Urethral Lengthening in Metoidioplasty (Female-to-male Sex Reassignment Surgery) by Combined Buccal Mucosa Graft and Labia Minora Flap

Djordjević, Miroslav L.; Bizic, M.; Stanojević, D.; Bumbaširević, Marko; Kojović, V.; Majstorovic, M.; Acimovic, M.; Pandey, Sanjay; Perović, Sava V.

doi:10.1016/j.urology.2009.02.036

Cited by 56 publications

(45 citation statements)

References 8 publications

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“…Perovic and Djordjevic () published the results of metoidioplasty in 22 patients, with a mean follow‐up of 3.9 years, during which three urethral fistulas and two strictures were encountered. Therefore, a continual challenge in the search for new and better solutions resulted in many modifications of this original technique with the aim of changing the feminine appearance of the external genitalia to a more masculine morphology and of allowing voiding while standing (Djordjevic et al, ,b).…”

Section: Neophalloplastymentioning

confidence: 99%

“…The testicle implants can be dislocated upwards or downwards. The surgical repair always consists of repositioning the implant and its fixation into the proper place, together with the creation of a new capsule (Djordjevic et al, ,b; Djordjevic, 2013).…”

Section: Neophalloplastymentioning

confidence: 99%

“…Durfee and Rowland () were the first to report surgical penile substitution using the clitoris in female transsexuals. The techniques have been refined since then, with Laub et al () defining this surgical transformation as metoidioplasty, derived from the Greek words “meta”—“toward” and “oidion”—“male genitalia.” Recently, Djordjevic et al (,(b) reported their original technique of neophalloplasty/metoidioplasty, based on the repair of most severe forms of hypospadias.…”

Section: Introductionmentioning

confidence: 99%

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Anatomy of the clitoris and its impact on neophalloplasty (metoidioplasty) in female transgenders

Stojanovic

Djordjević

2015

Clinical Anatomy

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The current management of female to male transgender surgery is based on the advances in neophalloplasty, perioperative care and the knowledge of the female genital anatomy, as well as the changes that occur to this anatomy with preoperative hormonal changes in transgender population. Since the clitoris plays the main role in female sexual satisfaction, its impact on the outcome in female to male transgender surgery is predictable. Although female genital anatomy was poorly described in majority of anatomical textbooks, recent studies have provided a better insight in important details such as neurovascular supply, ligaments, body configuration, and relationship with urethral/vaginal complex. This article aims to review current state of knowledge of the clitoral anatomy as well its impact on clitoral reconstruction in female to male sex reassignment surgery.

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Section: Neophalloplastymentioning

confidence: 99%

Section: Neophalloplastymentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Anatomy of the clitoris and its impact on neophalloplasty (metoidioplasty) in female transgenders

Stojanovic

Djordjević

2015

Clinical Anatomy

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“…Metoidioplasty represents a valid option for changing the genital appearance in FtM transsexuals. Different techniques have been described for successful metoidioplasty by several authors, all of which attempting to create a microphallus with lengthening of the urethra to the tip of the hypertrophied and released clitoris (also called “clitoris penoid” or “clitpen”).…”

Section: Discussionmentioning

confidence: 99%

Pedicled superficial inferior epigastric artery perforator flap for salvage of failed metoidioplasty in female‐to‐male transsexuals

2014

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Metoidioplasty represents a viable option for female-to-male transsexual patients seeking gender reassignment surgery. The aim of this procedure is to create a microphallus with lengthening of the urethra to the tip of the hypertrophied and released clitoris. However, fistula formation and urethral obstruction might occur in the long term and reconstruction represents a challenging problem in this setting. In this report, we present the tubed superficial inferior epigastric artery perforator island flap as an option for urethral reconstruction after failed metoidioplasty in a female-to-male transsexual patient. In a 26-year-old transsexual patient a combination of urethral fistula, urethral stenosis, and disintegrated distal neourethra had developed as a consequence of postoperative hematoma formation. Metoidioplasty was reconstructed by means of a tubed, pedicled superficial inferior epigastric artery perforator flap from the left lower abdomen. The long-term result was stable with pleasing genital appearance, adequate functional outcome, and satisfactory donor site morbidity. In our opinion, this procedure may represent a viable alternative for urethral reconstruction in thin patients.

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“…partially lost.VAN DER SLUIS ET AL. | 919 when this was not (entirely) possible, covered with a split-thickness skin graft.The scrotoplasy with creation of the fixed part of the urethra was constructed according to the technique described bySelvaggi et al (2009) The pars fixa urethral lengthening was achieved by tubularization of the infundibular tissue in between the labia minora over a 18 French (FR) foley catheter(Djordjevic et al, 2009). The clitoris was denuded and one dorsal clitoral nerve was dissected.…”

mentioning

confidence: 99%

Double flap phalloplasty in transgender men: Surgical technique and outcome of pedicled anterolateral thigh flap phalloplasty combined with radial forearm free flap urethral reconstruction

et al. 2017

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IntroductionRadial forearm free flap (RFFF) tube‐in‐tube phalloplasty is the most performed phalloplasty technique worldwide. The conspicuous donor‐site scar is a drawback for some transgender men. In search for techniques with less conspicuous donor‐sites, we performed a series of one‐stage pedicled anterolateral thigh flap (ALT) phalloplasties combined with RFFF urethral reconstruction. In this study, we aim to describe this technique and assess its surgical outcome in a series of transgender men.Patients and MethodsBetween January 2008 and December 2015, nineteen transgender men (median age 37, range 21–57) underwent pedicled ALT phalloplasty combined with RFFF urethral reconstruction in one stage. The surgical procedure was described. Patient demographics, surgical characteristics, intra‐ and postoperative complications, hospitalization length, and reoperations were recorded.ResultsThe size of the ALT flaps ranged from 12 × 12 to 15 × 13 cm, the size of the RFFFs from 14 × 3 to 17 × 3 cm. Median clinical follow‐up was 35 months (range 3–95). Total RFFF failure occurred in two patients, total ALT flap failure in one patient, and partial necrosis of the ALT flap in one patient. Long‐term urinary complications occurred in 10 (53%) patients, of which 9 concerned urethral strictures.ConclusionsIn experienced hands, one‐stage pedicled ALT phalloplasty combined with RFFF urethral reconstruction is a feasible alternative surgical option in eligible transgender men, who desire a less conspicuous forearm scar. Possible drawbacks comprise flap‐related complications, difficult inner flap monitoring and urethral complications.

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Urethral Lengthening in Metoidioplasty (Female-to-male Sex Reassignment Surgery) by Combined Buccal Mucosa Graft and Labia Minora Flap

Cited by 56 publications

References 8 publications

Anatomy of the clitoris and its impact on neophalloplasty (metoidioplasty) in female transgenders

Anatomy of the clitoris and its impact on neophalloplasty (metoidioplasty) in female transgenders

Pedicled superficial inferior epigastric artery perforator flap for salvage of failed metoidioplasty in female‐to‐male transsexuals

Double flap phalloplasty in transgender men: Surgical technique and outcome of pedicled anterolateral thigh flap phalloplasty combined with radial forearm free flap urethral reconstruction

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