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Page 8 of 12 Meltzer et al. Plast Aesthet Res 2020;7:61 I http://dx.doi.org/10.20517/2347-9264.2020.122

Table 1. Demographic data (n = 91)
Characteristic Mean (SD) or No (%)
Age 39.8 (12.6)
BMI 25.9 (4.3)
Duration testosterone (months) 87.8 (79.8)
Previous hysterectomy and oopherectomy 46 (50.5)
Hysterectomy/oopherectomy at time of metoidioplasty 45 (49.5)

Table 2. Secondary procedures following metoidioplasty (n = 91)
Procedure Mean (SD) or No (%)
Scrotoplasty* 75 (82.4)
TE + TI 75 (82.4)
TI 68 (74.7)
Monsplasty 54 (59.3)
BMI 18-25 24
BMI 25-30 19
BMI 30-35 9
BMI 35 < 2
*Have had or are scheduled to have scrotoplasty. TE: tissue expanders; TI: testicular implants

Table 3. Urologic complications (n = 91)
Description No (%)
Fistula 1 (1)
Surgical revision 0
Spontaneously closed 1 (1)
Stricture 5 (5.5)
Stricture repair 2 (2.2)
Dilation and urethrotomy 3 (3.3)

patients, 75 (82.4%) patients underwent at least one secondary procedure [Table 2]. The most common
secondary procedure was placement of scrotal tissue expanders followed by scrotal implants (82.4%). A
monsplasty was performed in 54 (59.3%) patients and was indicated in a wide range of BMIs. Mean follow-
up for all patients was 15.4 months.

The urologic complications are listed in Table 3. The most common complication was a stricture in five
patients (5.5%). Two of these strictures were treated with buccal mucosa graft at the stricture site after one
internal urethrotomy and dilation failed. One of those patients had a stricture recurrence, and ultimately
underwent a perineal urethrostomy and secondary closure without buccal mucosa. The three other patients
were treated with intermittent self-dilation following a single urethrotomy.

There were 80 (87.9%) patients who reported being able stand and urinate with a strong stream [Table 4].
Two patients reported a strong stream, even if they were unable to urinate while standing.

While sexual function outcomes were not studied in depth, no patients reported a change in ability to
orgasm by clitoral stimulation following the procedure.

DISCUSSION
Metoidioplasty is a reliable procedure for creating a small phallus that allows patients to stand and
[8]
urinate . There exist several variations of this procedure around the world and relatively few practitioners.
[6]
Our approach is a novel modification of the Takamatsu technique . We propose that the primary