Complications of metoidioplasty
Bordás Noémi dr.1,2, Stojanovic Borko dr.2, Bizic Marta dr.2,
Szántó Árpád dr.3, Djordjevic Miroslav dr.2,4
1Kiskunhalasi Semmelweis Kórház, a Szegedi Tudományegyetem Oktatókórháza,
Urológia Osztály, Kiskunhalas (osztályvezető: Molnár Sándor dr.)
2Belgrade Center for Genital Reconstructive Surgery, Belgrád, Szerbia (igazgató: Djordjevic Miroslav dr.)
3Pécsi Tudományegyetem KK, Urológiai Klinika, Pécs (igazgató: Szántó Árpád dr.)
4Icahn School of Medicine at Mount Sinai, New York, NY, USA
Objectives: Types of masculinizing genital reconstruction in gender dysphoria are metoidioplasty and total phalloplasty. After metoidioplasty a small sized neophallus can be created which enables voiding in standing position but inadequate for penetrative sexual intercourse. Advantages of the method can be the single stage, cost effective surgical alternative with shorter rehabilitation time and less scars. Aim of the study is to demonstrate the complications of metoidioplasty.
Materials and methods: Between February 2006 and April 2020 813 trans men (mean age: 24,4 years, range: 18-58 years) were operated. Belgrade type metoidioplasty was performed in all cases with urethral lengthening, vaginectomy (colpocleisis), perineo-scrotoplasty and implantation of testicular implants. In 657 cases hysterectomy and bilateral salpingo-oophorectomy was done before, and in 156 patients it was performed simultaneously with metoidioplasty. In 755 cases bilateral mastectomy was done before, and in 58 patients it was performed simultaneously with metoidioplasty. In 46 patients all above mentioned procedures were done with metoidioplasty at the same stage. Electronic postoperative questionnaires of quality of life and satisfaction were sent.
Results: Mean follow up was 94 months (range from 16 to 180 months). Mean operative time was 170 minutes and mean hospitalization was 3 days. Mean size of neophallus was 5.6 cm (range 4.8-10.2 cm). Success rate was 89%. Urethral stricture occurred in 8.85%, urethral stricture in 1.7%, testicular implant rejection in 2%, implant displacement in 3.2%, vaginal remnant in 9.6%. 655 patients filled in the postoperative questionnaires. 79% were totally satisfied, 20% were mainly satisfied with the results. All patients are able to void in standing position, have intact erogenous sensation of neophallus without the ability of penetration.
Conclusion: Metoidioplasty can be a good alternative of total phalloplasty in selected patients. The most challenging part of the procedure is the urethral reconstruction. Centralized health care is advised to minimize complications and maximize success rates. Total phalloplasty can be performed after metoidioplasty in case of patients’ interest.