Abstract
Aim: 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. Methods: This is a retrospective, single surgeon chart review of all patients undergoing metoidioplasty from 2010 to 2020. Demographics, outcomes, and complications are reported. A self-reported patient questionnaire provided data on patient-perceived urologic outcomes. Results: Ninety-one patients were included in the study, with 80 (87.9%) patients reporting ability to stand and void with a strong stream. We observed five strictures (5.5%) and one fistula (1%). Scrotoplasty with tissue expanders and testicular implants were performed in 75 (82.4%) patients, while monsplasty was performed in 54 (59%) patients. Conclusion: Our technique has a low complication rate and patients report a strong urinary stream and the ability to stand in the large majority of cases. Ancillary masculinizing procedures are common. The limitations of metoidioplasty, in general, still persist, which are the small phallus size and variable ability to clear the zipper without lowering the pants to void.
Highlights
IntroductionThe surgical treatment of gender dysphoria related to genital anatomy for transmasculine patients is largely achieved via phalloplasty or metoidioplasty
The limitations of metoidioplasty, in general, still persist, which are the small phallus size and variable ability to clear the zipper without lowering the pants to void
The surgical treatment of gender dysphoria related to genital anatomy for transmasculine patients is largely achieved via phalloplasty or metoidioplasty
Summary
The surgical treatment of gender dysphoria related to genital anatomy for transmasculine patients is largely achieved via phalloplasty or metoidioplasty. Both techniques offer masculine anatomy and the potential to urinate while standing. Metoidioplasty aims at masculinizing the genitalia by making the hypertrophied clitoris appear as a penis and may include urethral lengthening and scrotoplasty. While there are several variations, most published reports of this technique describe the release of the urethral plate and dorsal suspensory ligaments of the clitoris to facilitate lengthening[1,2,3,4]. The defect created by dividing the urethral plate is typically grafted with either vaginal or buccal mucosa, and possibly buttressed with local flaps. Anterior vaginal wall flaps harvested during vaginectomy may be utilized for construction of the proximal portion of the pars fixa[5]
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