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The terminology for sexual health in men with lower urinary tract (LUT) and pelvic floor (PF) dysfunction has not been defined and organized into a clinically based consensus terminology report. The aim of this terminology report is to provide a definitional document within this context that will assist clinical practice and research.This report combines the input of the members of sexual health in men with LUT and PF Dysfunction working group of the International Continence Society (ICS), assisted at intervals by external referees. Appropriate core clinical categories and a sub-classification were developed to give coding to definitions. An extensive process of 18 rounds of internal and external review was involved to exhaustively examine each definition, with decision-making by collective opinion (consensus). The Committee retained evidence-based definitions, identified gaps, and updated or discarded outdated definitions. Expert opinions were used when evidence was insufficient or absent.A terminology report for sexual health in men with LUT and PF dysfunction, encompassing 198 (178 NEW) separate definitions, has been developed. It is clinically based with the most common diagnoses defined. Clarity and user-friendliness have been key aims to make it interpretable by practitioners and trainees in all the different speciality groups involved. Conservative and surgical managements are major additions and appropriate figures have been included to supplement and clarify the text. Emerging concepts and measurements, in use in the literature and offering further research potential, but requiring further validation, have been included as an appendix. Interval (5-10 years) review is anticipated to keep the document updated.A consensus-based terminology report for sexual health in men with LUT and PF dysfunction has been produced to aid clinical practice and research. The definitions that have been adopted are those that are most strongly supported by the literature at this time or are considered clinical principles or consensus of experts' opinions.

To explore the impact of body mass index (BMI) on the outcomes of gender-affirming vaginoplasty.A cohort consisting of all gender-affirming vaginoplasties in our practice between September 27th, 2018, and September 1st, 2022 were identified, and data were retrospectively collected. Patients were classified as obese if their BMI was ≥30 kg/mA total of 58 patients with a mean follow-up time of 6.9 months were included. Seventeen patients (mean BMI = 36.8 kg/mSimilar results can be achieved with gender-affirming vaginoplasty in obese patients when compared to their nonobese counterparts. Eligibility for this procedure should not be restricted based on BMI alone.

Gender dysphoria, the discordance between one's gender identity and anatomy, affects nearly 25 million people worldwide, and the prevalence of transgender and non-binary identities is increasing because of greater acceptance and awareness. Because of the improved accessibility to gender-affirming surgery (GAS), many providers will care for patients during and after gender transition. For trans men (female-to-male), GAS represents a combination of procedures rather than a single surgery. The particular combination of masculinizing procedures is chosen on the basis of informed patient-provider discussions regarding the patient's goals and anatomy and implemented through a multidisciplinary team approach. In this review, we describe the common procedures comprising masculinizing GAS to improve delivery of specialized care for this patient population.

The Pelvic Floor Disorders Consortium (PFDC) is a multidisciplinary organization of colorectal surgeons, urogynecologists, urologists, gynecologists, gastroenterologists, radiologists, physiotherap...

