Summery The genital surgical phase of the gender affirming process in transgender men can alter the urological anatomy and urological function. This advocates urological involvement during this phase of the affirming process. This thesis is divided into three parts that describe respectively: measures taken to prevent postoperative urological complications after gGAS, experience and results after implantation of prostheses and results of psychological and sexual functioning and well-being after gGAS. Introduction The first part of the introduction provides an explanation of gender care. The rest describes the structure of the thesis. Part 1 Part one covers adjustments made to reduce risks after gGAS in transgender men. In chapter 2 functional and surgical outcomes and patient satisfaction are described after genital gender affirming surgery(gGAS) without urethral lengthening (UL). The outcomes of gGAS without UL, shows good surgical and urological results. After extensive counseling the majority of this selective group of patients show favorable patient reported outcomes. In chapter 3 a video article with the surgical technique of the scrotoplasty of gGAS without UL is presented together with surgical and the urological outcomes as described above. In chapter 4 the effectiveness of preoperative laser depilation of the neo-urethral donor site was assessed together with the correlation between urethral hair density and voiding. The outcomes show that laser depilation reduces hair and intraurethral hair does not cause voiding complaints. Part 2 In part two our experience and results of testicular and penile prostheses in the VUMC are presented. Chapter 5 describes the clinical outcomes and risk factors for postoperative complications of testicular prostheses implantation used for neo-scrotal augmentation in transgender men. This data shows that over the years, scrotoplasty techniques and testicular prostheses preferences have changed and explantation rates have dropped. In chapter 6 on overview is given of the preliminary experience with the ZSI 100 FtM malleable penile implant which was designed for phalloplastys. The outcomes of this study show that complication rate of the ZSI100FTM malleable penile implant is high at the start of the learning curve. Although designed specifically for the transgender community, not all transgender men will be eligible for this type of prosthesis. In chapter 7 a historical overview is given of surgical outcomes of penile prosthesis implantation in transgender men who underwent phalloplasty in the VUMC. Outcomes of this overview show that prosthesis explantation, replacement or revision surgery occurs frequently after penile prosthesis implantation. Part 3 In part three the process of the development of the decision aid for gGAS in transgender men is described. The next two chapters give the results of psychological and sexual functioning and well-being after gGAS in transgender men. Chapter 8 describes the process of the development of a decision aid (DA) for genital surgery in transgender men (DA-GST). At the end an online DA was developed to support transgender men with their decision-making process concerning all surgical options for removal of reproductive organs and genital GAS. In Chapter 9 a longitudinal study of 21 transgender men at least 1 year after GAS was conducted to evaluate motivations for and psychosexual outcomes after gGAS. These outcomes indicate that counseling and decision making for GAS in transmen should be a highly personalized and interdisciplinary practice. In Chapter 10 a clinical follow-up study was conducted in 38 transmen at least one year after gGAS in order to evaluate measures of experienced sexuality. The outcomes of the data show that genital GAS positively impacts transmen’s sexuality, although possible issues with genital sensation or penetration may exist and should be communicated preoperatively.
|Qualification||Doctor of Philosophy|
|Award date||1 Apr 2021|
|Publication status||Published - 1 Apr 2021|