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It's complicated: Gender reassignment operations sometimes require repairs


A surgeon skilled in reconstructive urology for men and women has developed a specialization in caring for transgender patients at Upstate.

genderDmitriy Nikolavsky, MD, does not perform initial gender reassignment surgeries. Rather, he handles occasional complications that may occur in the months afterward, as well as follow-up medical care for years to come.

“Patients after such complex operations, even without complications, will need lifelong urologic care,” he says. “It is not surprising that urologists who are not familiar with specificities of transgender anatomy may not be comfortable offering even routine urologic care.”

His first patient was a Central New Yorker who traveled out of state for gender reassignment surgery. Three months later, the person was still unable to urinate properly. Nikolavsky, in collaboration with the original surgeon, made surgical repairs, and the patient recovered.

Some of the most common complications after gender reassignment surgery include strictures caused by scar tissue, abscesses that harbor pus and the formation of abnormal passageways called fistulas. Niklolavsky says it‘s not uncommon for a patient to have more than one complication concurrently.

Dmitriy Nikolavsky, MD

Dmitriy Nikolavsky, MD

To stay current with his techniques, Nikolavsky connects with other reconstructive urologists who offer repairs, and he stays in touch with reconstructive plastic surgeons who perform gender reassignment surgeries. Multiple approaches can be used for male-to-female and female-to-male surgeries, and the initial approach can dictate the type of repair for which Nikolavsky must be prepared.

He says this specialty is something he did not envision when he graduated from Wayne State University School of Medicine in 2004 in Michigan. Even today, the number of gender reassignment surgeries remains low, but it‘s growing. In addition to providing surgical expertise, Nikolavsky says he has diligently helped select properly trained nurses and office staff who want to create a trans-friendly office environment.

In January, Upstate hosted a Transgender Health Panel, designed as an introduction to the challenges transgender patients face in the health care system.

Also, parent Terri Cook spoke on campus about the “long and difficult process” of her child transitioning from female to male, the subject of a book called “Allies and Angels: A Memoir of Our Family‘s Transition.”

HLOA logo“I watched my son grow from a depressed, struggling-with-anxiety, bullied, withdrawn, isolating individual into a young man who is now rising in his life,” she describes in an interview with Nikolvasky on Upstate‘s weekly podcast and talk radio show, "HealthLink on Air."

Cook goes on to discuss the surgery and its results. “He is a successful college student,” she says. “He has held a full-time job. He is in a happy, healthy relationship. I don‘t know what more any parent could want for their child.”

Common steps in transition 

 Gender transition is a different experience for everyone. Some common steps in a medical transition are:

    1. Live in the new gender role for a year.

    1. Seek therapy from mental health professionals who can provide letters of support, which a health care provider may require for surgery later on.

    1. Take appropriate hormones for another year.

    1. Schedule surgery, which would be done in stages. Some transgender men may desire chest reconstruction. Some transgender women may seek a tracheal shave, facial feminization surgery or other feminization procedures.

    1. Undergo genital reconstruction.

summer 2016 upstate healthThis article appears in the summer 2016 issue of Upstate Health magazine.