Gender dysphoria affects over 1 million American adults. Vaginoplasty is a critical step in gender affirmation, and many patients have insufficient genital skin for full-depth penile inversion vaginoplasty (PIV). We reviewed the literature for technical considerations addressing this and present our data supporting the use of peritoneal flaps (Davydov technique).A comprehensive review of modern literature was conducted. Second, we present a retrospective case review of our experience with PIV, including data from procedures utilizing peritoneal flaps.We identified 20 original articles, including retrospective and prospective case and cohort studies. Approaches included the application of local soft tissue grafts and flaps, peritoneal flaps, and intestinal segments. Between June 2018 and February 2021, 47 patients at our institution, underwent PIV for the treatment of gender dysphoria. Nineteen of those patients underwent robotic-assisted peritoneal flap procedure in addition to PIV. In this cohort, the mean follow-up was 200.6 ± 124.8 days. Mean neovaginal depth was 13.1 ± 3.0 cm intra-operatively and 11.0 cm at the last follow-up. Twenty-six percent of complications were Clavien Grade 1 or 2; others included wound dehiscence (30.4%), perianal and urethral fistula (13.0%), and neovaginal stenosis (8.7%). The majority of patients reported satisfactory results in terms of sexual function with intact tactile and erogenous sensation. Almost half were able to have penetrative vaginal intercourse at the last follow-up. We did not aim to perform statistical calculations to compare the outcomes of PIV with and without robotic-assisted peritoneal flap augmentation, as the groups were not constructed in that manner. However, it is evident that anatomical and functional results as well as the distribution of postoperative complications seem similar.Vaginoplasty is indicated in a growing population of patients with a wide range of medical histories and anatomic variations. Genitourinary reconstructive surgeons must have several methods to achieve full-depth vaginoplasty in cases of inadequate genital skin. Peritoneal flaps serve as a versatile, safe, and functionally advantageous solution.

Background: Ovotesticular disorder of sexual development (OT-DSD) is a rare condition characterized by abnormal gonadal development. Although most OT-DSD is diagnosed during infancy, diagnosis is o...

This nonsystematic review aims to discuss the contemporary literature about sexual (dys)function in transgender population from the biopsychosocial model point of view, focusing on those patients who underwent gender-affirming genital reconstruction (GAGR). We analyzed the questionnaires and diagnostic tools that have been used to evaluate sexual health-related issues, including the non-specific ones and the ones specifically designed for transgender individuals. All aspects of sexual function including desire, arousal, orgasm, and pain have been shown to be influenced by GAGR. Literature regarding sexual activity in trans women are diverse, showing increase, decrease, and no changes after genital surgery, while sexual satisfaction was shown to be highly related to self-image and self-esteem. Metoidioplasty and flap-based phalloplasty in trans men are successful in treating gender dysphoria, and improving quality of life which commonly lead to high satisfaction rates.

Objectives To demonstrate the feasibility, surgical technique and initial outcomes of robotic vaginoplasty with peritoneal flap (Davydov) technique for vaginal reconstruction. Methods Following appropriate preoperative patient counseling, 11 consecutive patients underwent robotic vaginoplasty with the da Vinci (Intuitive Surgical, Sunnyvale CA) multi-port Xi and single port (SP) robotic platforms. Perioperative and postoperative outcomes of interest were retrospectively collected. Results Between March 2019 and October 2019, a total of 11 patients have undergone robotic vaginoplasty with peritoneal flap technique at our institution – 9 using the da Vinci SP platform and 2 using the da Vinci Xi platform. Reasons for vaginoplasty included primary gender-affirming genital reconstruction, vaginal stenosis after gender confirmation surgery, and vaginal hypoplasia secondary to disorders of sexual development. Mean operative time was 267.2 +/- 85.9 minutes. Initial post-operative mean vaginal depth was 13.9 +/- 0.5 cm. Mean estimated blood loss was 131.8 +/- 92.9 ml. Mean length of stay was 5.2 +/- 0.6 days and time to return of bowel function was 1.7 +/- 0.9 days. Thirty-day readmission rate was 18% (N = 2/11) with 1 patient (9%) requiring surgical revision of the neovagina. Conclusions Robotic-assisted Davydov technique is a potentially applicable, efficacious and safe method of vaginal reconstruction in cis-gender and transgender individuals.

The Pelvic Floor Disorders Consortium (PFDC) is a multidisciplinary organization of colorectal surgeons, urogynecologists, urologists, gynecologists, gastroenterologists, radiologists, physiotherapists, and other advanced care practitioners. Specialists from these fields are all dedicated to the diagnosis and management of patients with pelvic floor conditions, but they approach, evaluate, and treat such patients with their own unique perspectives given the differences in their respective training. The PFDC was formed to bridge gaps and enable collaboration between these specialties. The goal of the PFDC is to develop and evaluate educational programs, create clinical guidelines and algorithms, and promote high quality of care in this unique patient population. The recommendations included in this article represent the work of the PFDC Working Group on Magnetic Resonance Imaging of Pelvic Floor Disorders (members listed alphabetically in Table 1). The objective was to generate inclusive, rather than prescriptive, guidance for all practitioners, irrespective of discipline, involved in the evaluation and treatment of patients with pelvic floor disorders.

