Wikipedia

Metoidioplasty

Metoidioplasty,metaoidioplasty,ormetaidoioplasty[2](informally called ametoormeta) is afemale-to-male gender-affirming surgery.[3]

Example of completed metoidioplasty including neourethra and scrotoplasty, two years post-operation[1]

Testosterone replacement therapygradually enlarges theclitoristo a mean maximum size of 4.6 cm (1.8 in)[4](as the clitoris and thepenisare developmentallyhomologous). In a metoidioplasty, theurethral plateandurethraare completely dissected from the clitoral corporeal bodies, then divided at the distal (far) end, and the testosterone-enlarged clitoris straightened out and elongated. A longitudinal vascularized island flap is configured and harvested from the dorsal skin of the clitoris, reversed to the ventral side, tubularized and ananastomosis(connection) is formed with the native urethra. The new urethral meatus is placed along the neophallus (newly formed penis) to the distal end and the skin of the neophallus andscrotumreconstructed usinglabia minoraandmajoraflaps.[5]The new neophallus ranges in size from 4–10 cm (1.6–3.9 in) (with an average of 5.7 cm (2.2 in)) and has the approximate girth of a human adult thumb.[6]

The term derives frommeta-"change",Ancient Greekαἰδοῖον,aidoion,'genitals', and-plasty,denoting surgical construction or modification.[2]

Operation

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Metoidioplasty procedure (via 'Belgrade technique'). A) Preoperative appearance (hormonallyenlarged clitoris). B) Cutting ofligaments that suspend the clitoristo elongate it. C) Division ofurethral platewith gap filled withvaginal mucosagraft D) Combining the vascularized labial tissue with the formed urethra to form final structure.

Alternative techniques

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Recent studies have introduced an operative technique known asextensive metoidioplasty.This method extensively detaches the clitoris, nearly completely detaching it from thepubic archbefore its reattachment and elongation. Current studies show this method yielding penile lengths of 6 to 12 centimeters (2.4 to 4.7 in), with 7 out of 10 patients able to obtain erections that are capable ofpenetrative intercourse.[7]

Complications

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Complicationsfrom metoidioplasty vary in severity. Minor complications may be resolved through minor supportive care, while more serious complications may require surgical correction. Like other surgical procedures, each metoidioplasty procedure comes with the possibility of complications such as pain, infection, bleeding,blood clots,and damage to surrounding tissues. There is also a risk of adverse reactions toanesthesiaor other medications that are required for the procedure or post-operative period.

If urethral lengthening is performed, urethral complications such as urinaryfistulamay occur.[8]Patients who experience postvoidincontinenceor dribbling following surgery report their symptoms as resolved within three months.[9]

Satisfaction rates among patients who undergo metoidioplasty are generally very high regarding both appearance and sexual satisfaction.[9][10]

Comparison with phalloplasty

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Metoidioplasty is technically simpler thanphalloplasty,more affordable, and has fewer potential complications. However, phalloplasty patients are far more likely to be capable ofsexual penetration(mainly due to size constraints) after they recover from surgery.[11]

In a phalloplasty, aplastic surgeonfabricates a neopenis byautograftingtissue from a donor site (such as from the patient's back, arm or leg). A phalloplasty takes about 8–10 hours to complete (the first stage), and is generally followed by multiple (up to three) additional surgical procedures including glansplasty,scrotoplasty,testicular prosthesis,and/orpenile implantation.

Metoidioplasty typically requires 2–3 hours to complete. Because the clitoris'erectile tissuefunctions normally, a prosthesis is unnecessary for erection (although the clitoris might not become as rigid as apenile erection). In nearly all cases, metoidioplasty patients can continue to haveclitoral orgasmsafter surgery.

