MP20-08: The effect of colpectomy on lower urinary tract function in transgender men

Brechje L. Ronkes, Freek P.W. de Rooij, Freek A. Groenman, Mark-Bram Bouman, Jakko A. Nieuwenhuijzen, R. Jeroen A. van Moorselaar, Garry L.S. Pigot*, Amsterdam, Netherlands

Introduction: In transmen, negative side effects of colpectomy on voiding function are unknown, except for the incidence rates of urine tract infections and urinary retentions, while gynecological surgery in cisgender women is known for postoperative voiding dysfunction and the need for clean intermittent self-catheterization (CISC). In this study we prospectively assessed lower urinary tract function before and after colpectomy in transmen, as this is important in preoperative counseling.

Methods: A single-center, prospective cohort study was conducted among transmen who underwent colpectomy between 01-2018 and 01-2021. Primary outcomes were differences in voiding analyses (i.e. International Prostate Symptom Score (IPSS), frequency volume chart, and uroflowmetry with post-void residual volume) pre and post colpectomy. Secondary outcomes were duration of indwelling transurethral catheter and the need for CISC.

Results: Of 132 included transmen, 89 (67%) underwent Robot-assisted Laparoscopic Colpectomy (RaLC) and 43 (33%) Vaginal Colpectomy (VC). Postoperative voiding analysis was performed after a median time interval of four months (IQR 2-8). Comparison of voiding analyses showed a higher total IPSS score (median [IQR] of 4 [2-7] vs. 3 [1-4], p<0.001) and a lower maximum flow rate on uroflowmetry (median [IQR] of 27 mL/s [18-34] vs 37 mL/s [29-49], p<0.001) postoperatively. Subjective changes in voiding, described by 40% of the cohort, mostly improved during the first months postoperatively. A few examples were incomplete emptying (14; 11%), frequency (10; 8%), intermittency (10; 8%), strangury (7; 5%), and stress incontinence (5; 4%). Clinical trial without catheter (TWOC) one day postoperatively was successful in 103/132 (78%) men, 79/89 (89%) after RaLC and 24/43 (56%) after VC (p < 0.001). The remaining 29/132 (22%) patients had a subsequent TWOC in daycare, which was successful in 22/29 (76%) patients after a median of eight days (IQR 8-10.5) postoperatively, 6/10 (60%) after RaLC and 16/19 (84%) after VC. In 5/29 (17%) men (two RaLC and three VC), temporary CISC was necessary for a period ranging from 5-21 days. The last 2/29 (7%) patients were in need of permanent CISC, both after RaLC due a hypotonic bladder after urinary retention.

Conclusions: Colpectomy affects lower urinary tract function in transgender men, with in our cohort postoperatively a higher total IPSS score and lower maximum flow rate on uroflowmetry. Additionally, subjective changes in voiding were stated by 40% of transgender men, of which the majority improved during the first months post colpectomy.

Source of Funding: Nothing to disclose.