(013) Simple Metoidioplasty Technique for Masculinizing Gender Affirming Surgery

Introduction Metoidioplasty is a masculinizing genital gender-affirming surgery that reconstructs native genital tissue into a more masculine form. Several variations exist, with or without urethral lengthening. However, the “simple” metoidioplasty-performed without urethral reconstruction-remains poorly characterized in the literature. The technique is suited for transmasculine patients seeking increased phallic projection and preserved erogenous sensation while maintaining vaginal function and minimizing urethral or donor-site morbidity. Objective This video presents a reproducible, low-morbidity approach to simple metoidioplasty using labia minora–based flaps for ventral shaft coverage, performed without urethral lengthening, vaginectomy, or scrotoplasty. Methods A 44 year old Transgender man, who was interested in having metoidioplasty. His history included gender affirming testosterone treatment for the last 4 years. Surgical goals included: Masculinizing genital appearance, enhanced phallic projection (while erect) with preserved erogenous sensation, native voiding to avoid urethral complications, and vaginal preservation. Following a discussion of surgical options he elected a simple metoidioplasty. Operation began with assessment of the patient’s genital anatomy, showing evidence of hypertrophic clitoris and labia minora, a stretched clitoral length of 8cm. Stay sutures were placed through the glans and labia minora for retraction, a Foley catheter was inserted. The urethral plate and inner labia minora were marked for excision, preserving 2cm above and up to 2cm lateral to the urethral meatus as well as the clitorial glans. The marked area was sharply de-epithelialized with a 15 blade. The ventral chordee of the clitoris were then incised to allow the clitoral body to unfold and lengthen. The inferior aspect of the labia minora were incised laterally, creating a rotational flap medially to the defect, and superior to the urethral meatus. Excess skin of the labia minora was marked for symmetry and then sharply de-epithelialized, preserving the subcutaneous tissue to add bulk to the phallus. A layered subcutaneous closure and skin closure were performed following a pudendal block, the foley catheter was removed. A dressing was placed for 24 hours. Results The stretched phallic length measured at the end of surgery was 9 cm, with a symmetric contour and no ventral tethering. Operative time was 198 minutes. Estimated blood loss was <100 cc. Patient stayed <24 hours in hospital per protocol. No voiding complications, no opioid use beyond post-operative day 3, Symmetric sensation reported at post-operative day 7. Conclusions Simple metoidioplasty provides functional and aesthetic masculinization with preserved sensation and low morbidity. It represents an alternative for patients wishing to avoid vaginectomy and urethral lengthening or as part of a staged masculinizing surgical pathway. The video highlights key operative steps, technical pearls, and postoperative outcomes to support reproducibility across centers. Disclosure No