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Instructional Course

Instructional Course - Available with the Platinum and Silver packages or Individual Course Ticket

069IC - What the General Urologist Should Know about Care of Transgender Patients

Sunday, May 15, 2022

4:00 PM – 6:00 PM

Location: Room 211

Instructional Course Director(s)

Polina Reyblat, MD

Professor
Kaiser Permanente, Los Angeles Medical Center
DN

Dmitriy Nikolavsky, MD (he/him/his)

Professor
SUNY Upstate Medical University

Instructional Course Faculty(s)

Geolani W. Dy, MD

Assistant Professor
OHSU
Min Jun, DO

Crane Center for Transgender Surgery

Learning Objectives:

Describe and understand the steps of the gender affirmation surgery - penile inversion and robot assisted vaginoplasty, zero-depth vaginoplasty, metoidioplasty, phalloplasty, GU prosthetics (penile and testicular implants). .
Demonstrate how to evaluate and assess a transgender patient after their gender affirming surgery in a sensitive and patient-centered manner.
Identify and be able to diagnose common post-operative problems: urethral stricture, deviated urinary stream, voiding dysfunction, clitoral phimosis, recto-neovaginal fistula, urethra-neovaginal fistula, vaginal stenosis, urethral stricture of pars-fixa, urethra-cutaneous fistula, opening of the vaginal remnant, recurrent UTI's, sexual dysfunction.
List and review the steps and approaches to management of post-vaginoplasty urethral stricture, deviated urinary stream, voiding dysfunction, clitoral phimosis, recto-neovaginal fistula, urethra-neovaginal fistula and vaginal stenosis, and discuss management of post-phalloplasty urethral stricture of pars-fixa, urethro-cutaneous fistula, opening of the vaginal remnant, recurrent UTI's and sexual dysfunction.
Identify the need and importance of collaboration and institutional support for transgender health programs and demonstrate the role of multidisciplinary teams to provide high quality care to this challenging group of patients.

Over 1.6 million Americans identify as transgender. Along with increasing demand for gender affirming surgery in the U.S., surgical volume of these surgeries continues to increase across the country. Many academic centers are rapidly developing programs to support the diverse population they are serving. As the volume of gender affirming surgery increases, the complications of these complex genitourinary reconstructions are more frequently seen in the urology clinics and offices around the United States and the world. Current state of knowledge of postoperative care as well as the ability to evaluate and manage complications is limited. Most practicing urologists have received limited or no formal training in how to handle complications of these complex surgeries. Additionally, cultural sensitivity and interpersonal skills required to deliver high quality patient-centered care requires special training and deep understanding. Care for transgender persons requires a multidisciplinary approach—specialists from urology, plastic surgery, physical therapy, endocrinology and mental health professionals are needed to provide proper patient-centered care to transgender individuals.

We plan to structure this course in the case-based format and to focus on complications and scenarios most commonly seen by the urologists in general practice. This course will specifically cover surgical anatomy and steps of masculinizing and feminizing gender affirming bottom surgery, with focus on complications after penile inversion and robot-assisted vaginoplasty, metoidioplasty and phalloplasty, as well as complications after genitourinary (GU) prosthetics in transgender men. Additionally, we will cover voiding dysfunction and sexual function in patients post-gender affirming procedures.

We will use a case-based scenario format. For example: using a case of wound breakdown, granulation tissue, meatal stenosis and a rectovaginal fistula we will walk attendees through step-by step evaluation and management options of these complications. We will incorporate the audience response system to query participants pre- and post- each case presentation. A learning platform (i.e. Kahoot!) will be utilized to encourage engagement, active participation and stimulate some competitive spirit. A variety of surgical videos will be used to highlight surgical techniques.