Dr. Jean-Etienne Terrier and Dr. Elie Pricaz, both urological surgeons, performed a metoidioplasty with the implantation of a ZSI 100 D4 implant at the Jean Mermoz private hospital in Lyon, France.

The operation went very well and lasted just over 4 hours. We spoke with Dr. Terrier to learn more about this procedure.

Technique used

The technique for this operation is to free the cavernous bodies of the clitoris, in order to release any adhesions that might be, to gain as much elasticity as possible.

The patient can choose to have an implant, designed to stiffen the metoidioplasty and to maintain the length obtained after the surgery. It also helps improving the ability to urinate while standing.

The different stages of metoidioplasty with urethral reconstruction

“We start by taking a vaginal mucosa graft that will be used to reconstruct the urethra. The vagina is closed completely. Then, the entire clitoris is released. We insert the clitoral prostheses to give the clitoris as much length and elasticity as possible. Finally, we recreate the urethra from the meatus to the end of the clitoral glans. For this, we use both the vaginal mucosa that we have removed and we will use two flaps of the labia minora to close the urethra” explained Dr. Terrier.

It is a meticulous and long intervention. The reconstruction of the scrotum does not take place in the first stage. “It would be technically possible, but with the insertion of the implant, it is preferable to do it in a second step, about 3 months later. This allows to retouch the urethra if necessary.”

The benefit of the implants

Metoidioplasty allows for the most natural reconstruction possible and the appearance of a micro penis. The sensitivity is preserved, and the patient can void while standing in good conditions (70% of patients according to the studies, depending on the length of the meta).

“The ZSI prosthesis is interesting from a cosmetic point of view, but above all from a functional point of view. The longer the meta, the straighter the stream will go and the greater the chance to urinate while standing. The prosthesis is not used to penetrate. It is used to have length so that the results are more aesthetic possible, but it is also used at the functional level to allow standing up to urinate.”

Surgeons managed to insert a length of 9 cm into the corpora cavernosa. The length obtained does not depend on the surgical technique of the surgeon. It is linked to the clitoral development. Not all patients are equal at this level. The greater the development, the more interesting the aesthetic aspect will be.

The patient left after 3 days. On average, patients stay between 3 and 5 days. The patient left with a urinary catheter in the metoidioplasty which will be left in place for 15 days. He has a suprapubic catheter, it is a probe above the pubis, which is left in place for 3 weeks postoperatively. Then the surgeon will check that it is well healed, that the patient is urinating correctly and that there are no fistulas. If there is no problem, the patient can leave without a catheter.

Photos are available on request (in agreement with the patient and the surgeon). Feel free to write us !

ZSI is the only European manufacturer of artificial urinary sphincters and of malleable and inflatable penile implants, as solutions for male urological problems (incontinence), sexual complications (Erectile Dysfunction), and gender identity procedures (prostheses for transgender people).