Step by Step Metoidioplasty

C. Giraldo, J. Belinky, L. Ramil, L. Zamitto, M, C. Fentini

Phalloplasty, Metoidioplasty, Functionality

Introduction: Current female-to-male gender reassignment surgery requires the creation of a neophallus, either by phalloplasty or metoidioplasty. Although attractive for its resemblance to a native penis, total phalloplasty presents a technically complex multi-step procedure with a wide range of potential complications, mainly due to the requirement of extragenital tissue. In contrast, the metoidioplasty involves the creation of a neophallus from a hormonal enlarged clitoris. This allows for a one-step surgery, granting acceptable outcomes in terms of aesthetics, standing urination, and erogenous sensation, while exhibiting minimal complications. Nonetheless, metoidioplasty poses the disadvantage of an inadequate length to enable vaginal penetration, although it can be used as a first stage for a future total phalloplasty.

Objectives: In the following video, we aim to describe a step by step guide of the technique of metoidioplasty, as performed in our institutio

Methods: This video presents a single case of metoidioplasty performed on a 27-year-old transgender male patient with no significant medical history. The patient had been receiving crossed hormonal therapy for 5 years and had previously undergone an abdominal hysterectomy with bilateral salpingo-oophorectomy and bilateral mastectomy. The surgery was performed using the metoidioplasty and augmentation urethroplasty technique.

Results: Total surgery time was 3.5 hours. A neophallic length of 6.5 cm was achieved. Due to limited labia minora tissue, part of the neophallus was reconstructed using the right labia minora, while the left side was used to create the neourethra, resulting in a mildly hypospadic configuration. No immediate complications occurred, and the patient was discharged after 4 days. The urethral catheter was maintained for 3 weeks, and testicular prostheses were placed 6 months post-op. At 8 months, the patient reported no complications and full satisfaction with functional and sexual outcomes.

Conclusions: Metoidioplasty has proven to be a safe and feasible alternative for female-to-male transgender patients who desire an aesthetically acceptable neophallus, voiding while

standing, and preservation of clitoral sensation without undergoing the multiple surgical steps and risks of a phalloplasty. This procedure however, does not enable vaginal penetration and patients should be informed in advance.

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