A STUDY OF THE UROLOGICAL COMPLICATIONS FOLLOWING SEX REASSIGNMENT SURGERY

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A STUDY OF THE UROLOGICAL COMPLICATIONS FOLLOWING SEX REASSIGNMENT SURGERY

Journal Title: Journal of Evolution of Medical and Dental Sciences - Year 2018, Vol 7, Issue 42

Abstract

BACKGROUND Sex reassignment surgery is the GOLD standard in the management of gender dysphoria. As the issue of gender dysphoria is on the rise, new management strategies need to be evolved in the way of multidisciplinary approach. Contrary to other countries, India lacks a definite policy and legislation towards transsexuals. Lack of insurance coverage for SRS and paucity of specialised tertiary centres compel the gender dysphoric to seek medical assistance from persons who lack formal training and also resort to traditional methods with high morbidity, seriously undermining their quality of life and hampering future reconstructive procedures. The social stigma coupled with illiteracy and unemployment deter the transsexuals from a regular follow-up. The high rate to alcoholism and substance abuse, lack of a decent job and low self-esteem make them vulnerable to unsafe sex practices and acquiring HIV and other STD. Paucity of the Indian inputs in medical literature concerning transsexualism was noted by the authors. They also found deficiencies in the Indian Law as applied to the individuals undergoing gender affirmation surgery (GAS). (1) Transsexuals experience themselves as being of the opposite sex, despite having the biological characteristics of one sex.[2] Aim- To study the urological complications following Sex Reassignment Surgery in male to female individuals in a tertiary institute for a period of 1 year. MATERIALS AND METHODS All post SRS patients who attended the Urology OP between January 2012 and December 2012 in a tertiary institute were included in the study. A total of 33 patients were studied, clinically evaluated and subjected to USG, Uroflowmetry, Urine culture, Renal function test and CT scan in selected cases. The observations were recorded and statistically evaluated. There was obstructive voiding disorder due to progressive meatal stenosis. RESULT In our study, urologist was not involved in any of the surgeries. Most of the complications were preventable. Severe complications were seen in surgeries done by inadequately trained persons. Lack of proper follow-up aggravates the situation. It must be mandatory for the urologist to be included in primary surgery. A proper mucosal to mucosal apposition is needed to prevent urethral stenosis. Patient must be motivated to come for regular follow-up. CONCLUSION GID is a complex disorder and a clinical entity demanding a multidisciplinary approach. The goal is to produce an outward appearance consistent with the patient’s gender identity. Hormonal and surgical treatment should be managed by a multiprofessional team familiar with the procedures. [3] In my study, urologist was not involved in any of the surgeries. Most of the complications were preventable. Severe complications were seen in those surgeries done by inadequately trained persons. Lack of proper follow-up aggravates the situation. It must be mandatory for the urologist to be included in primary surgery. A proper mucosal to mucosal apposition is needed to prevent urethral stenosis. Patient must be motivated to come for regular follow-up. Male-to-female surgery can achieve excellent cosmetic and functional results. Although, the operative technique is partly standardised, surgery remains challenging because of several possible complications. None of the present patients claimed to regret their decision to undergo gender-transforming surgery. [4]

Authors and Affiliations

Aysha Shaheen Basheer, Vetrichander Sattanathan

Keywords

GID- Gender Identity Disorder GAS- Gender Affirmation Surgery SRS- Sex Reassignment Surgery FTM- Female-to-Male MTFMale-to-Female PVR- Post-Void Residue USG- Ultrasonogram CT- Computed Tomogram AUG- Ascending Urethrogram SPCSuprapubic Catheter PN- Pyelonephritis.

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EP ID EP548462
DOI 10.14260/jemds/2018/1001
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