title: MR imaging in patients with male-to-female sex reassignment surgery: postoperative anatomy and complications.
abstract: OBJECTIVE
  To investigate the role of MRI in the evaluation of both the new female anatomy and complications in male-to-female sex reassignment surgery (MtF-SRS).
  
  
  METHODS
  71 consecutive patients with MtF-SRS had 74 MRI [age range, 21-63 years; mean (±standard deviation) age, 36 ± 10 years; median age, 37 years]. In 47 patients, MRI was performed to rule out early post-operative complications after gender conversion (n = 40), vaginoplasty (n = 6) or remodelling of the labia majora (n = 1). In 27 patients, MRI was performed 1-20 years after MtF-SRS for late post-operative complications, pain or dysuria, inflammatory changes or poor cosmetic outcome. Three patients had MRI both before and after the operation.
  
  
  RESULTS
  MRI allowed investigation of the new female anatomy in all cases. Soon after MtF-SRS, a small amount of blood was identified in all patients around the neoclitoris, urethral plaque and labia. Post-operative complications were clinically significant fluid collections (n = 5), labial abscesses (n = 2), severe cellulitis (n = 3), partial neovaginal prolapse (n = 3), focal necrosis and dehiscence of the vaginal wall (n = 2) and hypovascularization of the neoclitoris (n = 1). After ileal vaginoplasty, three patients developed clinically insignificant haematomas, one a large rectovaginal fistula with dehiscence of the intestinal anastomosis and bowel perforation (n = 1). In the 27 patients investigated 1-20 years after MfF-SRS, MRI demonstrated cavernosal remnants (n = 10), spared testis (n = 1) neovaginal strictures (n = 8), fistulas and abscesses (n = 3) and prolapse (n = 2). Three of these patients also had fibrotic changes. In the remaining three patients, no pathological features were identified.
  
  
  CONCLUSIONS
  After genital reconfiguration, MRI allows assessment of the post-operative anatomy and of post-operative complications. Advances in knowledge: Imaging features of the new anatomy and of surgical complications after SRS are discussed and illustrated.
authors.affiliation: 1 Department of Radiology, University of Trieste, Ospedale di Cattinara, Trieste, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Bertolotto
authors.affiliation: 2 Department of Urology, University of Trieste, Ospedale di Cattinara, Trieste, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Liguori
authors.affiliation: 2 Department of Urology, University of Trieste, Ospedale di Cattinara, Trieste, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Bucci
authors.affiliation: 1 Department of Radiology, University of Trieste, Ospedale di Cattinara, Trieste, Italy.
authors.forename: Mariano
authors.initials: M
authors.lastname: Iannelli
authors.affiliation: 2 Department of Urology, University of Trieste, Ospedale di Cattinara, Trieste, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Vedovo
authors.affiliation: 2 Department of Urology, University of Trieste, Ospedale di Cattinara, Trieste, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Pavan
authors.affiliation: 2 Department of Urology, University of Trieste, Ospedale di Cattinara, Trieste, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Trombetta
authors.affiliation: 3 Department of Health Sciences (DISSAL), Radiology Section, University of Genoa, Genova, Italy.
authors.forename: Lorenzo E
authors.initials: LE
authors.lastname: Derchi
mesh_terms: D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000000981:diagnostic imaging*; D057830:Gender-Affirming Surgery; D014621:Vagina / Q000033:anatomy & histology* / Q000000981:diagnostic imaging* / Q000601:surgery; D055815:Young Adult