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Metoidioplasty Risks and Complications

Is Metoidioplasty Really Worth It?

While all surgeries come with risks, the importance of educating patients about Metoidioplasty risks and complications can't be overemphasized. Despite the technically challenging nature of Metoidioplasty, studies reveal a high rate of satisfaction among patients.

Metoidioplasty Satisfaction Rates
Metoidioplasty Satisfaction Rates
Source: The Role of Clitoral Anatomy in Female to Male Sex Reassignment Surgery

What to Keep in Mind

There are some important things to keep in mind when considering Metoidioplasty risks and complications:

  • Different methods of Metoidioplasty have different levels of complexity and risks;
  • Complication rates between surgeons are usually different;
  • Complication rates published in journals tend to be more accurate than those that are self-stated by surgeons.

General Risks of Surgery include: Infection, bleeding, blood clots, damage to surrounding tissues, pain, negative reactions to anesthesia or other medication.

Common (and Not So Common) Metoidioplasty Complications

  • Urethral complications
  • Wound breakdown
  • Pelvic bleeding or pain
  • Bladder or rectal injury
  • Loss of sensation
  • Prolonged need for drainage
  • Dissatisfaction with the size or shape of the penis
  • Inability to stand-to-pee
  • Need for revisions

Early On-Set Complications

Urethral complications are fairly common with Metoidioplasty when urethral lengthening is performed. Urinary fistula is an opening in the urethra that causes urine leakage. While there aren't enough studies to offer precise estimates of the risk of fistula, a recent review suggested that up to 16% of patients will experience a fistula.

Postvoid incontinence or dribbling occurs in about 17.53% of Metoidioplasty patients according to this study. These spontaneously resolved within 3 months after surgery in all cases.

Other potential urinary complications in the early days following surgery can also include partial or total death of the tissue used to create the new urethra, a clogged catheter, bladder spasms and urinary tract infections (UTIs).

Wound infections can present as cellulitis, fungal infection or both. Antibiotics and antifungal cream are usually sufficient for treatment.

Wound breakdown commonly occurs at points where multiple incisions meet. Most wound breakdown complications can be treated with local wound care.

Hematomas can occur and are usually managed by drains, though some may require surgical drainage.

Bladder and rectal injury are rare but serious complications. Inadvertent injury to the bladder or rectal wall can occur during the Vaginectomy that is often performed during Metoidioplasty. Early detection is critical as the injury can be repaired during surgery. If not, the patient may develop symptoms of sepsis and require surgical intervention. In some cases, multiple surgieries over a period of many months are required to treat bladder and rectal fistulas.

Tissue necrosis, or tissue death, occurs when there is a lack of blood flow. Depending on the location and severity, a "wait-and-see" approach may be used, with repair occuring during a second revision surgery.

Long-term Complications

Urethral stricture is a narrowing or closure of the new urethra caused by scar tissue. Strictures typically develop 6-12 months post-operatively. Symptoms include a weak urine stream, difficulty urinating, or a complete inability to urinate.

Scars can stretch, become red and raised (hypertrophic), or grow beyond their original dimensions (keloid).

Risks Associated with Testicular Implants

Infection is the most common complication with implants. If an implant becomes infected, it typically has to be removed. Replacement can occur six months later.

Erosion is when the implant breaks through the skin. Surgical removal is required if this occurs.

Loss or displacement of testicular implants occurs at a rate of 2-30% according to this study and can increase the risk of urethral complications.

Metoidioplasty Satisfaction Rates

While the list of risks and potential complications with Metoidioplasty is daunting, several studies have revealed high satisfaction rates among trans men:

When complications are experienced, they can most often be managed by the original Metoidioplasty surgeon, or a Reconstructive Urologist or Plastic Surgeon experienced with Metoidioplasty complications and repair surgeries.


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