[Lower urinary tract symptoms (LUTS) following gender-affirming genital surgery: special anatomy, specific...

Lower urinary tract symptoms (LUTS) following gender-affirming genital surgery are an increasingly relevant challenge in urological practice. Although these symptoms largely correspond to well-known storage and voiding disorders, their underlying causes differ substantially from those encountered in the general population. Anatomical reconstruction after feminizing or masculinizing genital surgery results in characteristic functional alterations and procedure-specific complications that require tailored diagnostic and therapeutic approaches. Following feminizing genital surgery, changes in urinary stream, meatal stenosis, and urinary tract infections are the most common urological issues. In contrast, after urethral lengthening, urethral strictures, urethrocutaneous fistulas, neourethral pseudodiverticula, and hair-related complications predominate. Distinguishing functional anatomical characteristics from clinically relevant complications is essential for appropriate patient management. Diagnostic evaluation generally follows established urological principles but must be adapted to the reconstructed anatomy. In particular, endoscopic examinations and transurethral instrumentation require careful consideration to avoid iatrogenic injury. This review provides a symptom-oriented overview of common LUTS following gender-affirming genital surgery and summarizes practical recommendations for diagnosis and management.