Reassignment Surgery Research Articles

Gender affirming care for the minimally invasive gynecologic surgeon.

Given the current political climate and the release of an updated version of the World Professional Association for Transgender Health's guidelines, this review assesses recent updates in the care of transgender and gender diverse (TGD) patients, specifically related to care provided by gynecologists. The number of people identifying as TGD and pursuing gender affirming care is increasing. Contraception for these patients is underdiscussed and high rates of pelvic pain and irregular bleeding were identified. Rates of regret are low following gender affirming surgeries, and studies have repeatedly shown their benefits for gender dysphoria. A minimally invasive approach is recommended for gender affirming hysterectomy, and the decision to proceed with bilateral salpingo-oophorectomy should be based on shared decision making. Surgical techniques include ensuring an adequate margin when taking the infundibulopelvic ligament, and consideration for two-layer vaginal cuff closure. Gynecologists play a key role in the care of TGD patients. Recent reviews have found extensive gaps in our knowledge, including a lack of guidelines for cancer prevention, effects of testosterone on benign conditions, and the long-term effects of bilateral salpingo-oophorectomy on health outcomes for patients on testosterone.

Differences in sexual development-S2k guideline update

Human beings with adifference in sexual development (DSD) often underwent gender reassignment surgery during early childhood. However, the medical decision was often not congruent with the gender identity that affected persons developed later on. To represent the interests of affected persons, an interdisciplinary guideline in cooperation with support groups was written. The revision of the first version of the guideline, published in 2016, was edited by 18professional societies and working groups as well as 3support groups. Aliterature search was performed for each of the 12chapters. Recommendations and statements created by the working groups were voted on during four consensus conferences. The guideline highlights the right of self-determination of affected persons. In this context, new legal requirements are reported. Other than necessary primary diagnostics, medical procedures should be postponed. Most important is the psychological support of parents and patients. Tumor risk of the gonads and protection of fertility are analyzed and discussed in detail. The content of the guideline represents aparadigm shift in dealing with human beings with adifference of sexual development. Projects as DSD Care and Empower-DSD help to promote the practical implementation of the guideline's recommendations.

Gender-affirming surgical procedures and their psychosocial impacts: an integrative review

Objective: Identify the main gender affirmation surgery techniques related to the construction of a neovagina and a neopenis and the consequent impact of these procedures on the mental issues of transgender people. Methods: This is an integrative literature review with an electronic survey of articles selected between August and September 2023, using MEDLINE (International Literature in Health Sciences) and LILACS (Latin American and Caribbean Literature in Health Sciences) via the Virtual Health Library (VHL) portal and PubMed (U.S. National Library of Medicine), portraying the main surgical procedures for gender reassignment and their psychosocial impacts on the transsexual community. Results: 21 articles were obtained that made up the final sample of the present study. Final considerations: Studies point to the satisfaction of transgender individuals after gender affirmation surgeries and consequent improvement in the mental health of this community despite the lack of standardization in measurement methods related to quality of life aspects, which impacts and limits the comparison between Works.

Risk of Suicide and Self-Harm Following Gender-Affirmation Surgery.

Introduction With the growing acceptance of transgender individuals, the number of gender affirmation surgeries has increased. Transgender individuals face elevated depression rates, leading to an increase in suicide ideation and attempts. This study evaluates the risk of suicide or self-harm associated with gender affirmation procedures. Methods This retrospective study utilized de-identified patient data from the TriNetX (TriNetX, LLC, Cambridge, MA) database, involving 56 United States healthcare organizations and over 90 million patients. The study involved four cohorts: cohort A, adults aged 18-60 who had gender-affirming surgery and an emergency visit (N = 1,501); cohort B, control group of adults with emergency visits but no gender-affirming surgery (N = 15,608,363); and cohort C, control group of adults with emergency visits, tubal ligation or vasectomy, but no gender-affirming surgery (N = 142,093). Propensity matching was applied to cohorts A and C. Data from February 4, 2003, to February 4, 2023, were analyzed to examine suicide attempts, death, self-harm, and post-traumatic stress disorder (PTSD) within five years of the index event. A secondary analysis involving a control group with pharyngitis, referred to as cohort D, was conducted to validate the results from cohort C. Results Individuals who underwent gender-affirming surgery had a 12.12-fold higher suicide attempt risk than those who did not (3.47% vs. 0.29%, RR 95% CI 9.20-15.96, p < 0.0001). Compared to the tubal ligation/vasectomy controls, the risk was 5.03-fold higher before propensity matching and remained significant at 4.71-fold after matching (3.50% vs. 0.74%, RR 95% CI 2.46-9.024, p < 0.0001) for the gender affirmation patients with similar results with the pharyngitis controls. Conclusion Gender-affirming surgery is significantly associated with elevated suicide attempt risks, underlining the necessity for comprehensive post-procedure psychiatric support.

