V07-05 GENDER-AFFIRMING METOIDIOPLASTY

Abstract

You have accessJournal of UrologyLower-Tract Reconstruction II: ED/Infertility & Transgender Surgery (V07)1 Apr 2020V07-05 GENDER-AFFIRMING METOIDIOPLASTY Geolani Dy*, Miroslav Djordjevic, Kamran Sajadi, and Daniel Dugi Geolani Dy*Geolani Dy* More articles by this author , Miroslav DjordjevicMiroslav Djordjevic More articles by this author , Kamran SajadiKamran Sajadi More articles by this author , and Daniel DugiDaniel Dugi More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000897.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Metoidioplasty involves release of clitoral attachments and local flap mobilization to create a small neophallus. Often combined with urethral lengthening, scrotoplasty and vaginectomy, this procedure may serve individuals who desire masculine-appearing genitalia and potential to stand to urinate while avoiding morbidity of an extra-genital flap-based phalloplasty. We describe our surgical approach and considerations for metoidioplasty. METHODS: Our metoidioplasty technique follows the Belgrade approach, utilizing overlapping labia minora flaps for ventral urethral reconstruction. Vaginectomy involves excision of all vaginal mucosa and colpocleisis, preserving an anterior vaginal wall flap for urethroplasty. After clitoral degloving, release of the suspensory ligament provides phallic length. Division of the urethral plate further detethers the phallus but leaves a dorsal urethral defect, to be reconstructed with a buccal mucosa or genital skin graft. The anterior vaginal wall flap is sutured to a labia minora flap to form the ventral urethra. Creation of a 16-French urethra and neomeatus precludes lengthening to the glans tip, but may produce a lower urethral complication rate in the long-term compared with more narrow reconstructions. The contralateral labia minora flap is used for ventral coverage of neophallus. Dorsal shaft skin reconstruction may be required. Two scrotoplasty options are described: the Belgrade technique, incorporating testicular implants during metoidioplasty; and the Ghent technique, our preferred approach, which involves supero-medial rotation of labia majora skin flaps to create an anterior scrotum. Perineorrhaphy creates a flat perineum. A second stage scrotoplasty with testicular implants V-Y scrotal advancement is offered 3 months later. RESULTS: The patient depicted in our video underwent metoidioplasty with urethral lengthening via buccal mucosa graft with ventral labia minora flap onlay, vaginectomy and first stage scrotoplasty. He had an improvement in phallic shaft length from 7 to 9.5 cm. There were no intraoperative or post-operative complications at 3 months follow-up. The patient is able to stand to void. CONCLUSIONS: Metoidioplasty is a gender affirming operation that offers preservation of erogenous sensation and potential to stand to void via a small neophallus. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e644-e644 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Geolani Dy* More articles by this author Miroslav Djordjevic More articles by this author Kamran Sajadi More articles by this author Daniel Dugi More articles by this author Expand All Advertisement PDF downloadLoading ...