Labial ring flap: a new flap for metaidoioplasty in female-to-male transsexuals.

OBJECTIVE: To describe the technical details of our experience in performing metaidoioplasty. PATIENTS AND METHODS: After the first officially approved sex-reassignment surgery on a patient with transsexualism was performed in Japan, we performed metaidoioplasties on 69 female-to-male transsexuals between 1998 and 2007. Oophorohysterectomy and metaidoioplasty were performed by a one-stage procedure. Hage's technique was used on the first 26 cases. The labial ring flap technique was performed on 43 patients (aged 18-33 years) after 2005. This new technique uses all the labia minora skin incorporated with the anterior vaginal flap for urethral lengthening. The clitoral chordee is also released by this procedure. RESULT: Using this method, we obtained a neo-urethra of a good diameter and a more male-like appearance for external genitalia along with a minipenis. The postoperative course was uneventful in 28 of 43 cases. Urethral fistula occurred in 12 cases, which was spontaneously closed in eight cases. Four other cases required secondary repair. Three cases with neo-urethral stenosis were treated by urethral dilation. Of the 43 cases, 28 can void in a standing position. For five patients who desired a larger phallus, various phalloplasty techniques were performed subsequently.
CONCLUSION: Satisfactory urine stream and appearance were achieved. Metaidoioplasty with minimal scarring can be selected independently or as the first step followed by phalloplasty if the patient requires such an operation.