Introduction and hypothesis This narrative review describes the existing epidemiologic literature and identifies gaps regarding pelvic organ prolapse (POP) prevalence, incidence, natural history, and current and future service needs. Materials and Methods A PubMed search identified relevant citations published in 2000 or later. Pre-specified criteria were used to screen titles, abstracts, and manuscripts, including reference sections. Study findings were summarized to define what is known, identify gaps in current knowledge, and suggest priority areas for future research. Results The reported prevalence of POP varies widely (1-65%) based on whether its presence is ascertained by symptoms (1-31%), pelvic examination (10-50%), or both (20-65%). Most existing population-based surveys do not include physical examination data. White women from higher income countries are overrepresented in the existing literature. Incidence and natural history data are limited and consist mainly of cohorts that follow women after pregnancy or menopause. Given global increases in aging populations in well-resourced countries, the need for POP treatment is anticipated to increase in the coming decades. In lower and middle income countries (LMICs) where demographic trends are different, there is a dearth of information about anticipated POP service needs. Conclusion Future POP incidence, prevalence, and natural history studies should include non-white women from LMICs and should combine pelvic examination data with validated patient-reported outcome measures when feasible. Anticipated future service needs differ globally, with a greater demand for POP treatment services in well-resourced settings where aging populations are prevalent.

Injection-based therapies and biomaterials can be used for the management of a variety of urological disorders. Experimental data has shown their potential to provide minimally invasive solutions for prevalent conditions such as benign prostatic obstruction, erectile dysfunction, stress urinary incontinence, and pelvic organ prolapse. Furthermore, acellular biomaterials and cell-seeded scaffolds were tested for the purpose of bladder augmentation or reconstruction in patients with neurogenic lower urinary tract dysfunction who would otherwise destined to undergo bowel interposition and be exposed to its inherent morbidities. Biomaterials were also used for the treatment of complicated urethral strictures, in the context of tubularized or augmentation urethroplasty.

INTRODUCTION AND OBJECTIVE:Urethral reconstruction within the context of gender affirming phalloplasty is important as almost half of the patients suffer from some degree of urethral complication p...

Current techniques of transmasculine genital surgery are based on a knowledge of urethral anatomy and physiology and advances learned through phalloplasty procedures and management of urethral complications. Although voiding in a male fashion is a priority for most transmen, early attempts at phalloplasty were limited to reconstruction of the male genital form. Surgeons were reluctant to perform urethral reconstruction due to the high rates of fistulas and strictures. As the surgeon’s understanding of the patients’ goals and expectations improved, urethral reconstruction is often a primary goal of both phalloplasty and metoidioplasty.

Phalloplasty represents the most complete genitoperineal transformation for trans men. Although voiding while standing is a priority for most trans men, most patients want to use the neophallus for sexual experience after they are accustomed to their new voiding abilities. Different techniques have been used to obtain rigidity in the neophallus, often resulting in complications and failure. Implantation of an erectile prosthesis remains the best option for achieving sexual intercourse in trans men. This article discusses the current state of art of penile prostheses in trans men, including a description of the prostheses, techniques for implantation, and complications.

