Metoidioplasty Journal Articles
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Metoidioplasty
NEW: Assessment of Neophallus Length Following
Metoidioplasty
Hannah Glick, Michael Tang, Stephanie Daignault-Newton, Miriam
Hadj-Moussa. Translational Andrology and Urology, Vol 12,
No 9. September 30, 2023.
Patients considering metoidioplasty often wonder how large their
neophallus will be. We found that patients can expect exposed
neophallus length to be about 0.6 cm longer than their
pre-operative stretched clitoral length. No evidence of
association of time on testosterone nor BMI with exposed
neophallus length was found.
A
Narrative Review of Outcomes Following Metoidioplasty:
Complications and Satisfaction. [FULL TEXT]
Alireza Hamidian Jahromi, Ari M. Spellman, Sydney Horen, Edward E.
Cherullo, Amir H. Dorafshar, Loren
S. Schechter. Plast Aesthet Res, Special Issue Gender
Confirmation Surgery: Risk Factors and Complications, June
2022;9:41.
While satisfaction with this procedure is high, complications can
occur. 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.
Technical Refinements to Extended Metoidioplasty
without Urethral Lengthening: Surgical Technique [FULL
TEXT]
Morrison, Shane D. MD, MS; Morris, Martin P. MBE; Mokken, Sterre
E. BSc; Buncamper, Marlon E. MD, PhD; Özer, Müjde MD. Plastic
and Reconstructive Surgery - Global Open: February 2022 -
Volume 10 - Issue 2 - p e4101.
The purpose of this article is to discuss refinements in
metoidioplasty to improve phallic length and utilize local adipose
tissue to add bulk to the scrotum and mimic testis.
Ring Flap Metoidioplasty
Alysen Demzik, Liem Snyder, Solomon Hayon, Mang
Chen, Bradley D. Figler. Urology, Volume 158,
December 2021, Page 243.
In a ring flap
metoidioplasty, the urethra is created from bilateral
anteriorly based labia minora and vestibular flaps. This technique
is combined with Ghent scrotoplasty,
vaginectomy
(distal mucosal excision and proximal mucosal fulguration followed
by cavity closure) and perineal masculinization. Suprapubic tube
is placed for urinary diversion. To avoid disrupting the
anteriorly based urethral pedicles, we do not perform monsplasty,
division of the suspensory ligament, or resection of the labial
folds adjacent to the penis at the time of ring flap
metoidioplasty. Typically, resection of labial folds adjacent to
the penis and testicular prosthesis insertion are performed 4-6
months after metoidioplasty.
Metoidioplasty: Surgical Options and Outcomes in
813 Cases [FULL TEXT]
Noemi Bordas, Borko Stojanovic, Marta Bizic, Arpad Szanto and
Miroslav L. Djordjevic. Front. Endocrinol., 13 October
2021.
Metoidioplasty has good cosmetic and functional outcomes, with low
complication rate and high level of patients' satisfaction. In
transmen who request total phalloplasty after metoidioplasty, all
available phalloplasty techniques are feasible.
Optimization
of Second-stage Metoidioplasty
Nkiruka Odeluga, Soumya A Reddy, Michael
H Safir, Curtis
N Crane, Richard
A. Santucci. Urology, June 2021.
Metoidioplasty generally requires a planned second-stage to place
testes prostheses, address complications, and perform additional
surgical steps to maximally lengthen the phallus. We found that
phallus length can be optimized in the second-stage by applying
surgical principles already established in the surgical treatment
of adult acquired buried penis. Escutcheonectomy/penile lift,
placement of scrotal implants, repair of chordee, and upper
scrotal blocking tissue reduction are procedures that are often
performed during a second-stage metoidioplasty.
A Systematic Review and Meta-Analysis of
Metoidioplasty Surgical Technique and Outcomes [FULL
TEXT]
Divya Jolly, MS Catherine A. Wu, BS Elizabeth R. Boskey, PhD, MPH
Amir H. Taghinia, MD David A. Diamond, MD Oren Ganor, MD. Sexual
Medicine, Vol 9, Issue 1, February, 2021.
A systematic review and meta-analysis of surgical techniques and
physician- and patient-reported outcomes of gender-affirming
clitoral release and metoidioplasty.
NEW: The Role of Androgens in Clitorophallus
Development and Possible Applications to Transgender Patients
[FULL TEXT]
Frances Grimstad, Elizabeth R. Boskey, Amir Taghinia, Carlos R.
