Metoidioplasty: a variant of phalloplasty in female transsexuals
Article first published online: 24 NOV 2003
Volume 92, Issue 9, pages 981–985, December 2003
How to Cite
Perovic, S.V. and Djordjevic, M.L. (2003), Metoidioplasty: a variant of phalloplasty in female transsexuals. BJU International, 92: 981–985. doi: 10.1111/j.1464-410X.2003.04524.x
- Issue published online: 24 NOV 2003
- Article first published online: 24 NOV 2003
- Accepted for publication 28 March 2003
To describe metoidioplasty, a technique for creating a neophallus from an enlarged clitoris in female transsexuals, without needing the complex, multi-staged surgical construction of a large phallus, as this reconstruction is one of the most difficult in female transsexuals.
PATIENTS AND METHODS
From September 1995 to April 2002 metoidioplasty was used in 22 patients (aged 18–33 years). The technique is based on the repair of the most severe form of hypospadias and intersex. The ‘urethral plate’ and urethra are completely dissected from the clitoral corporeal bodies, then divided at the level of the glanular corona, and the clitoris straightened and lengthened. A longitudinal vascularized island flap is designed and harvested from the dorsal skin of the clitoris, transposed to the ventral side, tubularized and anastomosed with the native urethra. The new urethral meatus is brought to the top of the neophallus, and the skin of the neophallus and scrotum reconstructed using labia minora and majora flaps.
The mean (range) follow-up was 3.9 (0.5–6) years; the neophallus was 5.7 (4–10) cm, considered satisfactory in 17 patients but the remaining five required additional phalloplasty. The complications were urethral stenosis in two and fistula in three patients.
Metoidioplasty is an alternative to phalloplasty, allowing voiding while standing. In patients who desire a larger phallus, various techniques of phalloplasty can also be used.