Part 1. Historical overview Chapter 1 gives an overview of the surgical revolution at the Amsterdam University Medical Center(AUMC), location VUMC. All surgical techniques from 1989 to 2018 are evaluated and put into perspective. Part 2. Reducing urological complications and improving surgical outcomes Chapter 2 describes the effects of a colpectomy on the incidence of urethral fistulas in transgender men undergoing gGAS with urethral lengthening. Chapter 3 describes the surgical and patient reported outcomes after gGAS without urethral lengthening. The Amsterdam UMC is the first center worldwide to offer transgender men this surgical option. This surgical technique is subsequently described in detail in the form of a video article in Chapter 4. In Chapter 5 the surgical techniques and outcomes in patients who were unsatisfied with their metoidioplasty and underwent a secondary phalloplasty is described. The study was conducted in collaboration with international gender affirming surgical clinics. In Chapter 6 the surgical management and patients reported outcome measures after (partial) phalloplasty flap loss is presented. Part 3. Novel surgical technique Chapter 7 presents a novel surgical technique to lengthen the neo-urethra in collaboration with the Belgrade University Medical Center. The surgical and clinical outcomes were assessed one year postoperatively. 1