Page 489 - Read Online

Page 6 of 8 Bizic et al. Plast Aesthet Res 2020;7:43 I http://dx.doi.org/10.20517/2347-9264.2020.80

Figure 4. Appearance at the end of surgery. Neophallic skin is reconstructed using available skin from the labia minora and dorsal clitoral
skin. Two testicular silicone prostheses are inserted into the scrotum created from the labia majora. Drain is placed in the vaginal vault

Table 1. Postoperative outcomes after metoidioplasty
Follow- Aesthetic Voiding Erogenous Sexual Urethral Urethral
No. of up while Complications
Author/year satisfaction sensation intercourse fistula stricture
patients (years, (%) standing (%) (%) (%) (%) (%)
mean) (%)
Perovic and Djordjevic [24] 22 3.9 77.3 NA NA NA 22.7 13.6 9
2003
Hage and van Turnhout [23] 70 8 75.7 NA NA NA 88.6 37.1 35.7
2006.
Takamatsu and Harashina [27] 43 0.6 88.4 67.4 100 2.3 34.9 27.9 7
2009
Djordjevic et al. [30] 2009 38 2.2 100 100 100 36.8 39.5 5.3 0
Djordjevic and Bizic [29] 2013 207 5.3 100 91.8 100 NA 47.8 7.7 2.9
Vukadinovic et al. [16] 2014 97 2.5 95.9 100 100 20.6 27.8 6.2 2.1
Stojanovic et al. [34] 2017 79 3.7 96.2 100 100 69.6 25.3 5.1 3.8
[5]
Bizic et al. 2019† 793 NA 94.7 100 100 100 46.8 8.8 1.4
van de Grift et al. [18] 2019 38* 2.7 68 NA 36 63.5 NA NA NA
*Twenty-nine patients received phalloplasty and nine patients received metoidioplasty; †Personal experience in review study. NA: not
applicable

conservatively and spontaneously, while 29.1% of our patients required surgical repair because of major
complications . The majority of patients undergoing metoidioplasty, up to 88% or more according to
[5]
recent reports, are satisfied with the appearance of their genitals [5,9,26] . Voiding in standing position was
possible for the vast majority of patients in recent studies, up to 93.2% (range 67.4%-100%). Recent studies
confirmed increased positive association among gender affirmation, body satisfaction, and sexual outcomes
after the performed GAS, which was reported for 63.5% of the patients undergoing metoidioplasty. It may
be associated to completely preserved erogenous sensation of the neophallus, which is more prominent.
Patients after metoidioplasty report sexual intercourse in a broader sense than just penetration, with
[18]
increased sexual initiative and pleasure . Metoidioplasty, as a one-stage genital gender affirmation surgery,
brings about 40% overall complication rate, the most common complications being related to urethral
[15]
reconstruction. Urethral fistulae are more common than urethral strictures, and most heal spontaneously
[Table 1]. However, between 1% and 24% of patients who have undergone metoidioplasty decide to pursue