023IC - Transition to Transitioning: Getting Started in Gender Affirming Surgery

Friday, April 28, 2023

4:00 PM – 6:00 PM CST

Location: S105A

Instructional Course Director(s)

JA

Jennifer Anger, MD (she/her/hers)

Professor of Urology
UC San Diego

Instructional Course Faculty(s)

Mang Chen, MD

Genitourinary Reconstructive Surgeon
James Hotaling, MD

University of Utah
Polina Reyblat, MD

Professor
Kaiser Permanente, Los Angeles Medical Center

Course Description: Transgender and nonbinary individuals have difficulty obtaining access to gender-affirming pelvic surgery. There is a need to train urologists in this field so that patients can have surgery without traveling far distances or waiting years for surgery. This course is designed to help urologists interested in gender-affirming surgery to take the necessary steps to begin a program at their institution. Although the course largely focuses on feminizing and masculinizing surgical techniques, attendees will also gain an understanding of potential programmatic barriers that exist and how to navigate them.

The course will focus on common pelvic surgeries performed. The steps of feminizing procedures will be presented, including penile inversion vaginoplasty, robotic-assisted vaginoplasty with peritoneal flaps and vulvoplasty (shallow-depth vaginoplasty). Masculinizing procedures to be presented will include metoidioplasty, phalloplasty and insertion of prosthetics. This will include tips on forming a strong collaboration with plastic surgery. Surgical pearls will be provided, including the avoidance and management of complications, as well as suggestions for how to go about obtaining additional personalized surgical training.

In starting a program, one must understand the basic needs of a program and how to plan the growth of a program over time. Since each institution has different programmatic needs and barriers, this course will provide a toolkit for urologists getting started in the field. This will include an assessment of immediate, medium-term and long-term needs and goals.

Learning Objectives:

Describe the steps of the most common feminizing procedures, including penile inversion vaginoplasty, robotic-assisted vaginoplasty with peritoneal flaps and vulvoplasty (shallow-depth vaginoplasty).
Apply the steps of the most common masculinizing procedures, including metoidioplasty, phalloplasty and the insertion of prosthetics. This will include an understanding of different methods of phalloplasty and staging these procedures.
Utilize the programmatic toolkit provided at their institution to identify the needs of a gender-affirming urological program, including obtaining appropriate training to start a surgical program, and provision of patient access to many services including electrolysis, plastic surgery, mental health professionals and patient navigation.