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Schirmann A, Neuville P, Morel-Journel N, Madec FX. [Genital gender affirming surgery in trans men]. ANN CHIR PLAST ESTH 2023; 68:462-467. [PMID: 37635042 DOI: 10.1016/j.anplas.2023.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 08/03/2023] [Indexed: 08/29/2023]
Abstract
OBJECTIVE Genital surgery for masculinisation in the context of gender incongruence is characterised by the reconstruction of male genitalia using multiple surgical techniques - free flap phalloplasty, pedicled flap phalloplasty or metaoidioplasty - which this article aims to describe. MATERIAL AND METHODS A narrative review of the literature on these trans surgeries was carried out. RESULTS Each technique has specific advantages and disadvantages, and does not produce the same results in terms of surgical risks, size of the reconstructed phallus, sensitivity, sexual function and urinary function. CONCLUSION This surgical decision must therefore be shared with the person concerned, based on a clear understanding of their expectations and objectives. Long-term follow-up is recommended.
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Affiliation(s)
- A Schirmann
- Service d'urologie, hôpital Foch, 92150 Suresnes, France
| | - P Neuville
- Service d'urologie, CHU Lyon Sud, 69495 Pierre-Benite, France
| | - N Morel-Journel
- Service d'urologie, CHU Lyon Sud, 69495 Pierre-Benite, France
| | - F-X Madec
- Service d'urologie, hôpital Foch, 92150 Suresnes, France.
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Glick H, Tang M, Daignault-Newton S, Hadj-Moussa M. Assessment of neophallus length following metoidioplasty. Transl Androl Urol 2023; 12:1390-1396. [PMID: 37814700 PMCID: PMC10560337 DOI: 10.21037/tau-23-155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 08/03/2023] [Indexed: 10/11/2023] Open
Abstract
Background An increasing number of gender diverse individuals are presenting for gender affirming care. An option for genital gender affirming surgery (gGAS) in transmasculine individuals is metoidioplasty, creating a small neophallus from enlarged clitoral tissue following prolonged testosterone exposure. The goal of this study is to understand factors which contribute to greater exposed neophallus length following metoidioplasty. Methods We performed a retrospective chart review on patients presenting to a single academic institution who underwent a metoidioplasty. All operations were performed using the Belgrade technique with or without urethral lengthening depending on patient preference. Results Twenty-seven patients underwent metoidioplasty from 2017-2022. Sixteen had recorded stretched clitoral length (pre-operatively) and exposed neophallus length (post-operatively). The median length of time on testosterone therapy was 4.6 years. The median stretched clitoral length was 5.8 cm, and exposed neophallus length was 6 cm. There was a strong correlation between pre-operative length and post-operative length (ρ=0.9; P<0.0001). There were no correlations between pre-operative length or exposed neophallus length and BMI (ρ=-0.02, P=0.93; ρ=0.05, P=0.83, respectively). Time on testosterone does not correlate with stretched clitoral length nor exposed neophallus length (ρ=-0.28, P=0.15; ρ=-0.35, P=0.18, respectively). Conclusions Patients considering metoidioplasty often wonder how large their neophallus will be. We found that patients can expect exposed neophallus length to be about 0.6 cm longer than their pre-operative stretched clitoral length. No evidence of association of time on testosterone nor BMI with exposed neophallus length was found. This information is crucial for gender diverse patients to make informed decisions about gGAS.