Estrada, Oren Ganor. Andrology, Volume 9, Issue 6 (Special Issue:
Transgender Health), April 2021.
There is mixed evidence about the use of exogenous testosterone to
affect the size and function of the clitorophallus. Where people
desire changes to their clitorophallus to affirm their gender
identity, there are several options. Androgens can be used to
enlarge the clitorophallus. Surgical modifications can be used to
change both its size and function. Additional research is needed
to understand which if any post-pubertal hormonal therapies are
superior in achieving clitorophallus enlargement in transmasculine
individuals with minimal prior androgen exposure.
Metoidioplasty
using labial advancement flaps for urethroplasty [FULL
TEXT]
Toby R. Meltzer,
Nick O. Esmonde.
Plast Aesthet Res. 2020;7:61.10.20517/2347-9264.2020.122
A variation of the ring metoidioplasty has been performed for
masculinizing transgender surgery by the senior surgeon since
2010. It does not require buccal grafts or vaginal wall flaps. An
excisional vaginectomy was completed in all patients. We sought to
evaluate the urologic outcomes and complications for this
technique. Further, we provide a detailed technical description of
the technique, including ancillary masculinizing procedures.
Metoidioplasty
as a one-stage phallic reconstruction in transmen [FULL
TEXT]
Bizic M, Stojanovic B, Bencic M, Bordas N,
Djordjevic M. Plast Aesthet Res 2020;7:43.
This narrative review aims to evaluate all available techniques of
metoidioplasty and to report the postoperative results and
complications.
Masculinizing
genital gender-affirming surgery: metoidioplasty and urethral
lengthening.
Kocjancic E, Acar O, Talamini S, Schechter
L. Int J Impot Res. 2020 Mar 19.
A review of the literature regarding masculinizing
gender-affirming genital surgery in the form of metoidioplasty,
focusing on the steps related to urethral lengthening and
reconstruction, and describe the authors' preferred surgical
technique. Metoidioplasty can be offered to transgender men with
sufficiently hypertrophied clitoris who wish to avoid a
complicated, multistage, flap-based total phalloplasty, or for
those individuals considering phalloplasty at a later date.
A Systematic Review of Metoidioplasty and Radial
Forearm Flap Phalloplasty in Female-to-male Transgender Genital
Reconstruction: Is the Ideal Neophallus an Achievable Goal?
Frey, Jordan D. MD; Poudrier, Grace BA; Chiodo, Michael V. MD;
Hazen, Alexes MD. Plastic and Reconstructive Surgery, December
2016 - Volume 4 - Issue 12.
The complex anatomy and function of the native penis is difficult
to surgically replicate. Metoidioplasty and radial forearm flap
phalloplasty (RFFP) are the 2 most commonly utilized procedures
for transgender neophallus construction. Although the current
literature suggests that metoidioplasty is more likely to yield an
"ideal" neophallus compared with RFFP, any conclusion is severely
limited by the low quality of available evidence.
Penile
Improvement Protocol in Postoperative Management of Patients
Undergoing Metoidioplasty.
Cohanzad S. Aesthetic Plast Surg. 2016
Dec;40(6):947-953.
This study introduces a postoperative traction protocol to
optimize the final size of the penis in patients undergoing
metoidioplasty. Fourteen patients who had undergone metoidioplasty
entered a penile improvement protocol (PIP) using a penile
traction device. All patients achieved an increase in their penile
length with a mean of 28.42 mm (21-47 ± 6.86).
Extensive
Metoidioplasty as a Technique Capable of Creating a Compatible
Analogue to a Natural Penis in Female Transsexuals.
Cohanzad S., Aesthetic Plast Surg. 2016 Feb;40(1):130-8.
Postoperatively all ten patients achieved a mean penile length of
8.7 (6-12) cm and 7/10 (70 %) were capable of obtaining erection,
rigid enough for intromission. No significant postoperative
complications were observed. Metoidioplasty in association with
traction could result in a natural-looking, erotically fully
sensate and functional penis in majority of FTM transsexuals
undergoing this procedure.
The
Role of Clitoral Anatomy in Female to Male Sex Reassignment
Surgery [FULL TEXT]
Vojkan Vukadinovic, Borko Stojanovic, Marko Majstorovic, and
Aleksandar Milosevic.
