8th Baltic Congress of Radiology

Obs&Gynecological Radiology

oral abstract

With the increased number of sex reassignment surgeries, the number of radiological examinations for transgender patients increases accordingly. Different radiological methods is performed for surgical procedures follow ups, for long and short-term complication evaluation, as well for pathologies detecting that are not associated with the sex reassignment surgery increases accordingly. A wide range of gender reassignment surgical techniques can cause difficulties in assessing the anatomical structures of the small pelvis, thereby leading to erroneous conclusions and diagnoses. Keywords: gender reassignment therapy, female to male (FTM), male to female (MTF), computed tomography (CT); magnetic resonance imaging (MRI), ultrasound (US).

Iterature research was performed using Pubmed, Web of science and Scopus databases. Inclusion criteria: English language, published in 2016-2021.

N the case of transgender patients, before radiological exam is taken, there are certain nuances - it is required to make sure that the patient is not pregnant, in case if CT or X-ray is scheduled. There is a need to clarify what gender anatomy is present and is the anatomy native or constructed if the imaging procedure sex-specific. Is patient is undergoing hormonal therapy and have any sex reassignment surgeries been performed? In case of MRI and CT it can be useful to use a non-metal containing (silicone or plastic) neovaginal dilator instrument to improve assessment. Radiological post-surgery report after MTF surgeries (vaginoplasty) must include neo-vaginal depth, length of the inferior pelvic aperture and pelvic inlet, angle of the neovaginal axis, and thickness of the rectovaginal septum. After FTM operations, it is necessary to evaluate whether hysterectomy was performed, what type of phalloplasty was performed (radial forearm free flap, anterolateral thigh flap or abdominal flap) or metoidioplasty procedure was chosen. Was any erectile device and/or testicular prosthesis implanted. Imaging is useful to confirm the following complications: rectal, urethral or bladder injury, hematomas or abscesses, flap dehiscence and/or necrosis , urethral stenosis and/or urinary retention, neovaginal stenosis or prolapse, rectoneovaginal and urethroneovaginal fistula, neoclitoral necrosis, prosthesis expulsion or displacement. Existing cancer imaging-based screenings can also be used for transgender patients. For example - regular prostate cancer screening guidelines to monitor for prostate cancer. Hormone replacement therapy also can cause different patologies. Testosterone in transgender men causes changes to the ovaries resembling polycystic ovary syndrome. For sexually active transgender men, who have not undergone sex reassignment surgery, unintended pregnancy has the potential to occur despite testosterone therapy.

Medical imaging is necessary in preoperative evaluation and postoperative management of transgender patients, also for cancer screening and for evaluation of non-genital organ pathologies. Information about patients and performed sex reassignment surgeries (as well what surgery method was chosen) significantly improves radiological report quality.

Wide range of gender reassignment surgical techniques can make imaging interpretation challenging. What points should be paid attention to when examining the small pelvis in transgender patients. What features of neoanatomy should be recognised; what short and long-term postsurgical complications can be differentiated and what types or imaging-based screenings can be useful for this group of patients.

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