IJCM_54A: Medical curriculum and published literature with focus on usage of appropriate LGBTQIA+ language: A situational analysis

Background: A sensitive language usage is important in scientific literature when reporting “lesbian, gay, bisexual, transgender, queer, intersex, asexual and other identities” (LGBTQIA+) and medical education can play an important role towards early sensitization of future professionals. Objective: To evaluate the competency based undergraduate curriculum (CBME) guidelines by National Medical Council and to conduct a content analysis of published medical education articles related to LGBTQIA+. Methodology: We reviewed the CBME guidelines for competencies pertaining to sensitization of medical students regarding LGBTQIA+. For content analysis, we searched PubMed using the MeSH terms “”Sexual and Gender Minorities”” AND “”Education, Medical”, restricting our search to English language. The Press Council of India (PCI) guidelines were used as reference for preferred and non-preferred terms. Results: At present, NMC has not brought about any teaching modules or sensitization on LGBTQIA+ for the undergraduate curriculum. However, the related competencies were psychosexual and gender identity disorders in Psychiatry (PS 13.1-13.7) and gender issues and women empowerment in community medicine (CM 10.9). A total of 177 articles were retrieved from PubMed. We selected 30 relevant articles, of which12 (40%) were from India. Majority of them (94%) complied to the PCI guidelines on LGBTQIA+, with respect to terms such as ‘transgender’, ‘transman’, ‘transwoman’ and ‘LGBTQ’. One Indian article used the term ‘transgenders. There was no usage of derogatory terms such as ‘eunuch’ and ‘victims’. Terms such as ‘Gender Non-conforming’ and ‘Gender affirming surgery’ were used in some surgery articles (6%) with no use of avoidable terms like ‘sex change surgery’ and ‘sex reassignment surgery’. Conclusion: The CBME needs to add specific LGBTQIA+ related competencies in the curriculum. The language in the medical education articles reviewed largely conformed with the PCI guidelines on LGBTQIA+ reporting with a fair, respectful, and informative coverage.

Predictors of Unplanned Reoperation after Gender-affirming Mastectomy: An Analysis of the NSQIP Database.

Gender-affirming mastectomy (GAM) is a gender-affirmation surgery designed to remove or reduce breast tissue, with or without nipple reconstruction. GAM is the most commonly performed gender-affirmation surgery and risk factors associated with unplanned return to the operating room and reoperation continue to be investigated. This is the largest study of transgender and nonbinary patients undergoing GAM to determine predictors of unplanned reoperation. The National Surgical Quality Improvement Program database was queried for patients undergoing GAM from 2012 to 2020. The primary outcome was the incidence of unplanned reoperation within 30 days postoperatively. The secondary outcome was the indication for unplanned reoperation within this period. Descriptive statistics were calculated. Bivariate analysis and multivariate logistic regression were performed to determine significant predictors of reoperation after GAM. A total of 2316 patients underwent GAM, of whom 2.2% (n = 51) underwent unplanned reoperation of the chest. The most common indication for unplanned reoperation was hematoma (n = 41, 71.9%) followed by abscess (n = 5, 8.8%). Significant predictors of reoperation were corticosteroid use [adjusted odds ratio (aOR) 95% confidence interval (CI) 5.07 (1.07-23.89)] and diabetes [aOR (CI) 10.98 (3.0-40.33)]. Hispanic/Latinx ethnicity [aOR (CI) 3.19 (1.22-8.33)] and corticosteroid use [aOR (CI) 6.81 (1.45-31.98)] were significant predictors of unplanned reoperation for hematoma evacuation after GAM. Diabetes mellitus and corticosteroid use were associated with unplanned reoperation after GAM. Ethnic correlations remain to be better elucidated as well as the effect of intersectionality. These findings can be used to guide patient selection and surgical decision-making.