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Affiliation(s)
| | - Michael Tang
- Department of Urology, University of Michigan, Ann Arbor, MI, USA
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Stojanovic B, Djordjevic ML. Updates on metoidioplasty. Neurourol Urodyn 2022. [DOI: 10.1002/nau.25102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 11/09/2022] [Indexed: 11/21/2022]
Affiliation(s)
- Borko Stojanovic
- Belgrade Center for Urogenital Reconstructive Surgery Belgrade Serbia
- School of Medicine University of Belgrade Beograd Serbia
| | - Miroslav L. Djordjevic
- Belgrade Center for Urogenital Reconstructive Surgery Belgrade Serbia
- School of Medicine University of Belgrade Beograd Serbia
- Icahn School of Medicine at Mount Sinai New York New York USA
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Neuville P, Carnicelli D, Boucher F, Carlier A, Ruffion A, Morel-Journel N. [Genital surgical care for trans people]. Med Sci (Paris) 2022; 38:919-925. [PMID: 36448899 DOI: 10.1051/medsci/2022153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Affiliation(s)
- Paul Neuville
- Service d'urologie, Hospices Civils de Lyon, Hôpital Lyon Sud, Pierre-Bénite Cedex, France - Université Claude Bernard Lyon 1, Lyon, France
| | - Damien Carnicelli
- Service d'urologie, Hospices Civils de Lyon, Hôpital Lyon Sud, Pierre-Bénite Cedex, France
| | - Fabien Boucher
- Service de chirurgie plastique et reconstructrice, Hospices Civils de Lyon, Hôpital de la Croix-Rousse, Lyon, France
| | - Adélaïde Carlier
- Service de chirurgie maxillofaciale, stomatologie, chirurgie orale et chirurgie plastique de la face, Hospices Civils de Lyon, Hôpital Lyon Sud, Pierre-Bénite Cedex, France
| | - Alain Ruffion
- Service d'urologie, Hospices Civils de Lyon, Hôpital Lyon Sud, Pierre-Bénite Cedex, France - Université Claude Bernard Lyon 1, Lyon, France
| | - Nicolas Morel-Journel
- Service d'urologie, Hospices Civils de Lyon, Hôpital Lyon Sud, Pierre-Bénite Cedex, France
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Stojanovic B, Bencic M, Bizic M, Djordjevic ML. Metoidioplasty in Gender Affirmation: A Review. Indian J Plast Surg 2022; 55:156-161. [PMID: 36017403 PMCID: PMC9398530 DOI: 10.1055/s-0041-1740081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Metoidioplasty is a variant of the gender affirmation technique neophalloplasty, where a hormonally enlarged clitoris is reconstructed to become a small penis. The goals of metoidioplasty are male appearance of the genitalia, voiding in standing position, and completely preserved erogenous sensation of the neophallus. However, it does not enable penetrative sexual intercourse due to the small dimensions of the neophallus. Basic principles of metoidioplasty were established 50 years ago, and many refinements of the technique have been reported since. The latest improvements are based on the advances in urethroplasty, perioperative care, and new insights into female genital anatomy. The current metoidioplasty technique is a one-stage procedure that includes vaginectomy, straightening and lengthening of the clitoris, urethral reconstruction by combined flaps and grafts, and scrotoplasty with insertion of testicular implants. Good aesthetic, functional, and psychosexual outcomes are achieved with this type of neophalloplasty.
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Affiliation(s)
- Borko Stojanovic
- Department of Urology, Belgrade Center for Urogenital Reconstructive Surgery, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Marko Bencic
- Department of Urology, Belgrade Center for Urogenital Reconstructive Surgery, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Marta Bizic
- Department of Urology, Belgrade Center for Urogenital Reconstructive Surgery, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Miroslav L. Djordjevic
- Department of Urology, Belgrade Center for Urogenital Reconstructive Surgery, School of Medicine, University of Belgrade, Belgrade, Serbia
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Sivagurunathan M, Du Mont J, Armstrong K, Englesakis M, Krakowsky Y, Lorello GR, Potter E, Smith A, Urbach DR. Protocol for a scoping review on transition-related surgery procedures, outcome measures and access to care. BMJ Open 2022; 12:e054781. [PMID: 35487523 PMCID: PMC9052047 DOI: 10.1136/bmjopen-2021-054781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION Transgender and gender diverse (TGD) individuals often identify with a gender different to the one assigned at birth. Transition is a term used to describe the process TGD individuals take to live as their true gender. Surgery can be a very important aspect of care for members of TGD communities. Transition-related surgery (TRS) refers to many different types of surgeries completed to meet a TGD individual's gender-related goals. While various systematic reviews have attempted to synthesise the existing peer-reviewed literature around aspects of TRS, there are few scoping reviews in this area. Our scoping review aims to address this gap through providing an up-to-date overview of the TRS literature in order to provide an overarching view of the topic. METHOD AND ANALYSIS This review will follow the methods outlined by the Joanna Briggs Institute's methodology for scoping reviews and will be reported according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews. A search of nine scientific databases resulted in 20 062 potential articles. After removing duplicates, articles will be screened for inclusion using Covidence. Data extraction and synthesis will be carried out using NVivo and reviewed by team members. ETHICS AND DISSEMINATION As this study is a scoping review of the existing literature, no ethics review is required. The findings from this review will be disseminated through multiple pathways including open access publication, submission to conferences, social media and Listservs. The findings of the study will also be readily available to clinicians, organizations, interest groups, and policy-makers.
