Metoidioplasty is the formation of genital tissue into a penis. It can be performed alone or in conjunction with other lower surgeries, including a hysterectomy, vaginectomy, or urethroplasty.
The results of metoidioplasty can be good or bad, depending on the goals of the procedure and the body structure of the person who is having it done. For many trans people, it is a great option for gender confirmation surgery.
Contents
Length of the Neophallus
The length of the neophallus after metoidioplasty varies depending on the technique used. The Belgrade technique, with or without urethral lengthening, can result in a shorter neophallus, which may be desirable to a patient who does not want to have a long neophallus.
Patients with a short neophallus, however, should be aware that they will need to undergo a urethroplasty. Complications such as urethral stricture and fistula can affect both the short and long term recovery.
Alternatively, some men opt to have a phalloplasty. In this procedure, large skin flaps are taken from other parts of the body to create a penis.
This is an option that has a high complication rate and can be difficult to manage. It is also not as erection-preserving as metoidioplasty.
Length of the Urethra
Metoidioplasty involves reconstruction of the urethra from the bulbar part up to the tip of the neophallus by joining well-vascularized vaginal flap with the proximal part of the urethral plate. Careful dissection is needed to prevent injury of the spongy tissue.
Urethral lengthening is done in a few different ways to make the urethra longer. One way is to use a skin graft from the inside of your cheek called a buccal graft and then suture it onto the back (dorsal) wall of the urethra.
Another way is to use the labial tissue that normally makes up the urethra to build it up as well. This way, the urethra is made longer while still keeping it connected to its blood supply and allowing it to heal better.
While metoidioplasty is a successful surgical procedure, it does have some complications. Some of the most common ones include fistulas and strictures. However, the majority of patients report high satisfaction with their results.
Sensitivity of the Neophallus
If you decide to have metoidioplasty, your neophallus should be long enough to provide you with good erogenous sensation, which is important for full penetration and orgasm. The length of the neophallus should also be long enough to allow you to stand up while urinating, but not so long that your neophallus will stay buried in excessive fat tissue.
The sensitivity of the neophallus after metoidioplasty varies from patient to patient, but most patients report that their neophallus has good orgasm potential and erogenous sensation. Some people have reported problems with arousal and masturbation after metoidioplasty, but these issues are usually attributed to other factors.
Complications associated with metoidioplasty include urethral retention, persistent bladder spasms and urethral diverticula. These complications occur in about 6% of cases and are usually treated non-operatively or with surgery.
Urination While Standing Up
After metoidioplasty, patients can urinate while standing up. This is possible even in obese patients as the neophallus is longer and stays in place.
The urethra may be extended through a urethral catheter that is placed in the bladder to keep it open and extend it. This is done in a procedure called metoidioplasty with urethral extension.
A urethral fistula (hole in the urethra) is a possible complication after metoidioplasty and is reported after 7-15% of cases. A urethral stricture (a narrowing of the urethra) can also occur in up to 2-3% of cases.
Hematuria (leakage of blood) is also a common occurrence after metoidioplasty. This is typically expected to last for about three months postop and can be red-wine like in appearance. It is a sign of old blood liquefying within the urethra. If it persists, it may be time to have a cystoscopy.