SP52. Facial Gender Affirmation Surgery May Have Both Osseous And Soft Tissue Changes Predicted With Virtual Surgical Planning And Deep Surface Artificial Intelligence Morphing

SP52. Facial Gender Affirmation Surgery May Have Both Osseous And Soft Tissue Changes Predicted With Virtual Surgical Planning And Deep Surface Artificial Intelligence Morphing

Pilot Test of A Gender-conscious Sexual Health Intake Questionnaire: Increasing Inclusivity and Mitigating Bias in Sexual History Taking

Background: Sexual health is critical to overall health, yet sexual history taking is challenging. LGBTQ+ patients face additional barriers due to cis/heteronormativity from the medical system. We aimed to develop and pilot test a novel sexual history questionnaire called the Sexual Health Intake (SHI) form for patients of diverse genders and sexualities. Methods: The SHI comprises four pictogram-based questions about sexual contact at the mouth, anus, vaginal canal, and penis. We enrolled 100 sexually active, English-speaking adults from a gender-affirming surgery clinic and urology clinic from November 2022 to April 2023. All surveys were completed in the office. Patients also answered five feedback questions and 15 questions from the Patient-Reported Outcomes Measurement Information System Sexual Function and Satisfaction (PROMIS-SexFS) survey as a validated comparator. Results: One hundred patients aged 19–86 years representing an array of racial/ethnic groups, gender identities, and sexuality completed the study. Forms of sexual contact varied widely and included all possible combinations asked by the SHI. Feedback questions were answered favorably in domains of clinical utility, inclusiveness of identity and anatomy, and comprehensiveness of forms of sexual behavior. The SHI captured more positive responses than PROMIS-SexFS in corresponding questions about specific types of sexual activity. The SHI also asks about forms of sexual contact that are not addressed by PROMIS-SexFS, such as penis-to-clitoris. Conclusions: SHI is an inclusive, patient-directed tool to aid sexual history taking without cisnormative or heteronormative biases. The form was well received by a diverse group of participants and can be considered for use in the clinical setting.

Concurrent Gender Dysphoria/Incongruence and Autism Spectrum Disorder, a literature review

IntroductionSeveral studies have found that ASD (Autism Spectrum Disorder) and GD (Gender Dysphoria by DSM-V)/GI (Gender Incongruence by ICD-11) tend to co-occur, and in recent years the interest and publications on this comorbidity has increased rapidly.ObjectivesTo review the prevalence of ASD in individual with a diagnosis of GD/GI.To better tailor and improve care offered in the National Health Service (NHS) Gender Identity Clinics (GICs) throughout the UK.MethodsSystematic literature review was conducted via Pub Med, MEDLINE and PsycINFO by the author, for all English-language articles published between 2018 and 2023, containing keywords as ASD, GD (Gender Dysphoria), GI (Gender Incongruence), transgender, autistic traits, autism, gender diversity, gender variance.ResultsRate of people with ASD appear to be higher in people accessing Gender Identity Clinics (GICs) than in the general population. Results from this literature review show increased prevalence of GD and GI in ASD population.ConclusionsThis comorbidity has highlighted the importance of better tailor transgender healthcare services for people with neurodevelopmental conditions and neurodiversity, to avoid delay in ASD individuals accessing care and gender affirming medical treatments. Services should strive to provide an effective and equitable service. It is also important to better identify potential barriers for ASD people in accessing gender care. Literature also shows the people with ASD have more difficulties in communicating and describing their gender narrative and to express their wishes for gender treatments. Symptoms including problems in communications and social skills, obsession and rigidity can also impact their assessment of GD/GI in gender identity services. Some studies showed that for individuals who have concurrent ASD and GD/GI, assessment in GICs may be extended to better review their wishes for gender identity and for gender affirming treatment. Further research is needed to better investigate and understand factors explaining the relationship between ASD and gender diversity. There is still limited research in the real life experiences of gender diverse and autistic people. There is also a need to improve Gender reassignment protocol nationally to better care for individual with ASD and GD/GI throughout GICs in the UK.Disclosure of InterestNone Declared