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Affiliation(s)
| | - Janice Du Mont
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
| | - Kathleen Armstrong
- Women's College Hospital, Toronto, Ontario, Canada
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
- University of Toronto, Toronto, Ontario, Canada
| | - Marina Englesakis
- Library and Information Services, University Health Network, Toronto, Ontario, Canada
| | | | - Gianni R Lorello
- Women's College Hospital, Toronto, Ontario, Canada
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
- Department of Anesthesia and Pain Management, University Health Network - Toronto Western Hospital, Toronto, ON, Canada
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Emery Potter
- Women's College Hospital, Toronto, Ontario, Canada
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Melancon DM, Walton AB, Mundinger G, Benson C. Surgical Outcomes and Complications of Genital Gender Affirmation Surgery. CURRENT SEXUAL HEALTH REPORTS 2021. [DOI: 10.1007/s11930-021-00318-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Grimstad F, Boskey ER, Taghinia A, Estrada CR, Ganor O. The role of androgens in clitorophallus development and possible applications to transgender patients. Andrology 2021; 9:1719-1728. [PMID: 33834632 DOI: 10.1111/andr.13016] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 04/02/2021] [Accepted: 04/05/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND The clitorophallus, or glans, is a critical structure in sexual development and plays an important role in how gender is conceptualized across the life span. This can be seen in both the evaluation and treatment of intersex individuals and the use of gender-affirming masculinizing therapies to help those born with a clitoris (small clitorophallus with separate urethra) enlarge or alter the function of that structure. OBJECTIVES To review the role of testosterone in clitorophallus development from embryo to adulthood, including how exogenous testosterone is used to stimulate clitorophallus enlargement in masculinizing gender-affirming therapy. MATERIALS AND METHODS Relevant English-language literature was identified and evaluated for data regarding clitorophallus development in endosex and intersex individuals and the utilization of hormonal and surgical masculinizing therapies on the clitorophallus. Studies included evaluated the spectrum of terms regarding the clitorophallus (genital tubercle, clitoris, micropenis, penis). RESULTS Endogenous testosterone, and its more active metabolite dihydrotestosterone, plays an important role in the development of the genital tubercle into the clitorophallus, primarily during the prenatal and early postnatal periods and then again during puberty. Androgens contribute to not only growth but also the inclusion of a urethra on the ventral aspect. Exogenous testosterone can be used to enlarge the small clitorophallus (clitoris or micropenis) as part of both intersex and gender-affirming care (in transmasculine patients, up to 2 cm of additional growth). Where testosterone is insufficient to provide the degree of masculinization desired, surgical options including phalloplasty and metoidioplasty are available. DISCUSSION AND CONCLUSION Endogenous testosterone plays an important role in clitorophallus development, and there are circumstances where exogenous testosterone may be useful for masculinization. Surgical options may also help some patients reach their personal goals. As masculinizing gender-affirming care advances, the options available for clitorophallus modifications will likely continue to expand and improve.
