Metoidioplasty With Urethral Lengthening: A Stepwise Approach

Area of Science:

• Gender-affirming surgery
• Urology
• Plastic surgery

Background:

• Metoidioplasty is a gender-affirming surgery offering masculine genitalia with preserved sensation.
• Concurrent urethral lengthening allows standing to urinate, enhancing patient satisfaction.
• Phalloplasty is an alternative but carries higher morbidity.

Discussion:

• The modified Belgrade technique involves specific flap reconstructions using buccal mucosa and vaginal wall.
• Testosterone therapy is crucial for maximizing clitoral growth prior to surgery.
• The procedure includes neoscrotum creation using the Ghent technique.

Key Insights:

• The modified Belgrade technique for metoidioplasty with urethral lengthening was successfully adapted.
• The procedure resulted in a low rate of urethral complications, with no fistulae observed.
• Postoperative complications were generally minor (Clavien-Dindo grade I-II).

Outlook:

• Further research can explore long-term outcomes and patient-reported satisfaction.
• Refinements in surgical techniques may further reduce complication rates.
• This adapted technique offers a viable option for gender-affirming genital reconstruction.