MD University Children's Hospital, Faculty of Medicine, University of Belgrade
Introduction: Metoidioplasty represents a variant of phalloplasty for those transmen who require less invasive and one-stage genital affirmation surgery (GAS), which will provide male appearance of genitals with the ability of stand up voiding. Methods: From February 2006 until January 2022, 967 transmen underwent metoidioplasty with urethral reconstruction in our institution. Urethroplasty technique depended on patients’ anatomy and availability of hairless genital skin: tubularization urethroplasty (95 cases), onlay flap urethroplasty with dorsal clitoral skin flap (12 cases), onlay flap urethroplasty with labia minora (LM) skin flap (34 cases), buccal mucosa graft (BMG) with clitoral skin flap urethroplasty (83 cases), BMG with LM skin flap (676 cases) and LM skin graft with clitoral skin/LM skin flap urethroplasty (67 cases). Results: Follow-up ranged from 9 to 199 months (mean 102 months). During the follow-up period we monitored urethral complications and divided them into early and late. Early urethral complications occurred within a first month postoperatively in 131 patients (13.50 %) and included: UTI (7 cases), spraying (34 cases), dribbling (42 cases) and urethral fistula (82 cases). Late urethral complications were present after first postoperative month in 103 patients (10.65 %) and during the follow-up period and required further treatment and included: recurrent UTI (1 case), post void dribbling (10 cases), urethral fistula (87 cases), urethral stricture (17 cases), and inability to empty the bladder completely (2 cases). In our patients’ group between 1.76% and 2.79% had more than one early and between 1.03% and 1.24% had more than one late urethral complication. Regarding urethroplasty technique, complications mostly occurred in onlay flap urethroplasty with dorsal clitoral skin flap, while BMG with LM skin flap proved to be the most successful urethroplasty technique in our series. Conclusions: Metoidioplasty as a one-stage GAS is safe and viable and time-saving surgical approach that offers satisfactory functional outcomes with stand-up voiding in majority of transmen. SOURCE OF Funding: None
