Metoidioplasty: techniques and outcomes

Abstract

Phalloplasty represents the latest step in female-to-male transitioning and still remains a great challenge for transgender surgeons. Since we have two options in this transitioning-metoidioplasty and total phalloplasty-the transgender surgeon has to fully inform the individual about all aspects such as surgical steps, outcomes, advantages and disadvantages, possible complications, and expectations. Total phalloplasty with the creation of a neophallus of a similar volume to that in genetic males, is a complex and multi-staged procedure. Many different tissues (i.e., flaps) can be used, and the ideal procedure is still not established. In contrast to the above complexities involved in total phalloplasty, metoidioplasty presents a simple and one-stage procedure for the creation of a neophallus from a hormonally enlarged clitoris. This technique is very promising for individuals who desire gender-affirmation surgery without having to undergo the difficult and multistage creation of a male-sized neophallus. Also, this technique prevents scarring to the extragenital region, making the final results more acceptable for transgender individuals. Our goal is to objectively present the techniques for metoidioplasty and to define their value based on postoperative results.

Metoidioplasty as a one-stage phallic reconstruction in transmen

“…It results in male-like genitals, with a sensate small phallus, scrotum with or without testicular implants, and native urethral opening without the possibility of voiding while standing. The complication rate with simple metoidioplasty is rather small and acceptable by the patients and their surgeons (less than 5%) and is usually related to the skin (dehiscence, local infection, and rotation of the neophallus) [25,26] .…”

“…Additional straightening and lengthening are obtained by urethral plate dissection to correct ventral chordee [ Figure 2]. Urethroplasty is performed using all available hairless skin and/or mucosal grafts over the urethral stent size 12-14Fr so that standing micturition would be possible, and a suprapubic urinary catheter is introduced to the bladder for urine derivation [5,26,29,30] [ Figure 3A and B]. Scrotoplasty is performed by joining two labia minora flaps in the midline and inserting two silicone prostheses [ Figure 4].…”

“…Minor complications are usually managed conservatively (hematoma, skin infection, urinary tract infection, partial skin necrosis, and dribbling and spraying during voiding). Major complications are usually related to urethroplasty and include either urethral fistulae or stricture, problems with testicular implants (displacement and rejection), and persistent vaginal cavity; these require surgical repair [2,5,26,33,34] . In our latest study, we reported overall complications in 46.8% of our 793 patients.…”

“…Minor complications occurred in 17.7% and were solved conservatively and spontaneously, while 29.1% of our patients required surgical repair because of major complications [5] . The majority of patients undergoing metoidioplasty, up to 88% or more according to recent reports, are satisfied with the appearance of their genitals [5,9,26] . Voiding in standing position was possible for the vast majority of patients in recent studies, up to 93.2% (range 67.4%-100%).…”

Is Clitoral Release Another Term for Metoidioplasty? A Systematic Review and Meta-Analysis of Metoidioplasty Surgical Technique and Outcomes

“…Despite metoidioplasty and phalloplasty being performed on transgender men at roughly equal rates, 5 research has focused on outcomes and techniques of phalloplasty. 6 While metoidioplasty techniques have been described by many authors, 7,8 there has been no thorough evaluation of the aesthetic and functional outcomes of each surgical approach. This systematic review and meta-analysis of metoidioplasty and clitoral release techniques was designed to bring attention to the variety of options for masculinizing genital surgery beyond phalloplasty and to compare the outcomes of such procedures in greater detail than has been previously addressed in the literature.…”