Voiding function, pain level, and patient satisfaction after gender-affirming surgery of transgender women – a prospective evaluation

Purpose: The aim of the study is to prospectively evaluate patient and clinician reported outcomes of voiding function, pain levels and patient satisfaction of transgender women preoperatively (t0), 6 months (t1), and 12 months (t2) after gender-affirming surgery (GAS) with penile inversion vaginoplasty. Methods: Transgender women undergoing two-stage GAS at our tertiary care center were included (02/2020–01/2023). Voiding function (Male Lower Urinary Tract Symptoms, MLUTS), pain (visual analogue scale) and patients reported outcome measures were assessed. Clini¬cal outcomes and complications were evaluated. A regression analysis was performed to identify possible risk factors for a deterioration in voiding function. Results: Fifty-three patients with an average age of 40.27+14.43 years were included. Complications were mostly minor (Clavien Dindo Classification grade I/II). Meatal stenosis occurred in three patients (6.38%). MLUTS voiding and incontinence complaints were low and did not change up to 12 months postoperatively (voiding symptoms p=0.16, incontinence symptoms p=0.32). The same applies to frequency and nocturia (p=0.54 and p=0.32, respectively). Pain intensity increased between t0 and t1 (p=0.003). Pelvic pain was reported by 71% (t1) and 47 % (t2). Patient satisfaction with the functional and cosmetical result was high and increased between t1 and t2, even though not significantly (p=0.71 and p=0.18). Age, pain intensity, and localization had no significant influence on postoperative voiding function in the regression analysis (all p>0.05). Conclusions: Gender-affirming penile inversion vaginoplasty is a safe procedure regarding complications with high patient satisfaction and no significant changes in postoperative voiding function up to 12 months postoperatively.