Is Clitoral Release Another Term for Metoidioplasty? A Systematic Review and Meta-Analysis of Metoidioplasty Surgical Technique and Outcomes

Divya Jolly; Catherine A Wu; Elizabeth R Boskey; Amir H Taghinia; David A Diamond; Oren Ganor

doi:10.1016/j.esxm.2020.100294

Is Clitoral Release Another Term for Metoidioplasty? A Systematic Review and Meta-Analysis of Metoidioplasty Surgical Technique and Outcomes

Sex Med. 2021 Feb;9(1):100294. doi: 10.1016/j.esxm.2020.100294. Epub 2021 Jan 8.

Authors

Divya Jolly¹, Catherine A Wu², Elizabeth R Boskey³, Amir H Taghinia³, David A Diamond⁴, Oren Ganor³

Affiliations

¹ Center for Gender Surgery, Boston Children's Hospital, Boston, MA; Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA. Electronic address: dee.jolly@childrens.harvard.edu.
² Harvard Medical School, Boston, MA.
³ Center for Gender Surgery, Boston Children's Hospital, Boston, MA; Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA; Department of Surgery, Harvard Medical School, Boston, MA.
⁴ Center for Gender Surgery, Boston Children's Hospital, Boston, MA; Department of Urology, Boston Children's Hospital, Boston, MA.

Abstract

Introduction: There has been an exponential increase in referrals for transmasculine patients seeking genital affirmation surgery. Despite transgender men's equal interest in metoidioplasty and phalloplasty, research has primarily focused on phalloplasty.

Aim: To summarize and investigate the relationship between surgical technique, complications, and patient-satisfaction.

Methods: We performed a systematic review and meta-analysis of surgical techniques and physician- and patient-reported outcomes of gender-affirming clitoral release and metoidioplasty (PROSPERO# 158722) with literature from PubMed, Google Scholar, and ScienceDirect. Data were extracted using PRISMA guidelines. All searches, extractions, and grading were independently completed by 2 authors.

Main outcome measures: Main measures were surgical technique, patient satisfaction, voiding, urethral stricture, and urethral fistula.

Results and conclusion: A total of 7 non-overlapping articles on metoidioplasty were identified, with a total of 403 patients. We identified 4 metoidioplasty techniques: Hage, Belgrade, labial ring flap, and extensive metoidioplasty. All techniques included urethral lengthening. The reported neophallus length ranged from 2 cm to 12 cm, with the smallest neophallus occurring with the labial ring flap technique and extensive metoidioplasty the largest. Across techniques, voiding while standing was reported in most patients, with the lowest rate reported with the labial ring flap (67%). Complications were impacted by surgical technique, with the lowest rates of fistula and stricture occurring with the Belgrade technique. Fistula rates ranged from 5% to 37%, while stricture ranged from 2% to 35% of patients. The Belgrade technique reported significantly lower rates of fistula and stricture (P = .000). The patient-reported outcomes were described for the Belgrade technique and extensive metoidioplasty. Both techniques showed high aesthetic and sexual satisfaction. Transgender individuals can achieve an aesthetically and sexually satisfactory neophallus using a variety of metoidioplasty techniques; however, urethral outcomes vary significantly by technique. The Belgrade technique reported the best outcomes, although data remains limited. Patient priorities should be used to determine surgical technique. Jolly D, Wu CA, Boskey ER, et al. Is Clitoral Release Another Term for Metoidioplasty? A Systematic Review and Meta-Analysis of Metoidioplasty Surgical Technique and Outcomes. Sex Med 2021;9:100294.

Keywords: Gender Affirmation Surgery; Metoidioplasty; Transgender Persons; Transition; Transsexualism; Urethral Lengthening; Urethroplasty.

Publication types

Review