Imaging Utilization, Findings, and Report Quality Post Gender-Affirming Genital Surgery: An 18-Year Single-Center Retrospective Study
2Colorectal Surgery, Sheba Medical Center, Isreal
3Plastic Surgery, Sheba Medical Center, Isreal
Purpose: The imaging literature on genital gender-affirming surgery (gGAS) is dominated by narrative reviews; primary data are scarce. We characterized post-operative imaging utilization, findings, and report quality in a national referral cohort.
Materials and Methods: An institutional gender-health registry was retrospectively analyzed. Patients who underwent gGAS (2008–2026) were identified, and all post-operative imaging examinations were extracted and classified by modality. Examinations unrelated to genital surgery (PET-CT, stone-protocol NCCT, multi-trauma CT; report-verified) were excluded. Reports were reviewed for indication, findings, neo-anatomy description, and quantitative measurements. Complications were ascertained from coded diagnoses, revision surgery, and clinical notes.
Results: Of 2,173 transgender patients, 218 underwent gGAS: 200 vaginoplasty (median age 29.7, IQR 24.0–41.3; median BMI 22.8) and 18 phalloplasty. Surgery-related post-operative imaging was performed in 39/218 patients (17.9%; 63 examinations); 23 examinations (26.7%) were unrelated and excluded. After vaginoplasty (32/200 patients, 16.0%; 47 examinations), modalities were CT (18, 38.3%), pelvic MRI (16, 34.0%), and fluoroscopy (13, 27.7%: cystography, contrast enema, urethrography, defecography, urodynamics); median surgery-to-imaging interval was 155 days (IQR 17–814), 40% within 90 days. After phalloplasty (7/18 patients; 16 examinations), 14 studies were urethral fluoroscopy. Revision surgery occurred in 47/200 vaginoplasty patients (23.5%): 39 secondary or revision vaginal surgery, 5 fistula, and 7 stenosis or dilation difficulty. Among 46 surgery-related post-operative reports, findings included fistula (10, 21.7%), fluid collection (9, 19.6%), neovaginal stenosis (5, 10.9%), urethral leak or stricture (5, 10.9%), and hematoma (3, 6.5%); 10 (21.7%) were normal. Neovaginal dimensions were measured in only 5/15 MRI reports (33.3%), without standardized parameters.
Conclusion: Surgery-related post-operative imaging after gGAS is uncommon. Divided between CT, MRI, and fluoroscopy. Quantitative assessment of the neovagina is scarce and unstandardized. These data support developing structured reporting templates and normative imaging reference values for this growing population.