Metoidioplasty With Implantation of a Specific Semirigid Prosthesis

Published:March 16, 2021DOI:



      Metoidioplasty is a possibility for penis reconstruction in transmen that could be enhanced by a semi-rigid prosthesis support.


      Describe the surgical technique of metoidioplasty with implantation of a specifically designed semi-rigid prosthesis -the ZSI100D4- and analyze preliminary results.


      Implantation of semi-rigid prosthesis was proposed to transmen who chose metoidioplasty for genital gender affirming surgery in a specialized university hospital.


      Surgical outcomes were collected from medical files. Functional outcomes and satisfaction were collected post-operatively with a questionnaire.


      A total of 15 patients were operated; the mean length of followup was 22 months (SD = 8.7). Median prosthesis size was 8.5 cm (range: 8.5-10). Seven (46.7%) minor complications (Clavien-Dindo grade 2; 5 wound dehiscence and 2 fistula, managed conservatively) and 1 severe (Clavien-Dindo grade 3b) complication (Hematoma that need surgical revision) occurred. Thirteen patients (86.6%) answered the questionnaire; 11 (84.6%) reported being either “very satisfied” or “satisfied” with the appearance of the new genitalia; 10 (76.9%) could void while standing; and 12 patients (92.3%) answered “not at all” to the question “do you have regrets about this surgery ?”.


      Implantation of a semi-rigid prosthesis in an enlarged clitoris seems to be a valuable option and can be proposed as another possibility
      for the complex surgical answer to neophallus reconstruction in transmen. Neuville P, Carnicelli D, Paparel P, et al. Metoidioplasty With Implantation of a Specific Semirigid Prosthesis. J Sex Med 2021;18:830–836.

      Key Words

      To read this article in full you will need to make a payment
      ISSM Member Login
      Login with your ISSM username and password.
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Purchase one-time access:

      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Selvaggi G
        • Dhejne C
        • Landen M
        • et al.
        The 2011 WPATH standards of care and penile reconstruction in female-to-male transsexual individuals.
        Adv Urol. 2012; 2012e581712
        • Hadj-Moussa M
        • Agarwal S
        • Ohl DA
        • et al.
        Masculinizing genital gender confirmation surgery.
        Sex Med Rev. 2019; 7: 141-155
        • Frey JD
        • Poudrier G
        • Chiodo MV
        • et al.
        A systematic review of metoidioplasty and radial forearm flap phalloplasty in female-to-male transgender genital reconstruction: Is the “ideal” neophallus an achievable goal?.
        Plast Reconstr Surg - Glob Open. 2016; 4: e1131
        • Djordjevic ML
        • Stojanovic B
        • Bizic M.
        Metoidioplasty: Techniques and outcomes.
        Transl Androl Urol. 2019; 8: 248-253
        • Cohanzad S.
        Extensive metoidioplasty as a technique capable of creating a compatible analogue to a natural penis in female transsexuals.
        Aesthetic Plast Surg. 2016; 40: 130-138
        • Coleman E
        • Bockting W
        • Botzer M
        • et al.
        Standards of care for the health of transsexual, transgender, and gender-nonconforming people, Version 7.
        Int J Transgenderism. 2012; 13: 165-232
        • Özer M
        • Pigot GLS
        • Bouman M-B
        • et al.
        Development of a decision aid for genital gender-affirming surgery in transmen.
        J Sex Med. 2018; 15: 1041-1048
        • Frey JD
        • Poudrier G
        • Chiodo MV
        • et al.
        An update on genital reconstruction options for the female-to-male transgender patient: A review of the literature.
        Plast Reconstr Surg. 2017; 139: 728-737
        • Al-Tamimi M
        • Pigot G
        • Elfering L
        • et al.
        Genital gender-affirming surgery in transgender men in the Netherlands from 1989 to 2018: The evolution of surgical care.
        Plast Reconstr Surg. 2020; 145
        • Hembree WC
        • Cohen-Kettenis P
        • Delemarre-van de Waal HA
        • et al.
        Endocrine treatment of transsexual persons: An endocrine society clinical practice guideline.
        J Clin Endocrinol Metab. 2009; 94: 3132-3154
        • Clavien PA
        • Barkun J
        • de Oliveira ML
        • et al.
        The Clavien-Dindo classification of surgical complications: Five-year experience.
        Ann Surg. 2009; 250: 187-196
        • Bizic MR
        • Stojanovic B
        • Joksic I
        • et al.
        Urol Clin North Am. 2019; 46: 555-566
        • Takamatsu A
        • Harashina T.
        Labial ring flap: A new flap for metaidoioplasty in female-to-male transsexuals.
        J Plast Reconstr Aesthetic Surg. 2009; 62: 318-325
        • Hage JJ
        • van Turnhout AAWM.
        Long-term outcome of metaidoioplasty in 70 female-to-male transsexuals.
        Ann Plast Surg. 2006; 57: 312-316
        • Vukadinovic V
        • Stojanovic B
        • Majstorovic M
        • et al.
        The role of clitoral anatomy in female to male sex reassignment surgery.
        Sci World J. 2014; 2014: 1-7
        • Kjölhede A
        • Cornelius F
        • Huss F
        • et al.
        Metoidioplasty and groin flap phalloplasty as two surgical methods for the creation of a neophallus in female-to-male gender-confirming surgery: A retrospective study comprising 123 operated patients.
        J Plast Reconstr Aesthetic Surg Open. 2019; 22: 1-8