Poster Session 8: Trauma and reconstruction| Volume 8, ISSUE 8, P648, September 2009

S124 Combined total phalloplasty and metoidioplasty as a single stage procedure in female to male gender reassignment surgery

      Introduction and Objectives

      Total phalloplasty includes creation of neophallus from an extragenital tissue, large enough to enable insertion of penile prosthesis and penetration during sexual intercourse. Urethroplasty, which enables voiding in standing position, is performed later on, in separate stages. Metoidioplasty presents creation of small phallus, from hormonally enlarged clitoris, which enables voiding in standing position, but without possibility for sexual intercourse. We evaluated advantages of combining phalloplasty and metoidioplasty as one stage procedure.

      Material and Methods

      Between May 2007 and June 2008, five female transsexuals, aged 26–42 years (mean 35 years) underwent one stage phalloplasty combined with metoidioplasty. Surgery included: removal of internal/external female genitalia, creation of neophallus using microvascular latissimus dorsi free flap, clitoral incorporation into the eophallus, urethral lengthening and insertion of testicle prosthesis into the scrotum created from joined labia majora. Penile prosthesis insertion is planned for the next stage.


      Follow-up was from 11 to 21 months (mean 15 months). The length of neophallus ranged from 14–17 cm with circumference from 12–15 cm. There was no partial or total necrosis of the phallus. All patients obtained voiding in standing position. Urethral fistula occurred in one case and repaired 3 months later.


      Combined total phalloplasty and metoidioplasty is feasible and safe surgical procedure. The main advantage is complete reconstruction of neophallus that avoids multi-staged gender reassignment procedures in female to male transsexuals. Our results confirmed successful outcome.