"I'm not getting paid to give you a TED talk on how my trans body works". Experiences of hysterectomy gender affirming surgery: A qualitative study.

To explore the experiences of care surrounding hysterectomy as part of gender affirming surgery. An in-depth reflexive thematic analysis from accounts by 10 out of 12 people was undertaken. Experiences were then mapped to the surgery journey as a template for developing system responsiveness. No one person's experience of the procedure was affirmed across the entire surgery journey. Transgender health literacy was central to inclusive practice as it mediated bodily autonomy being upheld. The physical care environment influenced the experience, for example, the waiting room was marginalizing (intimidating), with a gendered clinic name and toilets. Some participants took a female support person/partner so that "people looking would assume that I was there supporting her, not the other way around." Communication misalignments were evident around information provided/understood about fertility and ovarian preservation. Participants were also placed in the position of both receiving care and providing education: "I also shouldn't have to be going in there for treatment, and then being expected to educate the medical professional that's meant to be helping me… I'm not getting paid to give you a TED talk on how my trans body works." The experiences mapped across the surgery journey highlighted multiple levels of service provision development needed to foster inclusive practice, for example, from workforce education to healthcare policy. Healthcare for transgender people can be unsafe and inequitable. Increasing transgender health responsiveness across the surgery journey will facilitate better alignments in communication and uphold bodily autonomy, leading to safer and inclusive practice.

Paucity of Online Information About Gender-Affirming Surgery Fellowships in the United States.

Despite growing demand for gender-affirming surgery (GAS), there are few formal GAS fellowships in the United States. Paucity of online information about GAS fellowships may discourage potential applicants and decrease the visibility of the field. Thus, it is important to analyze the existing online information about GAS fellowships to improve fellow recruitment and patient outcomes. To identify the number of GAS fellowship websites (GASFWs) and evaluate their robustness. Second, to report the social media presence of GAS fellowships. To identify GASFWs, existing databases sponsored by plastic surgery associations and Google query were used between April and May 2023. Thirty-five independent variables based on previously published data were evaluated for presence in a bivariate fashion on GASFWs. Accounts on popular social media websites were also identified by Google query. Website and social media analysis were also done for GAS fellowships that were offered by departments/specialties other than plastic surgery. In total, only 6 GASFWs associated with plastic surgery departments were identified and analyzed. Eight nonplastic surgery GASFWs were included for analysis. Overall, both categories of GASFWs were not robust; key information such as previous fellow listing and selection criteria was often missing. Furthermore, important topics specifically related to GAS such as community engagement and programmatic building are often not found on GASFWs either. In addition, none of the fellowships had any independent Facebook, Instagram, or Twitter. To ensure patient safety and quality outcomes, it is important to promote GAS by recruiting more applicants for specialized training beyond residency. With increased Internet use, improving GASFWs and social media presence as well as considering the use of a centralized database or match system can foster the growth of the field.

