Gender affirming surgery continues to grow across the United States, with more transgender individuals seeking procedures that align their bodies with their identities. Among transfeminine patients, vaginoplasty remains one of the most requested genital reconstruction surgeries. As surgical techniques evolve, attention is increasingly focused not only on cosmetic and functional outcomes but also on long term urinary health.
A recent study published in February 2026 examined changes in overactive bladder symptoms before and after vaginoplasty in transgender women. The findings offer valuable insight for patients, surgeons, and healthcare providers who aim to optimize outcomes and improve quality of life.
In this comprehensive review, we break down the study’s results, explain what overactive bladder means in this context, explore surgical risk factors, and discuss the real world clinical implications.
Gender affirming vaginoplasty typically involves removal of male genital structures and construction of female genital anatomy. The procedure may include penectomy, orchiectomy, urethral reconstruction, vulvoplasty, clitoroplasty, and creation of a neovaginal canal.
Common techniques include:
Each method differs in how the vaginal canal is constructed and how deeply surgeons dissect within the pelvis.
Gender affirming surgery rates have increased significantly in recent years. Data from national databases show nearly a tripling of procedures between 2016 and 2019 in the United States. As surgical volumes increase, understanding complications such as urinary symptoms becomes increasingly important.
Overactive bladder, often abbreviated as OAB, is defined by urinary urgency with or without urge incontinence. It is commonly associated with:
OAB falls under the broader category of lower urinary tract symptoms. These symptoms can significantly affect daily functioning, sleep, self esteem, and social participation.
To assess OAB symptoms in this study, researchers used the Overactive Bladder Questionnaire Short Form, known as the OAB q SF. This validated instrument evaluates two main domains:
The questionnaire was originally validated by Coyne KS and colleagues in 2015 in Neurourology and Urodynamics.
Vaginoplasty involves pelvic dissection near the bladder, rectum, and autonomic nerves. Several factors may influence urinary outcomes:
Given these factors, researchers sought to measure OAB symptoms both before and after surgery using a validated questionnaire.
This retrospective longitudinal study evaluated 53 transgender women who underwent vaginoplasty between 2022 and 2024 at a single institution.
Median age was 31 years. The oldest quartile ranged from 44 to 71 years.
Patients completed the OAB q SF before surgery and again after surgery, with a median follow up of 29 weeks.
Symptom bother scores increased from 6.7 to 13.3 out of 100. While this represented a doubling numerically, it was not statistically significant.
However, health related quality of life scores declined slightly from 96.9 to 93.8 out of 100. This decline was statistically significant.
Importantly, baseline OAB symptoms were generally low in this population.
When stratified by age, the oldest quartile showed the most significant worsening:
These changes reached statistical significance.
Younger age groups did not demonstrate meaningful worsening.
Possible explanations include:
Patients who underwent peritoneal flap vaginoplasty experienced a statistically significant decline in quality of life scores.
Other techniques did not show significant worsening.
This suggests that dissection near the peritoneal reflection and posterior bladder wall may influence bladder sensory pathways.
One of the most important takeaways from this research is the distinction between statistical and clinical significance.
Although certain changes reached statistical significance, the magnitude of symptom worsening remained relatively small.
Prior validation research suggested that a 10 point difference in OAB q SF scores represents a minimally important clinical difference. Most changes in this study did not reach that threshold.
Even in the oldest group, a postoperative symptom bother score of 20 out of 100 would still be considered relatively minor.
Therefore, while measurable differences were observed, the real world clinical impact appears limited.
Previous literature has reported postoperative urinary urgency and frequency in 12 to 30 percent of patients. However, most prior studies relied on cross sectional surveys without preoperative comparison.
Other validated tools used in transgender populations include:
However, this study is the first to compare preoperative and postoperative OAB symptoms using a validated bladder specific questionnaire.
Research on Mayer Rokitansky Kuster Hauser syndrome, a congenital condition affecting vaginal development, has not demonstrated major long term urinary consequences following vaginoplasty in cisgender women. However, that population differs anatomically and hormonally from transgender patients.
For transgender women considering vaginoplasty, the study offers reassurance.
Most patients do not experience clinically significant worsening of overactive bladder symptoms.
However, counseling should include discussion of:
Patients with preexisting urinary storage symptoms may wish to discuss surgical options carefully with their urologist and reconstructive surgeon.
Surgeons performing peritoneal flap vaginoplasty may consider:
Monitoring urinary symptoms longitudinally beyond six to twelve months would provide additional insight into recovery trajectories.
Future research should include multicenter prospective studies and longer follow up.
Overactive bladder symptoms may worsen slightly after gender affirming vaginoplasty, particularly in older individuals and those undergoing peritoneal flap techniques. However, the magnitude of change appears modest and often does not meet thresholds for clinical significance.
For most patients, vaginoplasty does not result in major long term bladder dysfunction.
As gender affirming care continues to expand, integrating urinary outcome tracking into routine postoperative care will help ensure the highest standards of patient centered treatment.
Ho P, Torres C, Andrade F, Palese M, Djordjevic M, Purohit RS. Overactive bladder after gender affirming vaginoplasty. Published February 6, 2026.
Coyne KS, Thompson CL, Lai JS, Sexton CC. Validation of the OAB q SF. Neurourology and Urodynamics. 2015;34(3):255 to 263.
This article is for educational and informational purposes only. It is not intended as medical advice, diagnosis, or treatment. Patients should consult a qualified healthcare professional for individualized medical guidance. Surgical decisions should be made in consultation with experienced gender affirming surgeons and urologists.
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