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CC BY-NC-ND 4.0 · Indian J Plast Surg 2022; 55(02): 156-161
DOI: 10.1055/s-0041-1740081
Review Article

Metoidioplasty in Gender Affirmation: A Review

Borko Stojanovic
1   Department of Urology, Belgrade Center for Urogenital Reconstructive Surgery, School of Medicine, University of Belgrade, Belgrade, Serbia
,
Marko Bencic
1   Department of Urology, Belgrade Center for Urogenital Reconstructive Surgery, School of Medicine, University of Belgrade, Belgrade, Serbia
,
Marta Bizic
1   Department of Urology, Belgrade Center for Urogenital Reconstructive Surgery, School of Medicine, University of Belgrade, Belgrade, Serbia
,
Miroslav L. Djordjevic
1   Department of Urology, Belgrade Center for Urogenital Reconstructive Surgery, School of Medicine, University of Belgrade, Belgrade, Serbia
› Institutsangaben Funding This work is supported by the Ministry of Science and Technical Development, Republic of Serbia, Project No. 175048.
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Abstract

Metoidioplasty is a variant of the gender affirmation technique neophalloplasty, where a hormonally enlarged clitoris is reconstructed to become a small penis. The goals of metoidioplasty are male appearance of the genitalia, voiding in standing position, and completely preserved erogenous sensation of the neophallus. However, it does not enable penetrative sexual intercourse due to the small dimensions of the neophallus. Basic principles of metoidioplasty were established 50 years ago, and many refinements of the technique have been reported since. The latest improvements are based on the advances in urethroplasty, perioperative care, and new insights into female genital anatomy. The current metoidioplasty technique is a one-stage procedure that includes vaginectomy, straightening and lengthening of the clitoris, urethral reconstruction by combined flaps and grafts, and scrotoplasty with insertion of testicular implants. Good aesthetic, functional, and psychosexual outcomes are achieved with this type of neophalloplasty.

Keywords

transman - metoidioplasty - clitoris - urethroplasty - gender affirmation - neophalloplasty


