Voiding Function, Pain Level, and Patient Satisfaction after Gender-Affirming Surgery of Transgender Women: A Prospective Evaluation

INTRODUCTION: The aim of the study was 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. Clinical outcomes and complications were evaluated. A regression analysis was performed to identify possible risk factors for 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 3 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). CONCLUSION: 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.