Al-Tamimi M, et al. - Experts evaluated the impact of performing a colpectomy before (primary) or after (secondary) gender affirming surgery (GAS) with single-stage urethral lengthening on the incidence of urethral fistulas in transgender men. They conducted a retrospective chart review of all transgender men who underwent GAS with urethral lengthening between January 1989 and November 2016 at VU University Medical Center. The incidence rate of urethral fistulas decreased by performing a primary colpectomy. Moreover, an effective treatment for fistulas at the proximal urethral anastomosis (PUA) and the fixed part of the neo-urethra was secondary colpectomy.