Imaging evaluation for the diagnosis and management of complications of gender-affirming surgeries

Abstract

Gender-affirming surgeries (GS) allow transgender individuals to align their physical sexual characteristics with their gender identity, which can result in profound changes to native anatomy. Medical imaging is a useful tool for evaluation of patients who have undergone or plan to pursue GS. Given the complex nature of some GS, complications may arise. The choice of imaging modality can be guided by the clinically suspected complications. For example, urethral complications of phalloplasty are best evaluated with fluoroscopic urethrography. Pelvic magnetic resonance imaging provides detailed depiction of pelvic neo-anatomy after vaginoplasty. Many GS involve the creation of vascular pedicles for tissue grafts, which are at risk of thrombosis and graft ischemia. Doppler ultrasound and computed tomography (CT) angiography are important for diagnosis of these dreaded complications. Moreover, interventional radiologists may participate in endovascular treatments for such complications. Various imaging modalities may assist the surgeon in the postoperative evaluation of patients with suspected complications after GS, and imaging protocol modifications may be required to improve diagnostic accuracy. For example, rectal or neovaginal contrast material may be necessary to ensure accurate imaging evaluation, such as delineation of fistulas.Working together, surgeons and radiologists can ensure accurate imaging assessment while accommodating for patient comfort.

Gynecological Fistulae—Has Anything Changed in the Diagnosis and Treatment over the Last Decade? A Narrative Literature Review

“…More than 3000 vaginoplasty procedures are performed annually worldwide, making it the most popular operation for gender affirmation. Generally, it is a safe and effective procedure for genital reconstruction in a patient who has undergone gender conversion [ 45 ]. The most widely utilized techniques are visceral interposition, pelvic peritoneal vaginoplasty, and penile inversion.…”

Gender‐affirming care in urology: emergency care of the gender‐affirming surgical patient—what the primary urologist needs to know

“…Retrograde urethrography (RUG) or voiding cystourethrography [43] can provide information on the characteristics of the stricture or fistula. Evaluation of the stricture/fistula and insertion of a suprapubic catheter can be done under anaesthesia, if needed.…”