Publikationsverlauf

Artikel online veröffentlicht:
24. Juni 2022

© 2022. Association of Plastic Surgeons of India. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 Frey JD, Poudrier G, Chiodo MV, Hazen A. An update on genital reconstruction options for the female-to-male transgender patient: a review of the literature. Plast Reconstr Surg 2017; 139 (03) 728-737
    CrossrefPubMedGoogle Scholar
  • 2 Bizic MR, Stojanovic B, Djordjevic ML. Genital reconstruction for the transgendered individual. J Pediatr Urol 2017; 13 (05) 446-452
    CrossrefPubMedGoogle Scholar
  • 3 Djordjevic ML. Novel surgical techniques in female to male gender confirming surgery. Transl Androl Urol 2018; 7 (04) 628-638
    CrossrefPubMedGoogle Scholar
  • 4 Durfee R, Rowland W. Penile substitution with clitoral enlargement and urethral transfer. In: Laub DR, Gandy P, eds. Paper presented at: Proceedings of the Second Interdisciplinary Symposium on Gender Dysphoria Syndrome; 1973; Palo Alto, CA
    Google Scholar
  • 5 Laub DR, Eicher W, Laub II DR, Hentz VR. Penis construction in female-to-male transsexuals. In: Eicher W, Kubli F, Herms V. eds. Plastic Surgery in the Sexually Handicapped. Berlin: Springer; 1989: 113-28
    Google Scholar
  • 6 Eicher W. Surgical treatment of female-to-male transsexuals. In: Eicher W, Kubli F, Herms V. eds. Plastic Surgery in the Sexually Handicapped. Berlin: Springer; 1989: 106-12
    Google Scholar
  • 7 Bowers ML, Stojanovic B, Bizic M. Female-to-male gender affirmation metoidioplasty. In: Salgado CJ, Monstrey SJ, Djordjevic ML. eds. Gender Affirmation: Medical and Surgical Perspectives. New York: Thieme Medical Publishers Inc; 2017: 109-18
    Google Scholar
  • 8 Takamatsu A, Harashina T. Labial ring flap: a new flap for metaidoioplasty in female-to-male transsexuals. J Plast Reconstr Aesthet Surg 2009; 62 (03) 318-325
    CrossrefPubMedGoogle Scholar
  • 9 Djordjevic ML, Majstorovic M, Stanojevic D. et al. Combined buccal mucosa graft and dorsal penile skin flap for repair of severe hypospadias. Urology 2008; 71 (05) 821-825
    CrossrefPubMedGoogle Scholar
  • 10 Djordjevic ML, Stojanovic B, Bizic M. Metoidioplasty: techniques and outcomes. Transl Androl Urol 2019; 8 (03) 248-253
    CrossrefPubMedGoogle Scholar
  • 11 Djordjevic ML, Stojanovic B. Metoidioplasty. In: Tran TA, Panthaki ZJ, Hoballah JJ, Thaller SR. eds. Operative Dictations in Plastic and Reconstructive Surgery. Cham, Switzerland: Springer International Publishing AG; 2017: 573-7
    Google Scholar
  • 12 Markiewicz MR, Lukose MA, Margarone III JE, Barbagli G, Miller KS, Chuang SK. The oral mucosa graft: a systematic review. J Urol 2007; 178 (02) 387-394
    CrossrefPubMedGoogle Scholar
  • 13 Stojanovic B, Bizic M, Djordjevic ML. Urethral reconstruction in female to male gender affirming surgery. In: Martins F, Kulkarni S, Tobias R. eds. Textbook of Male Genitourethral Reconstruction. Cham, Switzerland: Springer International Publishing AG; 2020: 883-96
    Google Scholar
  • 14 Bouman FG. The first step in phalloplasty in female transsexuals. (Letter) Plast Reconstr Surg 1987; 79 (04) 662-664
    CrossrefPubMedGoogle Scholar
  • 15 Hage JJ, van Turnhout AA. Long-term outcome of metaidoioplasty in 70 female-to-male transsexuals. Ann Plast Surg 2006; 57 (03) 312-316
    CrossrefPubMedGoogle Scholar
  • 16 Perovic SV, Djordjevic ML. Metoidioplasty: a variant of phalloplasty in female transsexuals. BJU Int 2003; 92 (09) 981-985
    CrossrefPubMedGoogle Scholar
  • 17 Hage JJ. Metaidoioplasty: an alternative phalloplasty technique in transsexuals. Plast Reconstr Surg 1996; 97 (01) 161-167
    CrossrefPubMedGoogle Scholar
  • 18 Djordjevic ML, Bizic M, Stanojevic D. et al. Urethral lengthening in metoidioplasty (female-to-male sex reassignment surgery) by combined buccal mucosa graft and labia minora flap. Urology 2009; 74 (02) 349-353
    CrossrefPubMedGoogle Scholar
  • 19 Djordjevic ML, Stanojevic D, Bizic M. et al. Metoidioplasty as a single stage sex reassignment surgery in female transsexuals: Belgrade experience. J Sex Med 2009; 6 (05) 1306-1313
    CrossrefPubMedGoogle Scholar
  • 20 Djordjevic ML, Bizic MR. Comparison of two different methods for urethral lengthening in female to male (metoidioplasty) surgery. J Sex Med 2013; 10 (05) 1431-1438
    CrossrefPubMedGoogle Scholar
  • 21 Vukadinovic V, Stojanovic B, Majstorovic M, Milosevic A. The role of clitoral anatomy in female to male sex reassignment surgery. ScientificWorldJournal 2014; 2014: 437378
    CrossrefPubMedGoogle Scholar
  • 22 Stojanovic B, Djordjevic ML. Anatomy of the clitoris and its impact on neophalloplasty (metoidioplasty) in female transgenders. Clin Anat 2015; 28 (03) 368-375
    CrossrefPubMedGoogle Scholar
  • 23 Stojanovic B, Bizic M, Bencic M. et al. One-stage gender-confirmation surgery as a viable surgical procedure for female-to-male transsexuals. J Sex Med 2017; 14 (05) 741-746
    CrossrefPubMedGoogle Scholar
  • 24 Jolly D, Wu CA, Boskey ER, Taghinia AH, Diamond DA, Ganor O. Is clitoral release another term for metoidioplasty? A systematic review and meta-analysis of metoidioplasty surgical technique and outcomes. Sex Med 2021; 9 (01) 100294
    CrossrefPubMedGoogle Scholar
  • 25 Bizic MR, Stojanovic B, Joksic I, Djordjevic ML. Metoidioplasty. Urol Clin North Am 2019; 46 (04) 555-566
    CrossrefPubMedGoogle Scholar