Outcomes Following Metoidioplasty and Phalloplasty Gender Affirming Surgery With Urethral Lengthening: A Modified...

To generate surgeon consensus on metoidioplasty and phalloplasty gender-affirming surgery outcomes statements using a modified Delphi method.

We invited metoidioplasty and phalloplasty gender-affirming surgery surgeons to anonymously participate in a two-round web-based Delphi survey to generate consensus on patient centered outcome statements generated from surgeon practice patterns, literature review, and patient input. Consensus was predefined as at least 70% agreement. Surgeons were asked to provide open ended feedback on statements which were thematically analyzed and used to revise statements not reaching consensus for a second-round survey.

Twenty-one metoidioplasty and phalloplasty surgeons were invited and 16 (76%) reviewed 39 statements in round one and 17/20 (85%) reviewed 10 statements in round two. Following round two, nearly all statements reached consensus: 14/15 (93%) of statements on metoidioplasty, 11/12 (92%) of radial forearm phalloplasty statements and 12/12 (100%) of anterolateral thigh phalloplasty statements. We found that 12/12 (100%) statements on sexual health, 8/8 (100%) statements on nonurinary complications, and 16/18 (89%) statements on urinary outcomes met consensus.

In a modified web-based Delphi survey, surgeons reached consensus on nearly all outcome statements. Variations in surgeon experience, length of follow up, and reporting of outcomes contribute to different definitions of urinary complications. Results from this study will help create decision making tools for individuals considering metoidioplasty and phalloplasty.