(O-19) GENDER REASSIGNMENT IN TRANSGENDER MEN IN BOGOTá, COLOMBIA

Abstract Introduction In the 21st century, the transgender population begun to have greater visibility and advances within the health field in terms of gender reassignment. This transition covers four aspects which includes legal, social, surgical reassignment and hormone therapy. Although the word transgender is no longer in the disorders section, it’s still seen as a disease. For this reason, the transgender population continues to be pathologized. In Bogotá, Colombia, information on the processes that encompass gender reassignment is currently not sufficient. Objective To understand the perception of transgender men about the four aspects of the female-to-male gender reassignment currently taking place in Bogotá. Method Qualitative descriptive study with biographical/narrative design carried out using semi-structured interviews were conducted with 4 transgender men over 18 years who have completed at least one of the aspects in Bogotá. These interviews were audio recorded, transcribed and analyzed. The results were divided into 2 dimensions, which were subdivided into various categories. Results and discussion Once gender reassignment began, most transgender men opt to start with the social aspect because it allows them to present themselves to society in their desired way. After this, they continued with the legal, hormonal and surgical aspects according to each person's preference. As a result, a lack of protocols and poor follow-up of health care guidelines for adequate care of this population were evident. Financing No conflict.

„The Gender Reassignment” Controversy - Between Affirmation and Kind Restraining

The review article presents the phenomenon of transsexualism through the prism of the etiology, scale and dynamics of the phenomenon as well as the most controversial social consequences concerning "sex change" and the acceptance or non-acceptance of voluntary personal forms adopted by children and adolescents. Review of contemporary literature, analysis of positions on the issues of the so-called gender changes (gender reassignment, gender matching). The text shows the evolution of understanding of gender identity disorders in the ICD-10 and DSM-5 classifications as well as the controversy related to the tendencies depathologizing gender inconsistency in the ICD-11. Looking at the etiological issues we present an attempt of in-depth psychological analyzes as opposed to the dominant, reductive medical approach. In the text, we also recall the basic developmental regularities of children and adolescents, often overlooked in discussions on transsexualism. The basic developmental regularities of children and adolescents, often overlooked in discussions on transsexualism, were also reminded. As the review of the data shows the rapid increase in gender identity disorders in recent years, their pronunciation leads to emphasizing the growing role of pop culture influences on young people. There is also a lack of research on the use of puberty blockers in children/adolescents - their introduction appears to be an experiment with, in fact, unknown consequences. The analysis of developmental regularities, the transience of dysphoric tendencies and the lack of reliable scientific data on the use of puberty blockers and the consequences of taking hormones of the opposite sex lead to the conclusion that accepting voluntary personal forms proposed by children/teenagers is premature.

Peri-surgical imaging of intersex and gender diverse youths.

This publication provides an overview of current imaging indications and practices for patients undergoing gender-affirming surgery, with an emphasis on the importance of tailored, patient-specific care. Gender-affirming surgeries are performed with personalized approaches at various stages of life for those with intersex traits or differences in sex development (I/DSD) and transgender and gender diverse (TGD) individuals. For I/DSD patients, ultrasound, genitography, or MRI occurs during infancy and puberty to evaluate genital and gonadal anatomy. Facial harmonization involves bony and soft tissue modifications, guided by maxillofacial computerized tomography (CT) with three-dimensional reconstruction. Ultrasound is the main modality in assessing hormone-related and post-surgical changes in the chest. Imaging for genital reconstruction uses cross-sectional images and fluoroscopy to assess neoanatomy and complications.

Embracing Inclusivity in Hospice Care: A Case Study in Supporting HIV Patients.

Despite the growing prevalence of human immunodeficiency virus (HIV) and acquired immunodefiency syndrome (AIDS) in the Philippines and the psychosocial challenges it engenders, there remains a dearth of research on the intersection of HIV and hospice care. Stigma and discrimination further compound the challenges of providing inclusive hospice care to HIV patients in the country. Drawing upon the results of a recently published article centered on a Veteran assigned male at birth who expressed a desire for gender reassignment while receiving end-of-life care, this paper highlights the importance of sensitivity, understanding, and affirmation in hospice settings for HIV patients in the Philippines.

