It has been estimated that 0.2% of the UK population identifies as transgender. For those who seek gender reassignment, the pathway can involve the expertise of multiple disciplines, including primary care, psychology, endocrinology and speech and language therapy. A small but significant number of the transgender population will also elect to undergo gender-affirming genital surgery in order to achieve gender congruence. In the UK, very few specialist centres provide genital gender-affirming surgery for trans-men and women. The population accessing these services spans the entire UK, and with such geographical dispersion, trans-patients with uro-genital complications after surgery in both the short and long term are likely to present locally, with initial assessment/management often conducted in a non-specialist setting. This article aims to help familiarise nurses with genital gender reassignment/affirming surgery and the resultant altered anatomy. It explores the urological issues trans-men and women may experience as a consequence of surgery.