(284) EVALUATION OF URETHRAL COMPLICATIONS IN A LARGE COHORT FOLLOWING TRANSMASCULINE GENDER AFFIRMATION SURGERY

Abstract Introduction Currently, literature regarding complications of transmasculine gender affirmation surgery (tGAS) is scarce and based mostly on small retrospective cohorts. The most frequent complications are strictures and fistulas, that frequently require additional surgical procedures to be corrected. Objective The purpose of this study is to describe our cohort and identify factors associated with the development of strictures and fistulas at the time of the neophallus construction and join-up stage. Methods We included patients undergoing tGAS in a three-stage procedure (neophallus-join up-penile prosthesis) between 2014 and 2019 collected from our prospective institutional database. Complications from the neophallus construction and join-up stage were extracted and analyzed using Chi-squared test, McNemar test, and univariable logistic regression. Results 314 individuals with a median follow-up of 4.3y were included. Types of phalloplasty include forearm flap (80.6%), anterolateral thigh flap (7.6%), and abdominal flap with free flap urethroplasty (11.8%). 138 patients experienced at least one complication, with an overall number of 195 complications recorded. Fistulas and strictures accounted for 48.7% and 37.4% of the complications, respectively. There was no association between experiencing fistulas/strictures before and after join-up, although there was a significantly lower incidence after join-up (p = <.001; 31.8% vs 15.7%). Vaginectomy did not significantly decrease the number of fistulas after join-up however, there was a possible trend (4.3% vs 11.5%). Waiting longer between the neophallus construction and the join-up significantly decreased both all-level complications (OR = .93, p = .039) and scrotal/perineal complications (OR = .92, p = .05) after the join-up. Conclusions Fistulas and strictures are the most frequent complications in tGAS but are significantly less frequent after the join-up when compared to after the neophallus construction. Vaginectomy does not associate with a lower number of scrotal/perineal fistulas however, our sample may be underpowered. A longer timeframe between the first and second stage proved to be protective against scrotal/perineal complications. Disclosure No.