The diagnosis of neurogenic bladder typically involves invasive urodynamic testing; however, recent literature has shown the utility in advanced functional brain imaging. These imaging modalities have proposed neural circuitry pathways for both healthy micturition and pathologic states. Advanced imaging including fMRI, PET, SPECT, and near infrared spectroscopy have identified cortical, subcortical, and spinal relationships to micturition, as well as changes that occur with neurogenic bladder patients. Imaging studies support both efferent control of micturition via the nucleus within the pons and afferent regulation of bladder storage via the periaqueductal gray area. These regulatory centers are controlled by both cortical activation and inhibition. Identifying the pathologic networks may create specific targets for physical, pharmaceutical, or neuromodulation of pathways including newer treatment modalities like deep brain stimulation.

Objective To evaluate the Urological resident's attitude and experience with surgical simulation in residency education using a multi-institutional, multi-modality model. Materials and Methods Residents from 6 area urology training programs rotated through simulation stations in 4 consecutive sessions from 2014 to 2017. Workshops included GreenLight photovaporization of the prostate, ureteroscopic stone extraction, laparoscopic peg transfer, 3-dimensional laparoscopy rope pass, transobturator sling placement, intravesical injection, high definition video system trainer, vasectomy, and Urolift. Faculty members provided teaching assistance, objective scoring, and verbal feedback. Participants completed a nonvalidated questionnaire evaluating utility of the workshop and soliciting suggestions for improvement. Results Sixty-three of 75 participants (84%) (postgraduate years 1-6) completed the exit questionnaire. Median rating of exercise usefulness on a scale of 1-10 ranged from 7.5 to 9. On a scale of 0-10, cumulative median scores of the course remained high over 4 years: time limit per station (9; interquartile range [IQR] 2), faculty instruction (9, IQR 2), ease of use (9, IQR 2), face validity (8, IQR 3), and overall course (9, IQR 2). On multivariate analysis, there was no difference in rating of domains between postgraduate years. Sixty-seven percent (42/63) believe that simulation training should be a requirement of Urology residency. Ninety-seven percent (63/65) viewed the laboratory as beneficial to their education. Conclusion This workshop model is a valuable training experience for residents. Most participants believe that surgical simulation is beneficial and should be a requirement for Urology residency. High ratings of usefulness for each exercise demonstrated excellent face validity provided by the course.

INTRODUCTION AND OBJECTIVE:Gender-Affirming Genital Reconstruction (GAGR) involves surgical procedures that are designed to give a sense of congruence between the outer body and the inner self in t...

We aimed to review all information on penile prosthetic surgery in patients with prior phalloplasty and give a detailed description of the authors's preferred technique. A nonsytematic review of the articles that were published in English and indexed on Pubmed, Google Scholar, and Embase databases was conducted. The relevant literature reports mainly on the outcomes of penile prosthesis (PP) implantation following gender affirming phalloplasty with the radial forearm free flap technique. Three-piece inflatable penile prostheses (IPP) have been the most commonly utilized hardware in this setting. PP implantation in a neophallus is a complex procedure and contains some technical nuances. Creation of spaces within the neophallus for the cylinder(s), wrapping the cylinder(s) with synthetic materials or allografts, and fixation of the prosthesis to the pubic bony structures can be considered as the most important steps of this procedure. Five-year IPP retention rates in flap phalloplasty range between 42 and 78% which is lower than the rate observed in anatomic phallus. In addition, complication and mechanical failure rates are higher in flap phalloplasty. However, satisfaction rates after PP implantations in anatomic penis versus neophallus seem to be similarly high. Infection, migration, and mechanical failure are the most frequent complications.