Gender Self-Identification: Opinions About Transgender Women from a National Online Survey in Taiwan

Gender self-identification (transgender) is not permitted in most Asian countries. In Taiwan, individuals recognized as transgender must meet requirements mandated by the Gender Recognition Act. Currently, lifting the requirement for proof of sex-reassignment surgery is pending. The aim of this study was to survey a large sample of Taiwanese to gain a better understanding of the general population’s attitudes toward gender self-identification. A self-report survey, entitled “Opinions of Gender Self-Identification,” collected demographic information and responses (agree = 1, disagree = 0) to 14 statements about transgender women and women’s safety, personal rights, and the law; one statement discussed rights of transgender men to give birth; total scores ranged from 0 to 14. The online survey was distributed to non-government organizations across Taiwan and the Taiwanese islands and was available between April 16 and 30, 2022. Most of the 10,158 respondents were female (77.4%); ages of respondents ranged from 15 to > 65 years. The mean total score was 0.95 ± 2.27, indicating respondents strongly disagreed with support for transgender females; 91.56% disagreed with all statements. Although there were significant differences in scores between parents and non-parents, and those ≤ 35 years versus ≥ 36 years (p < .01), all strongly disagreed with gender self-identification. Given the majority of respondents were females, survey findings should be regarded with caution. Public acceptance of gender self-identification requires support from its residents. Our findings suggest that gender self-identification has not begun to approach even a moderate level of public support among survey respondents.

(040) Anterolateral Thigh Flap Phalloplasty: Outcomes Following Genital Gender Affirmation Surgery

Abstract Introduction Genital gender affirmation surgery (gGAS) is a key part of the management of patients with gender dysphoria. The anterolateral thigh (ALT) free flap was proposed as an alternative to the more common radial forearm free flap (RFFP) phalloplasty due to the twin advantages of a more easily hidden scar and improved flexibility in the length of the flap. A pedicled variant of the ALT flap offers greater security of vascular supply for suitable patients, and if suitable and desired the flap can be formed with an integrated urethra, facilitating voiding while standing. Objective The aim of the study is to report the contemporary surgical and functional outcomes of ALT phalloplasty. Methods All individuals undergoing ALT flap phalloplasty for genital gender affirmation surgery (GAS) between 2009 and 2023 nationwide were included. Individuals were managed in accordance with the World Professional Association for Transgender Health (WPATH) Standards of Care version 7. Data were extracted from a prospectively collected single surgeon database and medical records. Functional outcomes were assessed by non-validated questionnaire. Statistical analysis included Mann-Whitney, chi-squared, Fisher’s exact and unpaired T tests. Results Surgical outcomes: A total of 87 patients were included in the study. More than half (45, 51.7%) had an integrated urethra. The median length of stay following surgery was six days (IQR 6-7). Eleven patients (12.6%) had a 30-day Clavien-Dindo 3b complication or greater. Three patients (3.4%) experienced total flap loss. A further three patients (3.4%) had partial flap loss. Three patients (3.4%) required a salvage phalloplasty later. Thirteen patients (out of 42, 31.0%) without an integrated urethra went onto have a free flap urethroplasty. Functional outcomes: Thirty-nine individuals (44.8%) completed the patient reported outcomes questionnaire. Most patients (77%) were generally satisfied with their phalloplasty. More than half (56%) with an erectile device used their phallus for penetrative intercourse, while one in five reported experiencing orgasm using their phallus alone. Following urethral lengthening, all respondents were able to void standing. There was no significant difference in mean satisfaction scores for those with an integrated urethra compared to those without (4.18/5 vs 3.82/5, p=.45), as well as between those with or without an erectile device, respectively (3.78/5 vs 4.10/5, p=.26). Conclusions This study is one of the largest single centre cohorts of ALT flap phalloplasty reported to date. It further supports the use of the ALT flap as one of the main genital GAS options for transmen. Over half of the patients studied had an integrated urethra, the gold standard for urethral lengthening. Patient reported functional outcomes were promising, with similar scores regardless of urethral lengthening or erectile device insertion. Disclosure No.

