In 1996, metaidoioplasty was introduced as an alternative to phalloplasty in female-to-male transsexuals. To assess the long-term outcome in 70 consecutive patients (mean follow-up 8 years), we established the characteristics of postoperative events and additional surgical procedures. Metaidoioplasty and primary or secondary scrotoplasty was uneventful in 8 patients. In the other patients, postoperative events included immediate postoperative complications (n = 23), urethral fistulas (n = 26) or strictures (n = 25), or loss (n = 22) or dislocation (n = 34) of testicular prostheses. An average of 2.6 surgical procedures per patient was needed to complete genital confirmation and cope with all events. Additional phalloplasty was performed or scheduled in 17 patients. We conclude that genital reassignment by metaidoioplasty cannot usually be completed in 1 step and that phalloplasty is feasible subsequent to metaidoioplasty. We still consider metaidoioplasty to be a method of choice in selected patients.

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In our hands, neourethral stenosis is the main complication following metaidoioplasty in female-to-male transsexuals. We introduce the use of surplus of minor labial skin to correct these stenoses. The surplus was used as a subcutaneously pedicled flap with a 1.5 x 3.5 cm skin paddle to correct the circumferential deficit of neourethral lining at the level of the stenosis. After minimum undermining, the pedicle was retracted laterally to allow for a median external urethrotomy. The skin paddle was turned outside in to fit the resulting longitudinal neourethral defect. Subsequently, the major labial subcutis and skin were approximated in layers to cover the subcutaneous pedicled flap and to close the labioscrotum in the midline. Patients were kept immobilized for 3 days, and a suprapubic catheter was left open for 7 days. This technique was applied successfully in 15 of the 70 female-to-male transsexuals who consequently underwent metaidoioplasty in Amsterdam up to March of 1999. We conclude that the surplus of labial skin ought to be retained during primary surgery because it is an ideal substitute to correct neourethral stenosis.

The sensibility of the dominant hand was compared with that of the non-dominant hand using Semmes-Weinstein monofilaments in each of 22 bilateral palmar sites in 50 healthy volunteers. No difference in sensibility was found in 51% of all 2,200 tested palmar sites. Statistically significant superior sensibility was found in the non-dominant hand at 34% of all sites, whereas the dominant side showed superior sensibility in the remaining 15%.

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