Aims Evaluate the Altis single-incision sling for treatment of female stress urinary incontinence through 24 months. Methods This was a prospective, multi-center, industry-sponsored (Coloplast Corp.), single-arm trial with primary efficacy defined as ≥50% reduction in 24 h pad weight from baseline at 6-months. Device- and procedure-related complications were collected for safety. Secondary measures included cough stress test, Urogenital Distress Inventory-Short Form, Incontinence Impact Questionnaire-Short Form, and Patient Global Impression of Improvement. Results Of the 113 women implanted, 94 remained at 24-months. The average procedure time was 12.8 ± 8.4 min across all settings. Of those with paired baseline and follow-up data at 24-months, 90.0% (81/90) achieved ≥50% reduction in pad weight, 81.1% (73/90) were dry (pad weight ≤4.0 g), and 87.9% (80/91) had a negative cough stress test. Significant median reductions of 44.4 in Urogenital Distress Inventory (P-value

Purpose of review We aim to summarize and broaden the knowledge regarding diagnosis and treatment options of vulvodynia. This review also aims to describe epidemiology, presumed etiopathology, and the future directions of treating vulvodynia in order to add to understand to whether the disorders should be distinguished or combined.

Female stress urinary incontinence (SUI) is a common condition with significant impact on a woman's quality of life. The prevalence of SUI is about 50%. Previously, the majority of incontinence procedures were performed via an abdominal approach (Burch colposuspension). The tension-free procedures, with a synthetic tape material, have replaced almost completely the previous surgeries and is nowadays considered the gold standard option for surgical treatment of female SUI. A wide spectrum of tape-based surgical procedures and devices are currently available. Today, Burch colposuspension has a role in patients undergoing abdominal pelvic organ prolapse (POP) repair as a concomitant procedure in those patients with urethral hypermobility or those with contraindication to mid-urethral slings (MUS) placement. The objective success rate reported of this procedure ranges between 49% and 88%. Mid-urethral synthetic slings represent the most common procedures for SUI in North America and Europe. Cure rate of retropubic MUS approaches 86% with a satisfaction rate of about 75%. For transobturator tape MUS the objective success rate at 12 months is 87% and the satisfaction rate is 85%. Single incision mini-slings (SIMS) were introduced in 2003 and they have a different anchoring mechanism, located at the two extremities, that allows the stabilization of the tape in the obturator internal muscle or deeper in the obturator channel trough a single vaginal incision. Reported objective cure rate is 78% and satisfaction rate is 82%. According to the most recent EAU guidelines about incontinence and the UK National Institute for Healthcare and Clinical Excellence (NICE), the surgeon must be able to offer alternative surgical treatments and have the knowledge of efficacy and safety of these approaches at counseling of the patient. The objective cure rate is rather similar among the different types and routs of mid-urethral slings and the difference vs. Burch colposuspension seems to disappear at 5 years follow-up, when effectiveness is comparable. There is no significant difference in erosion rates between transobturator and retropubic approaches among mid-urethral tapes, but they are lower when compared to SIMS. The injury rate of nearby organs is quite low for all types of approaches, except for retropubic slings.

Aims To review, report, and discuss the complications associated with urethral bulking therapy in female stress urinary incontinence. Methods An extensive nonsystematic literature review on complications associated with injectable bulking agents used in the clinical practice was conducted. We reviewed articles published in English and indexed in the PubMed, Embase, and Google Scholar databases. Original articles, case reports, and case series were taken into consideration. Data regarding the safety of injectable bulking agents and the complications associated with their utility within the context of urethral bulking therapy for female stress urinary incontinence were extracted and discussed. Results Approximately, 1/3 of the patients experience some type of a complication after urethral bulking therapy. The majority of these complications are of low grade, transient, do not necessitate additional surgical intervention, and amenable to treatment with conservative measures such as clean intermittent catheterization and antibiotics. However, more serious complications such as abscess formation, delayed hypersensitivity reactions, and vaginal erosion have been reported. Some of the injectable bulking agents have been withdrawn from the market because of their unfavorable adverse effect profile. Conclusions Urethral bulking therapy can be considered as a low-risk procedure. However, it is not without complications which can be severe in rare instances. The search for the ideal urethral bulking agent is ongoing and future comparative studies assessing the safety and efficacy of these compounds in randomized controlled settings are warranted.

Although many transgender individuals are able to realize their gender identity without surgical intervention, a significant and increasing portion of the trans population is seeking gender-confirming surgery.