The Scientific World Journal, Volume 2014 (2014), Article ID
437378, 7 pages
Accurate knowledge of the clitoral anatomy, relations, and
neurovascular supply is crucial for achieving a successful
outcome. Release of all anatomical layers of suspensory ligaments,
followed by precise dissection of short urethral plate, is
necessary for a complete straightening and lengthening of the
clitoris. Preservation of the neurovascular supply, as well as
dorsal aspect of the glans, is essential in maintaining sexual
function.
Comparison
of Two Different Methods for Urethral Lengthening in Female to
Male (Metoidioplasty) Surgery.
Djordjevic ML, Bizic MR. J Sex Med. 2013 Feb 27. doi:
10.1111/jsm.12108. Also see: Article Review
Metoidioplasty
as a single stage sex reassignment surgery in female
transsexuals: Belgrade experience.
Djordjevic ML, Stanojevic D, Bizic M, Kojovic V, Majstorovic M,
Vujovic S, Milosevic A, Korac G, Perovic SV. J Sex Med. 2009
May;6(5):1306-13. Epub 2009 Oct 27.
Metoidioplasty is a single-stage and time-saving procedure that
can be employed as an alternative to total phalloplasty in FTM
transsexuals, or as a first step in cases where additional
augmentation phalloplasty is required.
Labial
ring flap: a new flap for metaidoioplasty in female-to-male
transsexuals.
Takamatsu A, Harashina T. J Plast Reconstr Aesthet Surg. 2009
Mar;62(3):318-25. Epub 2009 Jan 24.
This new technique uses all the labia minora skin incorporated
with the anterior vaginal flap for urethral lengthening. The
clitoral chordee is also released by this procedure.
Long-term
outcome of metaidoioplasty in 70 female-to-male transsexuals.
Hage JJ, van Turnhout AA.Ann Plast Surg. 2006 Sep;57(3):312-6.
While metaidoioplasty is a method of choice in selected patients,
the procedure cannot usually be completed in one step.
Phalloplasty is feasible subsequent to metaidoioplasty.
FEATURED - Metoidioplasty: a variant of phalloplasty in
female transsexuals
S.V. Perovic, M.L. Djordjevic. BJU International, Volume 92,
Issue 9, pages 981-985, December 2003
Metoidioplasty is a technique for creating a neophallus from an
enlarged clitoris in female to male transsexuals.
FEATURED - Beginnings of Sex Reassignment Surgery in Japan
Takamatsu Ako, M.D., Harashina Takao, M.D., Inoue Yoshiharu, M.D.,
Kinoshita Katsuyuki, M.D., Ishihara Osamu, M.D., Uchijima Yutaka,
M.D., Department of Plastic and Reconstructive Surgery,
Gynecology, Urology, Saitama Medical Center, Saitama Medical
School, Japan. The International Journal of Transgenderism, Volume
5, Number 1, January - March 2001.
Metaidoioplasty:
an alternative phalloplasty technique in transsexuals.
Hage JJ. Plast Reconstr Surg. 1996 Jan;97(1):161-7.
Metaidoioplasty uses the clitoris, overdeveloped by hormonal
treatment, to construct a microphallus in a way comparable to the
correction of chordae and lengthening of urethra in cases of
severe hypospadias.
Vaginectomy
Outcomes
of Transperineal Gender-Affirming Vaginectomy and Colpocleisis.
Hougen HY, Dugi DD 3rd, Berli JU, Sajadi KP. Female Pelvic
Med Reconstr Surg. 2020 Mar 19.
This is a large series studying the outcomes of gender-affirming
vaginectomy by complete mucosal excision approach in the
literature. Perioperative complications were low: 2 blood
transfusions, 1 pelvic hematoma, and 1 C. diff. infection of the
colon. No urethral fistulae to the vaginal space, mucoceles, or
visceral injures were seen with a median follow-up of 7.7 months.
Operative time decreased overtime such that after approximately 20
cases, the procedure fairly consistently takes 2 to 2.5 hours to
perform.
Vaginal
Colpectomy in Transgender Men: A Retrospective Cohort Study on
Surgical Procedure and Outcomes.
Nikkels C, van Trotsenburg M, Huirne J, Bouman MB, de Leeuw R, van
Mello N, Ronkes B, Groenman F. J Sex Med. 2019
Jun;16(6):924-933.
Colpectomy, removal of the vaginal epithelium, may be performed in
transgender men because of a disturbed male self-image, to reduce
vaginal discharge, or to reduce the risk of fistula formation at
the urethral-neourethral junction in future phalloplasty or
metaidoioplasty. This single-center retrospective cohort study
included 143 transgender men who underwent vaginal colpectomy
between January 2006 and April 2018. Vaginal colpectomy is a
procedure with a high complication rate, but its advantages seem
to outweigh its disadvantages. In all but 1 case, no long-term
sequelae were reported. However, the high complication rate and
reintervention rate should be discussed with patients who are
considering undergoing this procedure.
