Unusual iatrogenic common femoral artery injury during penile prosthesis placement in gender-confirming surgery

Abstract

Introduction: Gender dysphoria refers to the distress or discomfort experienced when a person's gender identity does not align with the sex assigned at birth. While many transgender individuals affirm their gender identity without surgical intervention, an increasing number undergo gender-confirming surgery. It is essential to recognize and promptly treat vascular complications that can arise during these procedures. There are no previous reports addressing arterial injuries during the implantation of penile prostheses for gender-confirming surgery. Case presentation: A 33-year-old patient with gender dysphoria underwent female-to-male surgical interventions for gender confirmation. During the latest urologic procedure, which involved the implantation of a three-piece inflatable penile prosthesis, a vascular complication occurred, resulting in injury to the right common femoral artery. Given the extent of the injury and the difficulty in repairing the arterial wall, vascular surgeons resected the damaged artery segment and performed an end-to-end anastomosis. Intraoperative duplex ultrasound at the conclusion of the surgery showed a triphasic waveform in the distal vessels. The urologist decided to postpone the implantation of the penile prosthesis. The patient was discharged on the sixth postoperative day without systemic or local complications and was prescribed single antiplatelet therapy. Conclusions: With the increasing number of transgender individuals seeking gender-affirming surgery, it is important to conduct a multidisciplinary preoperative evaluation to minimize complications that could affect their quality of life.

Keywords

• Transgender
• Penile prosthesis
• Complications
• Common femoral artery, Iatrogenic lesion