitalgenderaffirmingpenileconstructionurethrallengtheningandvaginectomy
AT sajadikamranp urinarysymptomsaftergenitalgenderaffirmingpenileconstructionurethrallengtheningandvaginectomy
AT dugidanield urinarysymptomsaftergenitalgenderaffirmingpenileconstructionurethrallengtheningandvaginectomy
AT dygeolaniw urinarysymptomsaftergenitalgenderaffirmingpenileconstructionurethrallengtheningandvaginectomy