Colpectomy Significantly Reduces the Risk of
Urethral Fistula Formation after Urethral Lengthening in
Transgender Men Undergoing Genital Gender Affirming Surgery.
Al-Tamimi, M., Pigot, G. L., van der Sluis, W. B., van de Grift,
T. C., Mullender, M. G., Groenman, F., & Bouman, M.-B. The
Journal of Urology, December 2018, olume 200, Issue 6,
Pages 1315–1322.
A total of 294 transgender men underwent gender affirming surgery
with urethral lengthening. A urethral fistula developed in 111 of
the 232 patients (48%) without colpectomy and in 13 of the 62
(21%) who underwent primary colpectomy (p <0.01). Secondary
colpectomy resulted in 100% fistula closure when performed in 17
patients with recurrent urethral fistula at the proximal urethral
anastomosis and the fixed part of the neourethra.
Gender-Affirming Vaginectomy And Colpocleisis
Helen Hougen, Kamran Sajadi. The Journal of Urology,
April 2018, Volume 199, Issue 4, Supplement, Page e1073.
Vaginectomy decreases the likelihood of retained mucocele and may
be safer than blind fulguration of the vagina, which is another
common practice. The companion video demonstrates the key steps in
this procedure as well as differences from a prolapse
colpocleisis.
Robot-assisted laparoscopic colpectomy in
female-to-male transgender patients; technique and outcomes of a
prospective cohort study [Full text]
Freek Groenman, Charlotte Nikkels, Judith Huirne, Mick van
Trotsenburg, Hans Trum
Surgical Endoscopy, August 2017, Volume 31, Issue 8, pp 3363–3369.
Study results show that [robot-assisted laparoscopic Vaginectomy]
combined with [robot-assisted laparoscopic Hysterectomy] is
feasible as a single-step surgical procedure in FtM transgender
surgery.
Laparoscopic
Vaginal-Assisted Hysterectomy With Complete Vaginectomy for
Female-To-Male Genital Reassignment Surgery.
Gomes da Costa A, Valentim-Lourenço A, Santos-Ribeiro S, Carvalho
Afonso M, Henriques A, Ribeirinho AL, Décio Ferreira J. J Minim
Invasive Gynecol. 2016 Mar-Apr;23(3):404-9.
This study suggests the feasibility of laparoscopic vaginectomy in
genital reassignment surgery. The procedure can be executed as a
continuation of the hysterectomy with the potential advantage of
the laparoscopy providing better exposure of the anatomic
structures with low blood losses (less than 500 mL) and few
complications. Furthermore, using this approach, adequate-sized
vaginal mucosa flaps were obtained for the urethral
reconstruction.
Outcome and Risk Factors for Vaginectomy in
Female to Male Transsexuals
M. Spilotros, DJ Ralph, N Christopher, Institute of Urology
London, presented at the World Meeting on Sexual Medicine. 2013.
This presentation includes reasons, treatment and results for
vaginectomy. Complications are few and easy to manage. The
severity of bleeding is directly related to vaginal length.
Patients report high satisfaction rates.
Colpocleisis:
a review.
FitzGerald MP, Richter HE, Siddique S, Thompson P, Zyczynski H;
Ann Weber. Int Urogynecol J Pelvic Floor Dysfunct. 2006
May;17(3):261-71. Epub 2005 Jun 28.
Summarizes published data about colpocleisis (in women) and to
highlight areas about which data are lacking.
Vaginectomy
and laparoscopically assisted vaginal hysterectomy as adjunctive
surgery for female-to-male transsexual reassignment: preliminary
report.
Ergeneli MH, Duran EH, Ozcan G, Erdogan M. Eur J Obstet Gynecol
Reprod Biol. 1999 Nov;87(1):35-7.
Urethroplasty
Urologic
Complications After Phalloplasty or Metoidioplasty.
Nikolavsky D,
Hughes M, Zhao LC. Clin Plast Surg. 2018
Jul;45(3):425-435.
In the past decade, issues facing transgender individuals have
come to the forefront of popular culture, political discourse, and
medical study. The evaluating physician should have knowledge of
the reconstructed anatomy, as well as potential postoperative
complications. This knowledge will aid in providing appropriate
care and recognizing issues that may require specialized urologic
care. Transgender anatomic definitions and a synopsis of common
urologic complications specific to transmen, including
urethrocutaneous fistulae, neourethral strictures, and persistent
vaginal cavities are discussed.