(001) Brain Activation Patterns Associated with Visually Evoked Sexual Arousal in Female-To-Male Transgender Individuals

Abstract Introduction Cross-sex hormones in female-to-male (FtM) transgender individuals play a crucial role in brain plasticity. Brain activity associated with sexual arousal in FtM transgenders receiving cross-sex hormones is poorly understood. Objective This study aimed to compare brain activation patterns associated with sexual arousal between FtM transgenders and premenopausal women using a 3.0 Tesla functional magnetic resonance imaging (fMRI). Methods This study included 13 FtM transgenders (mean age: 43.2±6.4 years) and 13 premenopausal women (mean age: 41.5 ± 8.3 years). The FtM transgender individuals, who have had sex-reassignment surgery, received testosterone supplementary therapy. Sexual orientation was evaluated using the Kinsey sexuality rating scale (0 = exclusively heterosexual; 6 = exclusively homosexual). Serum sex hormones were measured, including free testosterone (free-T), estradiol (E2), follicle-stimulating, and luteinizing hormones. Visual sexual stimulation began with a 30-s cross fixation (rest condition), followed by a 30-s natural documentary (neutral condition), 540-s erotic video (sexual activation condition), then a 30-s cross fixation (rest condition). The fMRI data were post-processed using SPM8 software. Results The average rating of the Kinsey scale in the FtM transgenders was 5.6 ± 0.5, indicating their sexual orientation falls within the category of homosexual. The FtM transgenders showed significant increases in the free-T levels (18.8±18.9 pg/mL vs. 0.4±0.4 pg/mL, p &amp;lt; 0.001) and significant decreases in the E2 levels (45.4±32.0 pg/mL vs. 279.2±247.3 pg/mL, p = 0.001) compared with premenopausal women. The brain areas with significantly higher activities during visual sexual stimuli in the FtM transgenders compared with premenopausal women included the superior parietal lobule, middle occipital gyrus, and superior frontal gyrus (p &amp;lt; 0.001). Conclusions This study illustrates the specific brain activation patterns associated with sexual arousal in female-to-male (FtM) transgenders. These findings could contribute to our understanding of the neural mechanisms associated with sexual arousal in relation to the levels of sexual hormones in FtM transgenders. This research was supported by grants from the National Research Foundation funded by the government (MSIT; 2022R1A2C2007809, 2021R1C1C2011748). Disclosure No.

(126) Medicolegal Considerations for Patients Undergoing Urologic Surgical Interventions and the Development of an Audio-Recording Application for use During Genital Gender-Affirming Surgical Consultation

Abstract Introduction Patient recollection of details discussed during medical consultation is often limited (Figure 1a). For genital gender-affirming surgery (gGAS) consultations, lengthy discussions and deep contemplation surrounding surgical options are critical. Inadequate communication can result in patient complaints and medico-legal action, whereupon issues such as a lack of discussion or poor documentation can lead to medico-legal liability against the care provider and hospital system. As a result, strategies must be developed to ensure that information discussed during complex medical consultations are made available so patients can properly weigh out the care options presented. Objective 1) Assess medico-legal incidents in Urologic and surgical specialties in the UK, US, and a Californian quaternary care center, 2) evaluate the advantages and feasibility of offering audio-recordings of patient consultations, and 3) create a user-friendly smartphone app for recording healthcare consultations. Methods A literature review evaluated current evidence on medical liability claims in the UK and US was conducted. Additionally, our center's Department of Risk Management provided information pertaining to medico-legal cases against our institution. Separately, gGAS patients consented to audio-record their consultation. Copies were provided to patients and kept in their medical records. A follow-up survey assessed its usefulness, and based upon patient feedback, a smartphone application was developed. Results A PubMed search yielded 921 results on "medical malpractice claims" from 2013–2023. In Urologic Surgery, 32 papers addressed medical malpractice, with 2 providing data over the last 15 years. In the UK, 660 claims were made from 2010–2020, of which 8.2% were due to poor communication (37 = informed consent; 17 = lack of follow-up). In the US, from 2020–2022, 38.3% of Urologists faced at least one legal proceeding in their career, and 5.3% were sued within 1 year for any reason. Our institution's Department of Risk Management reported 32% of lawsuits were related to surgical care. Informed consent involved 8% of cases and had a component in 32%. The average financial settlement for medical malpractice was $125,000.00 USD, and trial costs averaged $75,000.00 USD. 50/71 patients completed an anonymized, online survey post-audio recording. Positive results were noted regarding recording quality, comfort whilst being recorded, and wishes for future consultation recordings (Figure 1b). In addition, most patients felt less anxiety, and had greater confidence in their treatment choice (Figure 1c) Based upon patient responses, we developed a smartphone App which records 90 minutes of audio, allows for file and hyperlink attachments to be sent to patients before immediately deleting all information (Figure 1d). Routine use of audio-recordings led to a reduction in patient queries to our office. Conclusions Routine audio recording of patient consultations provides significant benefits with minimal cost to providers. As per our institution's Office of Risk Management, it offers protection against medico-legal risks. Adequate discussion, good documentation and providing adjuncts for patients can help prevent a large proportion of medicolegal complaints in addition to optimizing patient care. Considering that patients face similar challenges across different disciplines and regions, a larger study (multi-center, international, multi-language) is warranted. Disclosure No.

