“…Another series of retrospective ring metoidioplasty outcomes demonstrated an incidence of 13% (n=7) of urethrocutaneous fistula and a stricture rate of 8% (n=4) in a 51 patient cohort (17). Among these, one urethrocutaneous fistula resolved spontaneously wherein eight remaining patients underwent fistula repair and/or urethroplasty (20).…”
Section: Metoidioplastymentioning
confidence: 99%
“…Several metoidioplasty techniques have been described (5,(17)(18)(19)(20)(21). At our center, most patients undergo a modified Belgrade-style metoidioplasty with urethral lengthening (17,18).…”
Section: Metoidioplastymentioning
confidence: 99%
“…As an alternative to metoidioplasty with graft urethroplasty, surgeons may reconstruct the urethra utilizing the epithelium of the bilateral inner labia which are tubularized to create the ventral and dorsal urethra ("ring metoidioplasty") (19,20). Modifications to the ring metoidioplasty have been described to avoid use of vaginal flaps and decrease urethral complications (21).…”
Transgender and non-binary (TGNB) individuals are seeking penile reconstruction in greater numbers; many pursue urethral lengthening surgery with a goal of voiding while standing. Changes in urinary function and urologic complications-i.e., urethrocutaneous fistulae and urinary stricture-are common. Familiarity with presenting symptoms and management strategies for urinary complaints after genital gender-affirming surgery (GGAS) can improve patient counseling and outcomes. We will describe current gender-affirming penile construction options with urethral lengthening and review associated urinary complications that present as urinary incontinence. The incidence and impact of lower urinary tract symptoms after metoidioplasty and phalloplasty are poorly characterized due to limited post-operative follow-up. Post-phalloplasty, urethrocutaneous fistula is the most common urethral complication, ranging in incidence from 15-70%. Assessment of concomitant urethral stricture is necessary. No standard technique exists for management of these fistula or strictures. Metoidioplasty studies report lower rates of stricture and fistula, 2% and 9% respectively. Other common voiding complaints include dribbling, urethral diverticula and vaginal remnants. History and physical exam in the post-GGAS evaluation require understanding of prior surgeries and attempted reconstructive efforts; adjuncts to physical exam include uroflowmetry, retrograde urethrography, voiding cysto-urethrogram, cystoscopy, and MRI. Following gender-affirming penile construction, TGNB patients may experience a host of urinary symptoms and complications that impact quality of life. Due to anatomic differences, symptoms require tailored evaluation which can be done by urologists in an affirming environment.
“…Another series of retrospective ring metoidioplasty outcomes demonstrated an incidence of 13% (n=7) of urethrocutaneous fistula and a stricture rate of 8% (n=4) in a 51 patient cohort (17). Among these, one urethrocutaneous fistula resolved spontaneously wherein eight remaining patients underwent fistula repair and/or urethroplasty (20).…”
Section: Metoidioplastymentioning
confidence: 99%
“…Several metoidioplasty techniques have been described (5,(17)(18)(19)(20)(21). At our center, most patients undergo a modified Belgrade-style metoidioplasty with urethral lengthening (17,18).…”
Section: Metoidioplastymentioning
confidence: 99%
“…As an alternative to metoidioplasty with graft urethroplasty, surgeons may reconstruct the urethra utilizing the epithelium of the bilateral inner labia which are tubularized to create the ventral and dorsal urethra ("ring metoidioplasty") (19,20). Modifications to the ring metoidioplasty have been described to avoid use of vaginal flaps and decrease urethral complications (21).…”
Transgender and non-binary (TGNB) individuals are seeking penile reconstruction in greater numbers; many pursue urethral lengthening surgery with a goal of voiding while standing. Changes in urinary function and urologic complications-i.e., urethrocutaneous fistulae and urinary stricture-are common. Familiarity with presenting symptoms and management strategies for urinary complaints after genital gender-affirming surgery (GGAS) can improve patient counseling and outcomes. We will describe current gender-affirming penile construction options with urethral lengthening and review associated urinary complications that present as urinary incontinence. The incidence and impact of lower urinary tract symptoms after metoidioplasty and phalloplasty are poorly characterized due to limited post-operative follow-up. Post-phalloplasty, urethrocutaneous fistula is the most common urethral complication, ranging in incidence from 15-70%. Assessment of concomitant urethral stricture is necessary. No standard technique exists for management of these fistula or strictures. Metoidioplasty studies report lower rates of stricture and fistula, 2% and 9% respectively. Other common voiding complaints include dribbling, urethral diverticula and vaginal remnants. History and physical exam in the post-GGAS evaluation require understanding of prior surgeries and attempted reconstructive efforts; adjuncts to physical exam include uroflowmetry, retrograde urethrography, voiding cysto-urethrogram, cystoscopy, and MRI. Following gender-affirming penile construction, TGNB patients may experience a host of urinary symptoms and complications that impact quality of life. Due to anatomic differences, symptoms require tailored evaluation which can be done by urologists in an affirming environment.
“…While this can be performed at the time of metoidioplasty, performing monsplasty at a separate setting (before or after metoidioplasty) may avoid disruption of penile and scrotal vasculature/lymphatics and avoid excessive tension on the penis at the time of index metoidioplasty. 8,13…”
Section: Metoidioplastymentioning
confidence: 99%
“…In addition to extending the urethra onto the penile urethra, it is necessary to overcome a 4-6 cm gap created by releasing the ventral chordee. Techniques for urethral lengthening include combined tissue transfer (with a buccal mucosa graft and a labia minora flap) 7 or creating the entire urethra from bilateral labia minora “ring flaps” 8-10 (Figure 1). Figure 1.Urethral lengthening during metoidioplasty.…”
Genital gender affirming surgery is an effective treatment for gender dysphoria in transgender individuals. Optimization of medical and mental health conditions, including coordination with a patient’s entire care team, is essential. Feminizing procedures include vaginoplasty (creation of female genitalia with a vaginal canal) and vulvoplasty (creation of female genitalia with a short or absent vaginal canal). Masculinizing procedures include metoidioplasty (construction of male genitals via local tissue rearrangement) and phalloplasty (creation of a phallus from extra-genital tissue). We aim to provide an overview of genital gender affirming surgery for providers who are interested in learning more about genital gender affirming surgery.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
