This is a well presented manuscript describing a series of 240 patients undergoing male to female gender affirming surgery with penile inversion vaginoplasty by a single surgeon over an 18 month period of time in the United States. The authors are to be congratulated for maintaining a prospective database of these patients and beginning to report some of their findings and patient outcomes. The manuscript mainly focuses on short-term outcomes with 30, 60 and 90 day complication rates outlined as well as risk factors among patients who did and did not experience complications, reoperations and revision surgery. Overall, the short-term complications were fairly infrequent and typically minor with no significant differences noted among the 4 quintiles of patients in the surgeon's experience. When looking at various patient related factors, only patient noncompliance with postoperative wound care was significantly associated with an increased likelihood of short-term complications and the need for reoperation and revision surgery. In this series, simultaneous breast augmentation, neoadjuvant hormonal therapy, prior vaginoplasty, HIV status, hypertension, diabetes and usage of tobacco had no significant relationship with reoperation and revision surgery. The follow-up is extremely short for some patients, as stated to be a minimum of 1 week. That being said,the limitations of follow-up in this population of patients is aptly discussed by the authors. It is likely that the short-term complications noted in the series will increase over time. Whether the moderate and longer-term complications of this prospectively maintained patient series become comparable to other series in the published literature remains to be seen. Inclusion of appropriate patient reported measures, as they become available, will be another necessary facet to the follow-up for these patients.