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Urethral complications after gender reassignment surgery: a systematic review
1Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, 90033, USA.
International Journal of Impotence Research
|June 4, 2020
Summary
Gender reassignment surgery can lead to urethral complications. Female-to-male (FtM) procedures have higher complication rates than male-to-female (MtF) procedures, requiring informed patient-practitioner discussions.
Area of Science:
- Urology
- Gender-affirming care
- Surgical outcomes
Background:
- Urethral complications are a significant concern following gender reassignment surgery (GRS).
- Understanding the incidence and types of these complications is crucial for patient care.
Purpose of the Study:
- To systematically review and evaluate the impact of gender reassignment surgery on the development of urethral complications.
- To compare complication rates between female-to-male (FtM) and male-to-female (MtF) GRS.
Main Methods:
- A systematic literature search was conducted across major databases (PubMed, Scopus, Embase, Web of Science) up to June 2019.
- Included studies followed Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines.
- 32 studies involving 3463 patients were analyzed, with separate evaluations for FtM and MtF surgeries.
Main Results:
- Higher complication rates were observed in FtM surgeries compared to MtF surgeries, attributed to the larger neourethra size.
- Meatal stenosis (4-40%) is a key complication in MtF surgery, often requiring meatotomy.
- Stricture and fistulization are common in FtM surgery, with 19-54% of urethral fistulae resolving spontaneously.
Conclusions:
- Urethral complications, including strictures and fistulae, are frequently reported after GRS.
- Informed shared decision-making between patients and practitioners is critical for managing expectations and outcomes, particularly for FtM surgery.
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