Vaginal remnants, strictures, and fistula after masculinizing surgery

Gender-affirmation surgery (GAS) is becoming more prevalent with approximately 9.8 in 100,000 seeking affirmation therapy. Any genital reconstructive surgery should be tailored to each individual patient’s goals and anatomy. Up to 98% of transmasculine patients cite voiding from a standing position important to their transition and will undergo creation of a neourethra to achieve this [1–5]. Complication rates for these procedures are very high with up to 73% of patients requiring surgical revisions [6]. The most common complications after phalloplasty or metoidioplasty are urethrocutaneous fistulas, persistent vaginal cavities, and urethral strictures. Treatment options for these complications range from conservative management to endoscopic repairs to multistage surgical reconstructions. This chapter focuses on preoperative workup, clinical decision making, surgical technique, and postoperative follow up for patients that experience complications following masculinizing genital surgery.