Optimization of Second-stage Metoidioplasty.

Area of Science:

• Genital reconstructive surgery
• Gender-affirming care

Background:

• Metoidioplasty is a genital gender-affirmation surgery using natal tissues.
• A second stage is often required for optimizing phallus length, placing prostheses, and managing complications.
• Details of second-stage procedures are not widely documented.

Purpose of the Study:

• To describe a planned two-stage metoidioplasty procedure.
• To detail the common surgical steps, complications, and outcomes of second-stage metoidioplasty.

Main Methods:

• Retrospective chart review of patients undergoing metoidioplasty between August 2015 and June 2020.
• Analysis of patients who underwent a second-stage metoidioplasty, recording procedures, complications, and demographics.
• Procedures performed by four surgeons across two practice locations.

Main Results:

• Out of 75 metoidioplasty patients, 37 (49%) had a second stage.
• Common procedures included upper scrotal blocking tissue reduction (84%), escutcheonectomy/penile lift (81%), and bilateral implant placement (54%).
• Major complications occurred in 16% of patients, with 15% requiring a redo second-stage procedure.

Conclusions:

• Second-stage metoidioplasties are frequently performed to enhance phallic lengthening and repair complications.
• Key procedures include escutcheonectomy, scrotal implant placement, chordee repair, and scrotal tissue reduction.
• This stage is crucial for optimizing surgical outcomes in metoidioplasty patients.