Reconstructive Management Pearls for the Transgender Patient

  • Geolani W. Dy
  • Jeff Sun
  • Michael A. Granieri
  • Lee C. ZhaoEmail author
Surgery (J Simhan, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Surgery


Purpose of Review

A growing number of transgender patients are seeking gender-affirming genital reconstructive surgery (GRS). These complex procedures have high complication rates. We describe common surgical pitfalls in GRS and approaches for minimizing complications.

Recent Findings

Penile inversion vaginoplasty has been associated with excellent cosmetic and functional outcomes. A robotic-assisted dissection may minimize risk of rectal injury. As a younger transgender population chooses pubertal suppression, alternative sources for lining the vaginal canal, such as enteric vaginoplasties, may be more widely utilized. Since adoption of microvascular techniques in phalloplasty, transmasculine individuals have potential for a sensate neophallus and penetrative intercourse. Urethral complications are common and challenging to manage; techniques using flap coverage may minimize ischemia-related strictures. Innovations in prosthesis placement require adaptations to neophallus anatomy.


A growing number of transgender individuals are seeking genital reconstruction. Ongoing innovation in surgical technique is needed to improve patient outcomes.


Transgender Vaginoplasty Phalloplasty Urethral stricture Penile prosthesis 


Compliance with Ethical Standards

Conflict of Interest

Geolani W. Dy, Jeff Sun, Michael A. Granieri, and Lee C. Zhao each declare no potential conflicts of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Geolani W. Dy
    • 1
  • Jeff Sun
    • 2
  • Michael A. Granieri
    • 2
  • Lee C. Zhao
    • 2
    Email author
  1. 1.Department of UrologyUniversity of Washington School of MedicineSeattleUSA
  2. 2.Department of UrologyNew York UniversityNew YorkUSA

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