(286) Bladder Outlet Obstruction Warranting TUR in Transgender: Unusual Occurrence

Introduction Transgender’s make up of 0.3-0.5 % world numbers, with a population that is on the rise consistently. These patients will require multimodal management and involves gender affirming surgery and hormone therapy. However, there is little research on Lower urinary tract symptoms in transgender population with only two reported cases with BPE as the underlying problem requiring a TURP Objective we share a case report of a post gender affirming surgery patient who had subsequent Bladder outlet obstruction requiring TURP eventually. This is the third reported case of TURP in transgender to our knowledge. Methods A 22 year old patient, born as a male with gender Incongruence and was operated previously for Penectomy and bilateral orchidectomy without neovaginal reconstruction 4 years ago. She presented to Emergency room in Obstructive Uropathy which required an emergency Suprapubic catheterization. Sr. Creatinine was 8.1 on presentation. Ultrasound showed Bilateral Hydroureteronephrosis and gross thinning of renal parenchyma. Patient was referred to us for further management and sr.creatinine was 6.9 at that time. On Examination, Meatal stenosis was noted, and patient was taken up for Meatoplasty followed by cystoscopy showing high bladder neck. Patient was started on alpha blockers postoperatively and catheter was removed on Postoperative day 7, following which patient failed to void. A urodynamic study done showed Obstructive etiology. Results Patient was taken up for cystoscopy and bladder neck incisions were given, following which lateral lobes were falling.A formal Trans urethral resection of Lobes was done. Patient postoperative course was uneventful and voided well on catheter removal. Follow-up Uroflowmetry is normal and sr.creatinine at 3-month follow-up was 1.7. Histopathology showed Prostatic tissue replaced by fibromuscular stroma and showed dilated von Brunne nests with intestinal metaplasia, suggesting Cystitis cystica glandularis. Conclusions There is little research on Lower urinary tract symptoms in transgender population, prostate cancer was rather more studied. Increased Frequency and urgency were the most commonly noted complaints post Gender affirming surgery which have improved over the time. Only two reported cases of TURP worldwide for Bladder outlet obstruction and one case of Rezum was reported, warranting more research. Disclosure No