In aging men, lower urinary tract symptoms (LUTS) are increasing. Benign prostatic hyperplasia (BPH) is one of the main causes of LUTS. Many risks factors, both modifiable and nonmodifiable, can increase the risk of development and progression of BPH and LUTS.

Introduction Coital urinary incontinence (CUI) is not much explored during clinical history, and this could lead to an underestimation of the problem. Aim To evaluate the prevalence and clinical risk factors of CUI in women with urinary incontinence (UI), and to measure the impact of CUI on women’s sexuality and quality of life. Methods This was a multicenter international study, conducted in Italy, Greece, the United States, and Egypt. Inclusion criteria were: sexually active women with UI and in a stable relationship for at least 6 months. Exclusion criteria were: age Main Outcome Measures To evaluate the CUI and its impact on sexual life we used the open questions on CUI as well as the International Consultation on Incontinence questionnaire and Patient Perception of Bladder Condition questionnaire. Results In this study 1,041 women (age 52.4 ± 10.7 years) were included. In all, 53.8% of women had CUI: 8% at penetration, 35% during intercourse, 9% at orgasm, and 48% during a combination of these. Women with CUI at penetration had a higher prevalence of SUI, women with CUI during intercourse had higher prevalence of MUI with predominant SUI, and women with CUI at orgasm had higher prevalence of UUI and MUI with predominant UUI component. Previous hysterectomy was a risk factor for CUI during any phase, while cesarean delivery was a protective factor. Previous failed anti-UI surgery was a risk factor for CUI during penetration and intercourse, and body mass index >25 kg/m2 was a risk factor for CUI at intercourse. According to International Consultation on Incontinence questionnaire scores, increased severity of UI positively correlated with CUI, and had a negative impact on the quality and frequency of sexual activity. Clinical Implications This study should encourage physicians to evaluate the CUI; in fact, it is an underestimated clinical problem, but with a negative impact on quality of life. Strengths & Limitations The strength of this study is the large number of women enrolled, while the limitation is its observational design. Conclusion CUI is a symptom that can affect sexual life and should be investigated during counseling in all patients who are referred to urogynecological centers.

Item does not contain fulltext OBJECTIVES: Stress urinary incontinence in women is a common problem that significantly impacts quality of life. Periurethral injection of urethral bulking agents (UBAs) is a simple, noninvasive, and cost-effective treatment. However, complications associated with UBA are often underappreciated. Objective of this review was to get a complete overview of all published complications of UBA. METHODS: An extensive search of the scientific literature was conducted to quantitatively summarize the complications and their treatments of 8 UBAs. A total of 117 articles (original articles and case reports) were included in the final analysis. Complication incidence, treatment incidence, and follow-up time were extracted when mentioned. Statistical analysis of complication incidence of each UBA was calculated if possible. RESULTS: A total of 2095 complications in 6462 treated patients were reported in 79 studies. Sixty-seven (3%) were considered serious implying operative correction (Clavien grade III); of these, 46 (69%) required incision and drainage, and 21 (31%) required a more invasive procedure. In 38 case reports and small case series, 49 patients were treated for 110 complications. Of these 110 complications, 41 (37%) can be classified as Clavien grade III. CONCLUSIONS: This extensive review shows that various UBAs have different complication rates, with certain UBAs being more prone to serious complications. Based on available publications, most UBAs have a good safety profile, with low complication rates. However, although the majority of UBA complications are transient and require no or noninvasive treatment, serious complications may require invasive intervention and treatment.

