{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,9]],"date-time":"2026-03-09T00:30:19Z","timestamp":1773016219495,"version":"3.50.1"},"reference-count":21,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,3,3]],"date-time":"2026-03-03T00:00:00Z","timestamp":1772496000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,3,3]],"date-time":"2026-03-03T00:00:00Z","timestamp":1772496000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["bjui-journals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJU International"],"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To achieve an international expert consensus among surgeons on the indications, contraindications, and perioperative management of feminising genital surgery (FGS) for assigned\u2010male\u2010at\u2010birth (AMAB) individuals, using a Delphi process.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A two\u2010round on\u2010line Delphi survey (May\u2013July 2025) followed by a final consensus meeting (September 2025) was conducted among 27 urological surgeons specialised in gender\u2010affirming genital surgery. The survey explored eligibility criteria, risk factors, hormone therapy, counselling, and perioperative care. Consensus was defined a priori as \u226575% agreement or disagreement, with descriptive statistics summarising results.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      In all, 26 experts (96%) completed Round 1, and 24 (89%) completed Round 2. Consensus was achieved on 63 of 68 statements. Advanced age alone was not a contraindication but should be evaluated alongside comorbidities. Body mass index &gt;24.9\u2009kg\/m\n                      <jats:sup>2<\/jats:sup>\n                      , diabetes, smoking, and cardiovascular disease were identified as significant risk factors for postoperative complications. Major psychiatric disorders and spinal cord injury were relative contraindications for FGS. Previous pelvic surgery or radiotherapy, as well as Charlson Comorbidity Index \u22653, were considered relative contraindications for vaginoplasty only. No consensus was reached on the timing of hormone therapy interruption or re\u2010initiation. Preoperative counselling was essential for adherence to wound care and dilation protocols and for addressing complications such as infection, thromboembolism, bleeding, and bowel injury. Experts recommended genital hair removal, enoxaparin prophylaxis, postoperative dressings and catheterization for 3\u20135\u2009days, and pelvic rehabilitation before and after surgery. A dilation protocol of three daily 30\u2010min sessions was advised. FGS improved quality of life even in older or comorbid patients, although healing and function may be less optimal.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This study presents the first international Delphi consensus on indications and perioperative management of FGS in AMAB individuals, emphasising individualised, comorbidity\u2010based assessment, structured counselling, and multidisciplinary care. Unresolved issues regarding hormone therapy require further study.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/bju.70196","type":"journal-article","created":{"date-parts":[[2026,3,8]],"date-time":"2026-03-08T23:35:34Z","timestamp":1773012934000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["International Delphi consensus on feminising genital surgery in assigned\u2010male\u2010at\u2010birth individuals"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-7168-5499","authenticated-orcid":false,"given":"Marta","family":"Pezzoli","sequence":"first","affiliation":[{"name":"Department of Urology Azienda Ospedaliera Universitaria Careggi, University of Florence  Florence Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mattia","family":"Lo Re","sequence":"additional","affiliation":[{"name":"Department of Urology Azienda Ospedaliera Universitaria Careggi, University of Florence  Florence Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Valeria","family":"Pizziconi","sequence":"additional","affiliation":[{"name":"Department of Urology Azienda Ospedaliera Universitaria Careggi, University of Florence  Florence Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marco","family":"Falcone","sequence":"additional","affiliation":[{"name":"Department of Urology Citt\u00e0 della Salute e della Scienza di Torino, University of Turin  Turin Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mirko","family":"Preto","sequence":"additional","affiliation":[{"name":"Department of Urology Citt\u00e0 della Salute e della Scienza di Torino, University of Turin  Turin Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marco","family":"Capece","sequence":"additional","affiliation":[{"name":"Department of Urology University of Naples Federico II  Naples Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5074-2043","authenticated-orcid":false,"given":"Michele","family":"Rizzo","sequence":"additional","affiliation":[{"name":"Department of Urology University of Trieste  Trieste Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4361-4523","authenticated-orcid":false,"given":"Guglielmo","family":"Mantica","sequence":"additional","affiliation":[{"name":"Department of Urology University of Genoa, IRCCS Ospedale Policlinico San Martino  Genoa Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7357-0758","authenticated-orcid":false,"given":"Francesco","family":"Chierigo","sequence":"additional","affiliation":[{"name":"Department of Urology University of Genoa, IRCCS Ospedale Policlinico San Martino  Genoa Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5987-3883","authenticated-orcid":false,"given":"Malte","family":"Vetterlein","sequence":"additional","affiliation":[{"name":"Department of Urology University Medical Center Hamburg\u2010Eppendorf (UKE)  Hamburg Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Patrizio","family":"Vicini","sequence":"additional","affiliation":[{"name":"Department of Urology Saint Camillus International University of Health Sciences (UniCamillus)  Rome Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fran\u00e7ois\u2010Xavier","family":"Madec","sequence":"additional","affiliation":[{"name":"Department of Urology H\u00f4pital Foch  Suresnes 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Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-9068-2785","authenticated-orcid":false,"given":"Saskia","family":"Morgenstern","sequence":"additional","affiliation":[{"name":"Department of Urology Agaplesion Markus\u2010Hospital  Frankfurt am Main Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1642-7263","authenticated-orcid":false,"given":"Marjan","family":"Waterloos","sequence":"additional","affiliation":[{"name":"Department of Urology AZ Maria Middelares Gent  Ghent Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2298-3450","authenticated-orcid":false,"given":"Miroslav","family":"Djordjevic","sequence":"additional","affiliation":[{"name":"Department of Urology and Surgery, School of Medicine University of Belgrade  Belgrade 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Department Hospital Italiano de Buenos Aires  Ciudad Aut\u00f3noma de Buenos Aires Argentina"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tim","family":"Ludwig","sequence":"additional","affiliation":[{"name":"Department of Urology University Medical Center Hamburg\u2011Eppendorf (UKE)  Hamburg Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Silke","family":"Riechardt","sequence":"additional","affiliation":[{"name":"Department of Urology University Medical Center Hamburg\u2011Eppendorf (UKE)  Hamburg Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lisa","family":"Szyper","sequence":"additional","affiliation":[{"name":"Department of Urology MVZ Dr. Lubos Medizin Pasing  Munich Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maren","family":"Wenk","sequence":"additional","affiliation":[{"name":"Department of Urology and Urological Surgery University Medical Center Mannheim, University of 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