(272) Evidence-Based Strategies for Preventing Lower-Limb Complications Secondary to Prolonged use of the Dorsal Lithotomy Position

Abstract Introduction Patient positioning at the time of surgery plays a critical role in determining patient outcomes. Specific to patients undergoing genital gender-affirming surgery (gGAS), these patients are required to be placed in the lithotomy position to access the pelvis and perineum for their procedures. Lower-extremity injury due to prolonged surgical time in the lithotomy position can have significant post-operative morbidity affecting patient outcomes. This risk is increased in patients undergoing gGAS procedures due to high surgical complexity and especially long operative times as compared to other surgical procedures. Careful attention must be placed on the patient’s specific position perioperatively due to potential injury risk. Prolonged stasis can cause injuries ranging from mild soft-tissue injuries which rapidly resolve, such as mild pressure injuries to bony prominences, to severe injuries including pressure ulcers, nerve injuries, rhabdomyolysis, and compartment syndrome. These complications can have lasting impact on the patient, with associated morbidity and mortality risk, and can also impact healthcare systems through additional dollars spent caring for patients who suffer these complications and their associated rehabilitation, and legal recourse on behalf of the patient who suffered these severe complications. Objective Our study aimed to describe our technique for preventing lower extremity injuries in the dorsal lithotomy position, and to evaluate our positioning-related post-operative complications and rates. Methods We describe our technique for lower-limb positioning in the dorsal lithotomy position, with an emphasis on injury prevention for patients undergoing gGAS. We assessed positioning-related outcomes and complications among patients undergoing gGAS for prolonged periods (&amp;gt;300 minutes) in the lithotomy position between January 2017 to March 2023. Results A total of 227 patients underwent 310 gGAS procedures were included in our study (156 masculinizing: 154 feminizing gGAS procedures). Mean operative time was 495.5 minutes +/- 156.5 minutes (SD) (Range 300–1095 minutes) (Table 1a). A total of 6/227 (2.6%) patients (2 masculinizing and 4 feminizing surgical patients) had transient, self-limited LE pain post-operatively. No (0%) patients had major or chronic complications including chronic nerve injury, pressure ulcers, rhabdomyolysis or compartment syndrome (Table 1b). Our patient positioning employs the use of ½ inch foam placed to surround the lower extremity, ensuring that all at-risk areas of compression are adequately protected when placing the patient’s leg in the Allen stirrups whilst in the lithotomy position (Figure 1). In addition, a perioperative list is also utilized with regular leg checks every 1.5–2 hours with nursing documentation and also, ensuring patients are able to move their lower extremities without any pain post-operatively (Figure 2). Conclusions Our study is the first to describe a specific technique and outline strategies for protecting the lower extremities to prevent injuries in patients undergoing prolonged surgical procedures in the lithotomy position. The low complication rates associated with our technique warrants attention to further refine this technique, and, to integrate these strategies into operating-room programs across diverse specialties. Disclosure No.