Metoidioplasty -- clinical practice and literature review



Szu-Hsien Wu, M.D.
Division of Plastic and Reconstructive Surgery, Department of Surgery, Taipei Veterans General Hospital
Department of Surgery, School of Medicine, National Yang Ming Chiao Tung University

Metoidioplasty, one of the female-to-male sex reassignment surgeries, is technically simpler than phalloplasty, costs less, and has fewer potential complications. However, phalloplasty patients are far more likely to be capable of sexual penetration (mainly due to size constraints) after they recover from surgery. In a phalloplasty, the surgeon fabricates a neopenis by grafting tissue from a donor site and a phalloplasty takes about 8–10 hours to complete. Metoidioplasty typically requires only 3–4 hours to complete and presents a good option for creating a male genitalia by straightening and lengthening a hormonally enlarged clitoris.
Urethral reconstruction based on flap technique achieved good outcome with voiding while standing and with minimal complications. Results in clitoral lengthening confirm the importance of the technique based on postoperative reports describing excellent sensation, erection, and good psychosexual features.
The clinical results after metoidioplasty are discussed and the literatures were reviewed. According to literature data, urethral fistula and stricture are reported in 7–15% and 2–3% of cases, respectively. Revision surgery includes excision of fistula with appropriate covering or stricture repair either by direct anastomosis or urethral dilatation. The main disadvantage of metoidioplasty is that the length of the neophallus is usually inadequate for penetrative sexual intercourse.



Key word: metoidioplasty, female-to-male, transsexualism, gender-affirming surgery, sex reassignment surgery