Aim To present the ICS Teaching Module on ambulatory urodynamics monitoring (AUM). Methods This teaching module has been developed by the ICS Urodynamics Committee to assist ICS members in their routine clinical practice. A detailed literature search on studies published on the clinical role of AUM as well as expert opinions have been considered. A slide set on AUM has been developed, approved by all members of the ICS Urodynamics Committee and is available to the ICS membership on the ICS website. The final approved teaching module has been presented at the ICS Annual Scientific Meeting in Brazil 2014. Results The scientific evidence on the clinical role of AUM in patients with lower urinary tract symptoms is summarized. The catheters and recording systems used, the patient preparation for the test, the technique, the instructions to the patient, the analysis, interpretation, and quality control assessment of AUM trace as well as the contraindications for AUM are described. Conclusions The clinical role of AUM is still controversial. The scientific evidence on the usefulness of AUM is still limited but the ICS Urodynamics Committee recommends its use as a second line diagnostic tool when office laboratory urodynamics have failed to achieve a diagnosis. AUM has been showed to be more sensitive than laboratory urodynamics in diagnosing detrusor overactivity but the level of evidence for this measurement is not high. This manuscript summarizes the evidence and provides practice recommendations on AUM for teaching purposes in the framework of an ICS teaching module. Neurourol. Urodynam. 36:364–367, 2017. © 2015 Wiley Periodicals, Inc.

Midurethral slings may lose their effectiveness due to changes in urethral compression over time in patients with urinary incontinence due to intrinsic sphincter deficiency and neurogenic bladder. Adjustable continence devices offer potential solutions. We reviewed the current literature regarding six adjustable continence devices for male and female patients suffering from incontinence. We reviewed the following devices: Adjustable Continence Therapy® (Uromedica, Irvine, CA), Pro-Adjustable Continence Therapy® for men (Uromedica, Irvine, CA), TRT Remeex (Neomedic, Barcelona, Spain) for females, MRS II Remeex (Neomedic, Barelona, Spain) for men, Argus ®, and Phorbas® adjustable continence therapy for men (Promedon SA, Cordoba, Argentina). Based on the reviewed studies, adjustable continence devices offer similar, if not less, risk than traditional stress urinary incontinence (SUI) procedures with greater outcomes as reported by patients. Adjustable continence devices allow clinicians to adjust urethral tension post-operatively if necessary without secondary procedures and general anesthesia. Adjustable devices are particularly well-suited to SUI with a neurogenic etiology as these devices allow for post-operative adjustments to sphincter pressure from a clinical setting.

Background At this time, no formal training or educational programs exist for surgeons or surgery residents interested in performing gender confirmation surgeries. Aim To propose guiding principles designed to aid with the development of formal surgical training programs focused on gender confirmation surgery. Methods We use expert opinion to provide a “first of its kind” framework for training surgeons to care for transgender and gender nonconforming individuals. Outcomes We describe a multidisciplinary treatment model that describes an educational philosophy and the institution of quality parameters. Results This article represents the first step in the development of a structured educational program for surgical training in gender confirmation procedures. Clinical Implications The World Professional Association for Transgender Health Board of Directors unanimously approved this article as the framework for surgical training. Strengths and Limitations This article builds a framework for surgical training. It is designed to provide concepts that will likely be modified over time and based on additional data and evidence gathered through outcome measurements. Conclusion We present an initial step in the formation of educational and technical guidelines for training surgeons in gender confirmation procedures.

Radiation cystitis represents a relevant problem for people who have undergone pelvic radiation therapy. Radiation therapy is often used to cure prostate cancer and gynaecological malignancies, but bladder damage, due to induction of hypovascular tissue, is a frequent consequence. Urologists should be able to manage this condition, for many reasons: first, the patient’s life can be threatened by massive haematuria; second, also mild haematuria worsens significantly the patient’s life; and third, this condition has high social costs. Once the diagnosis is established, many therapeutic options are available: from intravesical therapies to systemic therapies. Hyperbaric oxygen therapy has a major role in improving radiation cystitis: it has been shown to be durable by many clinical studies. When all these therapies fail, surgical treatment represents the last choice. Unfortunately, few randomized clinical trials are available, so it is difficult to define the best treatment for patients. A step-based approach seems to be the best solution.