Note also, that the two alternative techniques are not mutually exclusive and phalloplasty extension of a metioidiplasic base neophallus is possible.[12]

History

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The first metoidioplasty was reported in 1973 and the term was coined in a 1989 paper.[13][14]

See also

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References

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  1. ^Bordas N, Stojanovic B, Bizic M, Szanto A, Djordjevic ML (2021-10-13)."Metoidioplasty: Surgical Options and Outcomes in 813 Cases".Frontiers in Endocrinology.12:760284.doi:10.3389/fendo.2021.760284.PMC8548780.PMID34721306.
  2. ^abHage JJ (January 1996). "Metaidoioplasty: an alternative phalloplasty technique in transsexuals".Plastic and Reconstructive Surgery.97(1): 161–167.doi:10.1097/00006534-199601000-00026.PMID8532774.S2CID38412526.
  3. ^Perovic SV, Djordjevic ML (December 2003). "Metoidioplasty: a variant of phalloplasty in female transsexuals".BJU International.92(9): 981–5.doi:10.1111/j.1464-410x.2003.04524.x.PMID14632860.S2CID11836091.
  4. ^Meyer WJ, Webb A, Stuart CA, Finkelstein JW, Lawrence B, Walker PA (April 1986). "Physical and hormonal evaluation of transsexual patients: a longitudinal study".Archives of Sexual Behavior.15(2): 121–38.doi:10.1007/BF01542220.PMID3013122.S2CID42786642.
  5. ^Perovic, S. and Djordjevic, M. (2003), Metoidioplasty: a variant of phalloplasty in female transsexuals. BJU International, 92: 981-985. doi:10.1111/j.1464-410X.2003.04524.x
  6. ^Djordjevic ML, Stanojevic D, Bizic M, Kojovic V, Majstorovic M, Vujovic S, Milosevic A, Korac G, Perovic SV (May 2009). "Metoidioplasty as a single stage sex reassignment surgery in female transsexuals: Belgrade experience".The Journal of Sexual Medicine.6(5): 1306–13.doi:10.1111/j.1743-6109.2008.01065.x.PMID19175859.
  7. ^Cohanzad S (February 2016). "Extensive Metoidioplasty as a Technique Capable of Creating a Compatible Analogue to a Natural Penis in Female Transsexuals".Aesthetic Plastic Surgery.40(1): 130–8.doi:10.1007/s00266-015-0607-4.PMID26744289.S2CID40551674.
  8. ^"Metoidioplasty Risks and Complications: Is Metoidioplasty Really Worth It?".Trans Media Network.
  9. ^abVukadinovic V, Stojanovic B, Majstorovic M, Milosevic A (2014)."The role of clitoral anatomy in female to male sex reassignment surgery".TheScientificWorldJournal.2014:437378.doi:10.1155/2014/437378.PMC4005052.PMID24982953.
  10. ^De Cuypere G, TSjoen G, Beerten R, Selvaggi G, De Sutter P, Hoebeke P, et al. (December 2005). "Sexual and physical health after sex reassignment surgery".Archives of Sexual Behavior.34(6): 679–90.doi:10.1007/s10508-005-7926-5.PMID16362252.S2CID42916543.
  11. ^Frey JD, Poudrier G, Chiodo MV, Hazen A (December 2016)."A Systematic Review of Metoidioplasty and Radial Forearm Flap Phalloplasty in Female-to-male Transgender Genital Reconstruction: Is the" Ideal "Neophallus an Achievable Goal?".Plastic and Reconstructive Surgery. Global Open.4(12): e1131.doi:10.1097/GOX.0000000000001131.PMC5222645.PMID28293500.
  12. ^Al-Tamimi M, Pigot GL, van der Sluis WB, van de Grift TC, van Moorselaar RJ, Mullender MG, et al. (November 2019). "The Surgical Techniques and Outcomes of Secondary Phalloplasty After Metoidioplasty in Transgender Men: An International, Multi-Center Case Series".The Journal of Sexual Medicine.16(11): 1849–1859.doi:10.1016/j.jsxm.2019.07.027.PMID31542350.S2CID202731384.
  13. ^Bordas, Noemi; Stojanovic, Borko; Bizic, Marta; Szanto, Arpad; Djordjevic, Miroslav L. (2021)."Metoidioplasty: Surgical Options and Outcomes in 813 Cases".Frontiers in Endocrinology.12:760284.doi:10.3389/fendo.2021.760284.PMC8548780.PMID34721306.
  14. ^Hage, Joris J. (1996). "Metaidoioplasty: An Alternative Phalloplasty Technique in Transsexuals".Plastic and Reconstructive Surgery.97(1): 161–167.doi:10.1097/00006534-199601000-00026.PMID8532774.S2CID38412526.

Further reading

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  • Greenwald D, Stadelmann W (July 2001). "Gender reassignment".EMedicine Journal.2(7).
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