Claeys Wietse, Wolff Dylan T, Zachou Alexandra, Hoebeke Piet, Lumen Nicolaas, Spinoit Anne-Françoise
Department of Urology, Ghent University Hospital, An ERN eUROGEN Accredited Center, Ghent, Belgium.
Department of Urology, Wake Forest School of Medicine, Winston-Salem, NC, USA.
BJU Int. 2025 Jan;135(1):40-53. doi: 10.1111/bju.16513. Epub 2024 Aug 29.
To review the available literature on variant genital gender-affirming surgery (GGAS), including the reasons for performing it, the surgeries themselves and their outcomes.
A systematic review on the performance of variant GGAS was conducted (International Prospective Register of Systematic Reviews [PROSPERO] identifier: CRD42022306684) researching PubMed, Embase, Web of Science and Cochrane databases from inception up to 31 December 2023. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed, and risk of bias was assessed for each study using the five-criteria quality assessment checklist.
In total 23 case series were included, of which 17 on masculinising and six on feminising surgeries. Patients mainly choose these surgical procedures out of personal desire to avoid risk of complication or because they do not have dysphoria about certain parts of their genitalia. Complications in masculinising surgeries primarily arose from the extended urethra, which could be mitigated through primary perineal urethrostomy. Both phalloplasty and metoidioplasty carried a higher risk of urethral complications when the vagina was preserved. In feminising surgeries, risk of visceral damage and requirement for lifelong self-dilation could be avoided when vulvoplasty was performed without vaginal canal creation. All studies had a high risk of bias.
This review highlights the importance of variant GGAS and acknowledges the preferences of transgender and gender-diverse individuals. Patients should be informed about the risks and benefits of each step in these procedures.
回顾关于生殖器性别确认手术（GGAS）变体的现有文献，包括进行该手术的原因、手术本身及其结果。
对GGAS变体手术进行了系统评价（国际系统评价前瞻性注册库[PROSPERO]标识符：CRD42022306684），检索了自数据库创建至2023年12月31日的PubMed、Embase、Web of Science和Cochrane数据库。遵循系统评价和Meta分析的首选报告项目（PRISMA）指南，并使用五标准质量评估清单对每项研究的偏倚风险进行评估。
共纳入23个病例系列，其中17个关于男性化手术，6个关于女性化手术。患者主要出于个人意愿选择这些手术，以避免并发症风险，或者因为他们对自己生殖器的某些部位没有性别焦虑。男性化手术的并发症主要源于延长尿道，可通过一期会阴尿道造口术缓解。保留阴道时，阴茎成形术和阴囊成形术的尿道并发症风险均较高。在女性化手术中，不创建阴道管进行外阴成形术可避免内脏损伤风险和终身自我扩张的需要。所有研究都有较高的偏倚风险。
本综述强调了GGAS变体的重要性，并认可了跨性别者和性别多样化个体的偏好。应告知患者这些手术每一步的风险和益处。
