[Gender confirming surgery : Female-to-male and male-to-female]

Area of Science:

• Urology
• Gender Affirming Surgery
• Surgical Management

Background:

• Gender confirming surgery (GCS) is a developing interdisciplinary field within urology.
• This review focuses on surgical strategies for male-to-female (MtF) and female-to-male (FtM) gender confirmation.

Purpose of the Study:

• To summarize the development of interdisciplinary strategies in GCS based on over 20 years of surgical experience.
• To present aspects of GCS relevant to urologists.

Main Methods:

• Comprehensive review of national and international literature on GCS.
• Evaluation of authors' extensive surgical experience in performing GCS procedures.

Main Results:

• Over 1200 primary MtF GCS and 230 primary FtM GCS performed since 1990.
• High complication and secondary procedure rates in MtF GCS necessitate specialized interdisciplinary teams.
• Patient numbers for GCS are limited, with an estimated incidence of at least 1:20,000 for gender dysphoria.

Conclusions:

• Postoperative satisfaction rates exceed 80% for both FtM and MtF individuals.
• Surgical procedures for GCS have become increasingly standardized over recent decades.
• The free forearm flap is the preferred method for penile reconstruction, though alternatives exist.