Optimization of Second-stage Metoidioplasty

Odeluga, Nkiruka; Reddy, Soumya; Safir, Michael H.; Crane, Curtis; Santucci, Richard A.

doi:10.1016/j.urology.2021.04.045

Cited by 3 publications

(4 citation statements)

References 17 publications

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“…Jolly et al [15] , Veerman et al [32] , 2020 LR 5 (62.5%) 4 (50%) 1 (12.5%) Vukadinovic et al [34] , Hysterectomy and bilateral salpingo-oophorectomy were performed in approximately 25% of the patients, and urethral lengthening was performed with a buccal mucosa graft and fasciocutaneous labial flaps in over 90% of patients. In an earlier report from 2009 by the same group using the same technique, urethral stricture and fistula rates were 2% and 9%, respectively [19] . Improved surgical technique and experience may be responsible for the decrease in complications.…”

Section: Urinary Complicationsmentioning

confidence: 86%

“…However, there are limited reports of estimated blood loss during metoidioplasty procedures. In their case series of 82 patients, Djordjevic et al reported no clinically significant postoperative bleeding [19] . Lin-Brande et al reported a median intraoperative blood loss of 400 mL (n = 21) in patients undergoing metoidioplasty with urethral lengthening and 75 mL (n = 12) in patients undergoing metoidioplasty without urethral lengthening [12] .…”

Section: Bleeding Complicationsmentioning

confidence: 91%

“…Metoidioplasty may be performed by a variety of techniques which include simple metoidioplasty (no urethral lengthening), ring metoidioplasty, Belgrade metoidioplasty, and combinations/permutations thereof. These techniques typically employ some combination of labia minora flaps, vaginal flaps, and/or buccal mucosal grafts [13][14][15][16][17][18][19] . Metoidioplasty techniques historically involve the degloving of the clitoral shaft, release of the suspensory ligament of the clitoris (either completely or sub-totally), transection of the ventral chordae, and rearrangement of the skin of the labia minora and prepuce to construct the penile shaft.…”

Section: Metoidioplasty Techniquesmentioning

confidence: 99%

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A narrative review of outcomes following metoidioplasty: complications and satisfaction

Jahromi¹,

Spellman²,

Horen³

et al. 2022

Plast Aesthet Res

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Metoidioplasty consists of lengthening and straightening the hormonally hypertrophied clitoris. The goals of the procedure include masculinizing the external genitalia and enabling standing micturition. Metoidioplasty may be performed as a stand-alone procedure or an interval procedure prior to phalloplasty. While most often performed with urethral lengthening, metoidioplasty may also be performed as a “simple release” (i.e., without urethral lengthening). Secondary procedures typically include scrotoplasty and placement of testicular implants. While satisfaction with this procedure is high, complications can occur. Complications are commonly categorized as either urologic (i.e., strictures and fistula) or wound healing (i.e., wound disruption, infection, bleeding, etc.). This narrative review discusses postoperative outcomes, including both satisfaction and complications. Published data on complications include fistula and stricture rates from 0%-50% and 0%-63%, respectively. Overall satisfaction with appearance ranges from 48%-100%, and patient ability to void while standing ranges from 67%-100%. Metoidioplasty is a safe and effective procedure for transgender men. Further research regarding surgical techniques and outcomes will help reduce complications and improve overall patient satisfaction.

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Section: Urinary Complicationsmentioning

confidence: 86%

Section: Bleeding Complicationsmentioning

confidence: 91%

Section: Metoidioplasty Techniquesmentioning

confidence: 99%

See 1 more Smart Citation

A narrative review of outcomes following metoidioplasty: complications and satisfaction

Jahromi¹,

Spellman²,

Horen³

et al. 2022

Plast Aesthet Res

View full text Add to dashboard Cite

show abstract

“…In an attempt to better anticipate the need for surgical revision, some surgeons propose second stage metoidioplasty as an opportunity to repair urethral complications and to address aesthetic concerns, including placement of scrotal implants, repair chordee or phimosis (59). Despite surgical technique differences or modification to surgical interventions, surgeons are also investigating patientmodifiable risk factors.…”

Section: Metoidioplastymentioning

confidence: 99%

Urinary symptoms after genital gender-affirming penile construction, urethral lengthening and vaginectomy

