{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,2]],"date-time":"2025-07-02T04:04:58Z","timestamp":1751429098645,"version":"3.41.0"},"reference-count":11,"publisher":"Oxford University Press (OUP)","issue":"7","license":[{"start":{"date-parts":[[2025,5,25]],"date-time":"2025-05-25T00:00:00Z","timestamp":1748131200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,6,29]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Metoidioplasty is a genital-masculinization surgery for transmen with gender dysphoria that creates a small penis from a hormonally enlarged clitoris, and while standing urination is currently facilitated by urethroplasty using buccal (Belgrade method) or labia-minora (Ring method) mucosal grafts combined with a vaginal flap, these techniques involve buccal wounds and are associated with high urethral-fistula rates.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Aim<\/jats:title>\n                  <jats:p>This study aims to describe our vaginal-mucosal graft metoidioplasty technique and report early outcomes from a case series of seven patients, based on the hypothesis that our approach may offer advantages over existing methods by avoiding buccal wounding seen in the Belgrade method and potentially reducing urinary complications compared to the Ring method.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We performed vaginal-mucosal graft metoidioplasty on seven patients who expressed a desire to undergo metoidioplasty during preoperative counseling. At our institution, metoidioplasty is performed simultaneously with hysterectomy, oophorectomy, and vaginal closure, which allows us to harvest long vaginal flaps and vaginal-mucosal grafts of various sizes. We incorporate these grafts into urethroplasty to improve surgical outcomes.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Outcomes<\/jats:title>\n                  <jats:p>Primary outcome was the incidence of urinary complications, namely, urethral fistula and stricture.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Median blood loss was 1610\u00a0mL. Median operative time was 4:57\u00a0h:min. Median postoperative follow-up period was 5 (range 2-11) months. One patient developed urethral fistula requiring closure surgery. Another had mild urethral stricture that is still under observation. The remaining patients had no noticeable complications.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Clinical implications<\/jats:title>\n                  <jats:p>Vaginal-mucosal graft metoidioplasty does not involve buccal wounding and it had similar urethral-fistula rates in our small series as the Belgrade method (14% vs. 7%-15%).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Strengths &amp; limitations<\/jats:title>\n                  <jats:p>The technique permits urethral reconstruction with readily available vaginal mucosa. Blood loss was high because the vaginal flap is elevated with scissors and the vaginal-mucosal graft must be harvested in a circumferential manner. However, we believe blood loss will improve with experience. Our case series also only involved seven patients and follow-up of 2-11\u00a0months, and patient satisfaction regarding cosmetic, urinary, and sexual outcomes was not routinely recorded. Longer follow-up, more cases, and the use of patient-recorded outcome measures are needed to determine long-term surgical, urinary, cosmetic, and sexual outcomes.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Vaginal-mucosal graft metoidioplasty provides an accessible method for urethral reconstruction and may have acceptable urinary-complication rates, although further studies are required to confirm its safety and efficacy.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/jsxmed\/qdaf125","type":"journal-article","created":{"date-parts":[[2025,5,25]],"date-time":"2025-05-25T21:03:37Z","timestamp":1748207017000},"page":"1275-1279","source":"Crossref","is-referenced-by-count":0,"title":["Vaginal-mucosal graft metoidioplasty: a novel surgical technique for urethral reconstruction in transmasculine surgery"],"prefix":"10.1093","volume":"22","author":[{"given":"Kanae","family":"Nakamura","sequence":"first","affiliation":[{"name":"Department of Plastic, Reconstructive and Aesthetic Surgery, Nippon Medical School , Tokyo 113-8603,","place":["Japan"]},{"name":"Department of Plastic Surgery, Gyotoku General Hospital , Chiba 272-0103,","place":["Japan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Toru","family":"Sakurai","sequence":"additional","affiliation":[{"name":"Department of Plastic, Reconstructive and Aesthetic Surgery, Nippon Medical School , Tokyo 113-8603,","place":["Japan"]},{"name":"Department of Plastic Surgery, Gyotoku General Hospital , Chiba 272-0103,","place":["Japan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aiko","family":"Sakamoto","sequence":"additional","affiliation":[{"name":"Department of Gynecology, Gyotoku General Hospital , Chiba 272-0103 ,","place":["Japan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kumi","family":"Watanabe","sequence":"additional","affiliation":[{"name":"Department of Plastic, Reconstructive and Aesthetic Surgery, Nippon Medical School , Tokyo 113-8603,","place":["Japan"]},{"name":"Department of Plastic Surgery, Gyotoku General Hospital , Chiba 272-0103,","place":["Japan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rei","family":"Ogawa","sequence":"additional","affiliation":[{"name":"Department of Plastic, Reconstructive and Aesthetic Surgery, Nippon Medical School , Tokyo 113-8603,","place":["Japan"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2025,5,25]]},"reference":[{"key":"2025070100264231700_ref1","doi-asserted-by":"publisher","first-page":"760284","DOI":"10.3389\/fendo.2021.760284","article-title":"Metoidioplasty: surgical options and outcomes in 813 cases","volume":"12","author":"Noemi","year":"2021","journal-title":"Front E"},{"key":"2025070100264231700_ref2","article-title":"Metoidioplasty","author":"Riley","year":"2024","journal-title":"Encyclopesia"},{"issue":"2","key":"2025070100264231700_ref3","doi-asserted-by":"publisher","first-page":"349","DOI":"10.1016\/j.urology.2009.02.036","article-title":"Urethral lengthening in metoidioplasty(female-to-male sex reassignment surgery)by combined buccal mucosa graft and labia minora flap","volume":"74","author":"Djordjevic","year":"2009","journal-title":"Urology"},{"issue":"3","key":"2025070100264231700_ref4","doi-asserted-by":"publisher","first-page":"318","DOI":"10.1016\/j.bjps.2008.11.038","article-title":"Labial ring flap:a new flap for metoidioplasty in female-to-male transsexuals","volume":"62","author":"Takamatsu","year":"2009","journal-title":"J Plast Reconstr Aesthet 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