Gender Affirming Surgery Experience and Exposure among Reconstructive Urologists

There is a paucity of data on contemporary practice patterns regarding gender affirming surgery among reconstructive urologists.

We surveyed members of GURS (Society of Genitourinary Reconstructive Surgeons), an international association of mostly academic urologists specializing in urological reconstruction. An 18-question leadership approved survey was emailed to every member of the society globally. Multivariable logistic regression models assessed factors influencing attitudes toward gender affirming surgery.

Of 304 members surveyed 80 (26%) completed the questionnaire. Of the respondents 89% had seen a transgender patient in their practice in the preceding year, with most (76%) seeing 10 or fewer transgender patients yearly. Of the respondents 50% stated that their organization wanted to develop a multidisciplinary gender affirming surgery program. Only 5% performed primary gender affirming surgery, and the most common procedures (43%) involved correction of complications of primary surgeries performed elsewhere. Of the respondents 66% were interested in pursuing additional gender affirming surgery training, and 75% thought that gender affirming surgery should be a discipline within GURS. Being in an organization that wanted to develop a multidisciplinary program predicted for desire to pursue additional gender affirming surgery training (OR 6.46, p=0.006) and the belief that gender affirming surgery should be a GURS subdiscipline (OR 4.42, p=0.032). Age 40 years or older predicted for belief that gender affirming surgery should not be covered by public insurance programs (OR 0.12, p=0.012).

Most reconstructive urologists see a low volume of transgender patients and repair complications of primary gender affirming surgery performed elsewhere. Most respondents think that gender affirming surgery should be a discipline within GURS. Younger age and working for an organization interested in developing a multidisciplinary gender affirming surgery program influence positive attitudes toward gender affirming surgery.