Fascelli¹,

Sajadi²,

Dugi³

et al. 2023

Transl Androl Urol

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Transgender and non-binary (TGNB) individuals are seeking penile reconstruction in greater numbers; many pursue urethral lengthening surgery with a goal of voiding while standing. Changes in urinary function and urologic complications-i.e., urethrocutaneous fistulae and urinary stricture-are common. Familiarity with presenting symptoms and management strategies for urinary complaints after genital gender-affirming surgery (GGAS) can improve patient counseling and outcomes. We will describe current gender-affirming penile construction options with urethral lengthening and review associated urinary complications that present as urinary incontinence. The incidence and impact of lower urinary tract symptoms after metoidioplasty and phalloplasty are poorly characterized due to limited post-operative follow-up. Post-phalloplasty, urethrocutaneous fistula is the most common urethral complication, ranging in incidence from 15-70%. Assessment of concomitant urethral stricture is necessary. No standard technique exists for management of these fistula or strictures. Metoidioplasty studies report lower rates of stricture and fistula, 2% and 9% respectively. Other common voiding complaints include dribbling, urethral diverticula and vaginal remnants. History and physical exam in the post-GGAS evaluation require understanding of prior surgeries and attempted reconstructive efforts; adjuncts to physical exam include uroflowmetry, retrograde urethrography, voiding cysto-urethrogram, cystoscopy, and MRI. Following gender-affirming penile construction, TGNB patients may experience a host of urinary symptoms and complications that impact quality of life. Due to anatomic differences, symptoms require tailored evaluation which can be done by urologists in an affirming environment.

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Secondary phallic prosthesis placement in transgender patients postmetoidioplasty: a case report on technique and outcome

Claeys,

Weynants,

Jamaer

et al. 2023

Sexual Medicine

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Introduction Gender affirming surgery is common among transgender and gender-nonconforming individuals. Genital gender-affirming surgery is a form of surgery that involves transformation and reconstruction of the genitalia while maintaining urologic and sexual function. Masculinizing genital gender-affirming surgery can involve the removal of the female genital and reproductive organs and the creation of a more masculine appearance by using phalloplasty or metoidioplasty techniques. While metoidioplasty has advantages such as limited scarring and preserved genital sensation and clitoral erection, it may not always guarantee the ability to void while standing or even penetrate a sexual partner. Aim To describe our method of secondary phallic enhancement after metoidioplasty with a phallic prosthesis. Methods Our case is based on a 39-year-old transgender male who underwent metoidioplasty with vaginectomy, scrotoplasty, and urethral lengthening. However, the original surgery was complicated by extensive hematoma formation in the suprapubic area and neoscrotum, leading to a buried position of the neophallus. Subsequent surgery was performed to reduce the prepubic fat pad and penoscrotal interposition, but it too was complicated by hematoma formation and wound dehiscence. To maximize phallic elongation, the tethering urethra was removed, and perineal urethrostomy was performed but could not sufficiently alleviate the buried phallus. As a further step to improve the outcome, we proposed the implantation of a specific phallic prosthesis designed for metoidioplasty with testicular prosthesis placement. Surgery was performed as a single procedure through a penoscrotal incision and greatly enhanced genital appearance. Results Three months after surgery, the patient had good sensation of the phallus and was able to have satisfactory sexual activity with his partner. However, he remained dissatisfied with the amount of prepubic tissue and opted to undergo further liposuction. Conclusion Phallic prosthesis implantation can be a procedure to improve the condition of multioperated cases of metoidioplasty with resistant phallic burying. Reconstruction with a phallic prosthesis was performed successfully in this case. However, long-term complications and functional outcomes, such as the ability to void while standing or penetrate a sexual partner, remain uncertain. Further experience is needed to determine the efficacy and safety of using a phallic prosthesis as a secondary procedure in patients undergoing metoidioplasty.

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Optimization of Second-stage Metoidioplasty

Cited by 3 publications

References 17 publications

A narrative review of outcomes following metoidioplasty: complications and satisfaction

A narrative review of outcomes following metoidioplasty: complications and satisfaction

Urinary symptoms after genital gender-affirming penile construction, urethral lengthening and vaginectomy

Secondary phallic prosthesis placement in transgender patients postmetoidioplasty: a case report on technique and outcome

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