Transgender and gender diverse (TGD) inclusivity in the investigation of lower urinary tract symptoms—Fundamental considerations for evaluation

Lower urinary tract symptoms (LUTS) are a common urological complaint. Transgender and gender diverse (TGD) individuals who have undergone masculinising or feminising genital gender-affirmation surgery (gGAS) experience a higher incidence of LUTS. Clinical assessment of LUTS involves symptom questionnaires, which are often gender-binary, and intimate examinations, which can be a source of distress if conducted without appropriate care. Inadequate clinical knowledge of complex anatomy following gGAS can cause further patient discomfort. Urodynamic studies often form an integral part of a urological assessment. These involve multichannel catheterisation. If performed by an inexperienced clinician, this can be a risky procedure for those who have undergone masculinising gGAS, as the reconstructed urethra is more fragile, tortuous and stenosed. The potential consequences of perforation are grave, risking the compromise of the functional and aesthetic outcomes of the original procedure. With this in mind, we highlight key areas during the investigation of LUTS where specific considerations for ensuring TGD inclusivity could be made.