Autologous Testicle Construction With Buried Metoidioplasty Correction

Abstract

Gender-affirming surgery is essential for transgender individuals seeking alignment between their physical appearance and gender identity. Metoidioplasty is a masculinizing option for those assigned female at birth and often includes vaginectomy, urethral lengthening, scrotoplasty, creation of a neophallus, and testicular prostheses, typically implanted during a second-stage procedure. We describe a 39-year-old transgender man who initially underwent a laparoscopic hysterectomy, metoidioplasty, and tubularized plate urethral lengthening 19 months earlier. Although the patient could achieve an erection and orgasm, he struggled with standing urination due to the penis being buried by the mons pubis and upper labia majora. In addition, he feared superior migration of the testicular prostheses, which could diminish the prominence of the neophallus. We elected to perform a monsplasty with resection and rearrangement of excess upper labial tissue to mimic testicles. This approach helps avoid the risks associated with prostheses, using the patient's own tissues instead. This second-stage operation enhances the appearance of the neophallus and creates the cosmetic appearance of testicles using the patient's own tissues, offering a safe and effective surgical option. Although metoidioplasty offers significant benefits in terms of appearance and sensation, it has limitations, including the challenge of achieving standing urination due to the typically shorter length of the neophallus. We aimed to present the effectiveness and associated patient satisfaction with this innovative approach, showing its viability as a safe surgical option.