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Affiliation(s)
- Frances Grimstad
- Division of Gynecology, Department of Surgery, Boston Children's Hospital, Boston, MA, USA.,Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston, MA, USA.,Center for Gender Surgery, Boston Children's Hospital, Boston, MA, USA
| | - Elizabeth R Boskey
- Center for Gender Surgery, Boston Children's Hospital, Boston, MA, USA.,Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA, USA.,Department of Surgery, Harvard Medical School, Boston, MA, USA.,Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Amir Taghinia
- Center for Gender Surgery, Boston Children's Hospital, Boston, MA, USA.,Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA, USA.,Department of Surgery, Harvard Medical School, Boston, MA, USA
| | - Carlos R Estrada
- Center for Gender Surgery, Boston Children's Hospital, Boston, MA, USA.,Department of Urology, Boston Children's Hospital, Boston, MA, USA
| | - Oren Ganor
- Center for Gender Surgery, Boston Children's Hospital, Boston, MA, USA.,Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA, USA.,Department of Surgery, Harvard Medical School, Boston, MA, USA
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Bordas N, Stojanovic B, Bizic M, Szanto A, Djordjevic ML. Metoidioplasty: Surgical Options and Outcomes in 813 Cases. Front Endocrinol (Lausanne) 2021; 12:760284. [PMID: 34721306 PMCID: PMC8548780 DOI: 10.3389/fendo.2021.760284] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 09/22/2021] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Metoidioplasty is a variant of phalloplasty for transmen that includes the creation of the neophallus from a hormonally enlarged clitoris, urethral lengthening and scrotoplasty. The procedure results in male appearance of genitalia, voiding in standing position and preserved sexual arousal, but without possibility for penetrative intercourse. We evaluated outcomes of metoidioplasty at our center, based on latest surgical refinements. METHODS During the period of 14 years (from February 2006 to April 2020), 813 transmen with mean age of 24.4 years and mean body mass index of 24.6, underwent one stage metoidioplasty. Hysterectomy was simultaneously performed in 156, and mastectomy in 58 cases. Hysterectomy, mastectomy and metoidioplasty were done as a one-stage procedure in 46 transmen. Patients are divided in 5 groups, depending on the type of urethroplasty. Postoperative questionnaires were used to evaluate cosmetic and functional outcomes, as well as patients' satisfaction. RESULTS Follow-up ranged from 16 to 180 months (mean 94 months). Mean surgery time was 170 minutes and mean hospital stay was 3 days. Length of the neophallus ranged from 4.8 cm to 10.2 cm (mean 5.6 cm). Urethroplasty was complication-free in 89.5% of cases, and ranged between 81% to 90.3% in different groups. Urethral fistula and stricture occured in 8.85% and 1.70% of cases, respectively. Other complications included testicular implant rejection in 2%, testicular displacement in 3.20% and vaginal remnant in 9.60% of cases. From 655 patients who answered the questionnaire, 79% were totally satisfied and 20% mainly satisfied with the result of surgery. All patients reported voiding in standing position and good sexual arousal of the neophallus, without possibility for penetrative intercourse due to small size of the neophallus. CONCLUSION Metoidioplasty has good cosmetic and functional outcomes, with low complication rate and high level of patients' satisfaction. In transmen who request total phalloplasty after metoidioplasty, all available phalloplasty techniques are feasable.
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Affiliation(s)
- Noemi Bordas
- Department of Urology, Semmelweis Hospital, Kiskunhalas, Hungary
- Belgrade Centre for Urogenital Reconstructive Surgery, Belgrade, Serbia
| | - Borko Stojanovic
- Belgrade Centre for Urogenital Reconstructive Surgery, Belgrade, Serbia
- School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Marta Bizic
- Belgrade Centre for Urogenital Reconstructive Surgery, Belgrade, Serbia
- School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Arpad Szanto
- Urology Clinic, University of Pecs, Pecs, Hungary
| | - Miroslav L. Djordjevic
- Belgrade Centre for Urogenital Reconstructive Surgery, Belgrade, Serbia
- School of Medicine, University of Belgrade, Belgrade, Serbia
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
- *Correspondence: Miroslav L. Djordjevic,
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