Pedicled
superficial inferior epigastric artery perforator flap for
salvage of failed metoidioplasty in female-to-male transsexuals.
Schmidt M., Grohmann M., Huemer GM. Microsurgery. 2014 Dec 2. doi:
10.1002/micr.22361. [Epub ahead of print]
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.
Urethral
Lengthening in metoidioplasty (female-to-male sex reassignment
surgery) by combined buccal mucosa graft and labia minora flap.
Djordjevic ML, Bizic M, Stanojevic D, Bumbasirevic M, Kojovic V,
Majstorovic M, Acimovic M, Pandey S, Perovic SV. Urology. 2009
Aug;74(2):349-53. Epub 2009 Jun 7.
Urethral lengthening is the most difficult part in female to male
transsexuals and poses many challenges. A combined buccal mucosa
graft and labia minora flap present a good choice for urethral
reconstruction with minimal postoperative complications.
Labial
ring flap: a new flap for metaidoioplasty in female-to-male
transsexuals [FULL TEXT]
A. Takamatsu, T. Harashina. JPRAS, Vol 63, Issue 3,
January 2009.
The labial ring flap technique was performed on 43 patients after
2005. This new technique uses all the labia minora skin
incorporated with the anterior vaginal flap for urethral
lengthening.
Saving
labium minus skin to treat possible urethral stenosis in
female-to-male transsexuals.
Hage JJ, van Turnhout AA, Dekker JJ, Karim RB. Ann Plast Surg.
2006 Apr;56(4):456-9.
Neourethral stenosis is the main complication following
metaidoioplasty in female-to-male transsexuals. We introduce the
use of surplus of minor labial skin to correct these stenoses.
Review
of the literature on construction of a neourethra in
female-to-male transsexuals.
Hage JJ, Bloem JJ. Ann Plast Surg. 1993 Mar;30(3):278-86.
A review of the literature on the construction of a pars pendulans
and a pars fixa urethrae in phalloplasty is given. The use of
local tissue for lengthening of the fixed part of the urethra can
be successful in case a vaginal flap is incorporated.
Scrotoplasty
Scrotal
Reconstruction in Transgender Men Undergoing Genital Gender
Affirming Surgery Without Urethral Lenghtening: A Stepwise
Approach
Pigot GL, Al-Tamimi M, van der Sluis WB, Ronkes B, Mullender MG,
Bouman MB.
A 29-year-old transgender men underwent scrotal reconstruction and
phalloplasty without urethral lengthening. For this purpose, the
traditional scrotal reconstruction technique in patients that
undergo urethral lengthening was modified. Scrotal reconstruction
using a horseshoe-shaped pedicled pubic flap, labia majora fat
pads, and 2 cranially pedicled U-shaped labia majora flaps results
in a neo-scrotum that resembles the biological scrotum closely in
terms of bulkiness, size, shape, tactile sensation, and anatomical
position.
Scrotal
reconstruction in female-to-male transsexuals: a novel
scrotoplasty.
Selvaggi G, Hoebeke P, Ceulemans P, Hamdi M, Van Landuyt K,
Blondeel P, De Cuypere G, Monstrey S
Plast Reconstr Surg. 2009 Jun;123(6):1710-8.
Testicular
Prostheses: Development and Modern Usage
D Bodiwala, DJ Summerton, and TR Terry. Ann R Coll Surg Engl. 2007
May; 89(4): 349–353.
Testicular prostheses produced from various materials have been in
use since 1941. The most common substance used around the world in
the manufacture of these implants is silicone; however, in the US,
this material is currently banned because of theoretical health
risks. This has led to the development of saline-filled prostheses
as an alternative. The long-term fears associated with silicone
implants, namely connective tissue or autoimmune diseases and
carcinogenesis, have not been substantiated. Longer-term
quality-of-life results are still pending.
Scrotal
construction by expansion of labia majora in biological female
transsexuals.
Sengezer M, Sadove RC. Ann Plast Surg. 1993 Oct;31(4):372-6.
In each patient, tissue expanders were inserted into the labia
majora several months before free flap phalloplasty. The
anatomical position of the labia majora produces a scrotum
properly located in relation to surrounding anatomical structures.
Excellent aesthetic results can be achieved with this procedure.
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Last updated: 09/15/23