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Surgical Anatomy: Metoidioplasty

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Urological Care for the Transgender Patient

Abstract

Neophalloplasty remains one of the most challenging issues in transgender male gender affirmation surgery. Metoidioplasty is a variant of phalloplasty for transgender male patients wherein a hormonally enlarged clitoris is used to create a small neophallus. Since the clitoris plays the main role in female sexual satisfaction, its impact on the outcome in gender affirmation surgery is evident. Successful surgical outcome of metoidioplasty is based on the new evidence on clitoral anatomy. Recent studies have provided new insight in the anatomy of the clitoris, its vascular supply and innervation, as well as its relations with urethra and vagina. The latest refinements in metoidioplasty technique are based on the new facts on female genital anatomy, as well as advances in urethroplasty and perioperative care. A few metoidioplasty techniques are described, depending on the extent of surgical reconstruction. The simple metoidioplasty results in small neophallus but without the ability to stand to urinate. Metoidioplasty with urethral lengthening includes various methods to elongate the urethral plate and the proximal urethra. Belgrade metoidioplasty includes simultaneous removal of vagina, the creation of a neophallus from the clitoris, and the reconstruction of the urethra and scrotum, with testicular prostheses implantation, in a one-stage surgery. The main goals include male appearance of genitalia, voiding in standing position and preserved sexual arousal. The main disadvantage of metoidioplasty is that the length of the neophallus is inadequate to allow vaginal penetration. Still, preserved sensation of the neophallus guarantees a satisfying functional and psychosexual quality of life for these patients. The objective of this chapter is to assess the current state of knowledge of the female genital anatomy and its impact on metoidioplasty techniques and outcomes.

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Acknowledgments

This work is supported by the Ministry of Science and Technical Development, Republic of Serbia, Project No. 175048.

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Authors and Affiliations

  1. Belgrade Center for Urogenital Reconstructive Surgery, School of Medicine, University of Belgrade, Belgrade, Serbia

    Borko Stojanovic, Marta Bizic & Miroslav L. Djordjevic

Authors
  1. Borko Stojanovic
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  2. Marta Bizic
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  3. Miroslav L. Djordjevic
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Correspondence to Borko Stojanovic .

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Editors and Affiliations

  1. Urology Department, SUNY Upstate Medical University, Syracuse, NY, USA

    Dmitriy Nikolavsky

  2. Urology Department, SUNY Upstate Medical University, Syracuse, NY, USA

    Stephen A. Blakely

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Stojanovic, B., Bizic, M., Djordjevic, M.L. (2021). Surgical Anatomy: Metoidioplasty. In: Nikolavsky, D., Blakely, S.A. (eds) Urological Care for the Transgender Patient. Springer, Cham. https://doi.org/10.1007/978-3-030-18533-6_9

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  • DOI: https://doi.org/10.1007/978-3-030-18533-6_9

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-18532-9

  • Online ISBN: 978-3-030-18533-6

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