Metoidioplasty as a Single Stage Sex Reassignment Surgery in Female Transsexuals: Belgrade Experience

Abstract

Introduction Metoidioplasty represents one of the variants of phalloplasty in female transsexuals. Its main characteristic is that it is a one-stage procedure. It involves lengthening and straightening of hypertrophied clitoris to create a neophallus, urethral lengthening to enable voiding while standing, and scrotal reconstruction with insertion of testicle prostheses. Aim Our aim is to describe our technique and highlight its advantages. Methods Between September 2002 and April 2007, 82 female transsexuals, aged 18–54 years (mean age 31) underwent one-stage metoidioplasty. Clitoris is lengthened and straightened by division of clitoral ligaments and short urethral plate. Urethroplasty is done with combined buccal mucosa graft and genital skin flaps. Scrotum is created from labia majora in which two testicle prostheses are inserted. Simultaneously, female genitalia are removed. Main Outcome Measures Patients’ personal satisfaction about sensitivity and length of neophallus, possibility to void in standing position, real length of reconstructed urethra as well as complication rate comparing to other published data. Results The median follow-up was 32 months (range 14–69). The mean neophallic length was 5.7 cm (range 4–10). Voiding in standing position was reported in all patients, while dribbling and spraying were noticed in 23 cases and solved spontaneously. There were two urethral strictures and seven fistulas that required secondary minor revision. All patients reported preserved sensation and normal postoperative erection. Testicle prostheses rejection was not observed in any of the patients. Conclusions Metoidioplasty is a single-stage and time-saving procedure. It could be an alternative to total phalloplasty in female transsexuals who do not wish to have sexual intercourse. Also, it represents a first step in cases where additional augmentation phalloplasty is required.

A Systematic Review of Metoidioplasty and Radial Forearm Flap Phalloplasty in Female-to-male Transgender Genital Reconstruction: Is the “Ideal” Neophallus an Achievable Goal?

“…Seven articles related to metoidioplasty 13,14,16–20 and 11 articles related to RFFP 11,15,21–29 met inclusion criteria for subsequent analysis. One article related to metoidioplasty 17 included patients who were subsequently incorporated into an additional study carried out with more patients and a lengthier follow-up period.…”

“…10,12,13,18 Metoidioplasty is advantageous for its capacity to yield “like-with-like” glans reconstruction with tactile and erogenous clitoral tissue, sufficient erectile rigidity without a prosthesis, scarring that is limited to the perineum, and shorter operative times. 5,12,13,20,31 The metoidioplasty-constructed neophallus is often shorter and smaller compared with other techniques; as a result, functional limitations can include difficulty with standing micturition and sexual penetration. 12–14,32 Though sometimes touted as a single-stage procedure, a series by Hage and van Turnhout 17 found that, on average, 2.6 procedures were required before a metoidioplasty reconstruction was considered complete.…”

The Role of Clitoral Anatomy in Female to Male Sex Reassignment Surgery

“…The main goals are straightening and lengthening of the clitoris, as well as reconstruction of the urethra. Clear understanding of the female genital anatomy and sexuality is necessary for a successful outcome [15]. …”

Oral mucosa grafts for urethral reconstruction

“…[47] Buccal mucosa is currently also employed in several reconstructive procedures, including glans recovering, vaginoplasty, ureteric reconstruction, metoidioplasty and repair of stenotic catheterizable continent stoma. [48,49] Mungadi and Ugboko: Oral mucosa grafts for urethral reconstruction to be in color**********…”