title: Metoidioplasty as a single stage sex reassignment surgery in female transsexuals: Belgrade experience.
abstract: BACKGROUND
  Metoidioplasty represents one of the variants of phalloplasty in female transsexuals. Its main characteristic is that it is a one-stage procedure. It involves lengthening and straightening of hypertrophied clitoris to create a neophallus, urethral lengthening to enable voiding while standing, and scrotal reconstruction with insertion of testicle prostheses.
  
  
  OBJECTIVE
  Our aim is to describe our technique and highlight its advantages.
  
  
  METHODS
  Between September 2002 and April 2007, 82 female transsexuals, aged 18-54 years (mean age 31) underwent one-stage metoidioplasty. Clitoris is lengthened and straightened by division of clitoral ligaments and short urethral plate. Urethroplasty is done with combined buccal mucosa graft and genital skin flaps. Scrotum is created from labia majora in which two testicle prostheses are inserted. Simultaneously, female genitalia are removed.
  
  
  METHODS
  Patients' personal satisfaction about sensitivity and length of neophallus, possibility to void in standing position, real length of reconstructed urethra as well as complication rate comparing to other published data.
  
  
  RESULTS
  The median follow-up was 32 months (range 14-69). The mean neophallic length was 5.7 cm (range 4-10). Voiding in standing position was reported in all patients, while dribbling and spraying were noticed in 23 cases and solved spontaneously. There were two urethral strictures and seven fistulas that required secondary minor revision. All patients reported preserved sensation and normal postoperative erection. Testicle prostheses rejection was not observed in any of the patients.
  
  
  CONCLUSIONS
  Metoidioplasty is a single-stage and time-saving procedure. It could be an alternative to total phalloplasty in female transsexuals who do not wish to have sexual intercourse. Also, it represents a first step in cases where additional augmentation phalloplasty is required.
authors.affiliation: University Children's Hospital-Urology, Belgrade, Serbia. djordjevic@uromiros.com
authors.forename: Miroslav L
authors.initials: ML
authors.lastname: Djordjevic
authors.forename: Dusan
authors.initials: D
authors.lastname: Stanojevic
authors.forename: Marta
authors.initials: M
authors.lastname: Bizic
authors.forename: Vladimir
authors.initials: V
authors.lastname: Kojovic
authors.forename: Marko
authors.initials: M
authors.lastname: Majstorovic
authors.forename: Svetlana
authors.initials: S
authors.lastname: Vujovic
authors.forename: Alexandar
authors.initials: A
authors.lastname: Milosevic
authors.forename: Gradimir
authors.initials: G
authors.lastname: Korac
authors.forename: Sava V
authors.initials: SV
authors.lastname: Perovic
mesh_terms: D000293:Adolescent; D000328:Adult; D001187:Artificial Organs; D002987:Clitoris / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D010413:Penis; D019651:Plastic Surgery Procedures / Q000379:methods*; D013524:Surgical Flaps; D014189:Transsexualism / Q000601:surgery*; D055815:Young Adult