Dr. Karl Coutinho is a fellowship-trained reconstructive urologist with advanced training in genitourinary trauma, urethral reconstruction, and prosthetic surgery. He is a founding member of the Society of Gender Surgeons and is part of the multidisciplinary Gender Affirming Medical and Microsurgical Associates (GAMMA) surgical team, where he works alongside gender-affirming plastic and reconstructive surgeons.
In many masculinizing genital procedures, Dr. Coutinho focuses on the urologic and urethral portions of reconstruction while the plastic surgery team performs complementary reconstructive portions. This collaborative model is particularly important because urethral reconstruction, soft-tissue coverage, flap blood supply, wound healing, and future prosthetic surgery all affect one another. Every patient’s anatomy, prior operations, and goals are different, so care is individualized and often staged.
Dr. Coutinho’s practice is centered on complex urethral reconstruction. That experience is particularly important after phalloplasty because the urinary channel crosses multiple reconstructed tissue segments and may require early surveillance or later revision. His goal is to provide careful urologic planning at the time of urethral lengthening and continuity of care if a stricture, fistula, or other urinary issue develops afterward.
His broader academic work in urethral stricture disease includes serving as a Co-Primary Investigator for the randomized ROBUST III trial, co-authoring its published one- and two-year results, and presenting longer-term results at urologic meetings. While that research involves non-gender-affirming stricture disease, it reflects the depth of his experience evaluating and reconstructing the urethra.
