Clitoral Release Surgery (Metoidioplasty)

Successful standing urination mainly depends on:

During the preoperative evaluation, the physician will pull the clitoris forward and upward to simulate the postoperative direction of urination.

If, after traction, the urine stream can be directed toward the micropenis, or even close to a horizontal direction, there is usually a greater chance of achieving standing urination after surgery.

However, each patient's anatomy is different. Therefore, the final urinary outcome still requires individual evaluation, and it cannot be fully guaranteed that all patients will be able to urinate stably in a standing position.

The deep tissues and ligaments that fix the clitoris are released, allowing the clitoris to extend forward and increasing the exposed length.

Tissue from both sides of the labia minora is rolled into a tube to reconstruct a new mid-segment, or membranous, urethra. This is connected to the native urethra to form a new urinary channel.

The appearance of the perineum is reshaped to more closely resemble male genital anatomy.

If necessary, this may be combined with:

In urethral reconstruction surgery, the site most prone to problems is the anastomosis between the native urethra and the newly constructed urethra.

To reduce the incidence of urinary leakage and urethral fistula, our center preserves part of the vaginal epithelium as a well-vascularized reinforcement layer, which is placed over the urethral anastomosis.

This technique may:

Through the concept of multilayer tissue coverage, urethral healing can become more stable.

Our center uses medical-grade tissue adhesive for wound closure, forming a waterproof protective layer.

For most patients:

The tissue adhesive usually falls off naturally within several weeks and does not need to be removed by the patient.

The greatest advantage of clitoral release surgery is that it preserves sensation and natural erectile function.

However, because the length of clitoral enlargement is limited, the micropenis formed after surgery usually cannot be used for penetrative intercourse.

In addition, the ability to urinate while standing is also affected by individual anatomical conditions, and not all patients can achieve this stably.

If the desired standing urination outcome cannot be achieved after surgery, or if the patient wishes to engage in penetrative intercourse, a wearable penile prosthesis may be used.

A wearable prosthesis may assist with:

Some patients may meet most of their functional needs through clitoral release surgery combined with a wearable prosthesis, without necessarily undergoing major penile reconstruction surgery, such as Phalloplasty.

Because the new urethra must be connected to the native urethra, healing problems may occur at the junction.

The most common complications are urethral fistula and urethral stricture.

An additional channel forms during urethral healing, causing some urine to flow out from another location in the perineum.

Common presentations:

The newly formed urethra becomes narrowed due to scar contraction.

Common presentations:

Although the newly constructed urethra heals successfully, the urethral opening may fail to reach the expected position at the tip of the clitoris due to poor healing or traction from the urinary catheter, and may remain in a more posterior position.

Common presentations:

Some patients may have a patent urethra without fistula or stricture, but still be unable to urinate smoothly while standing because the urethral opening is located more posteriorly. If this affects quality of life, urethral meatus advancement or urethral reconstruction may be performed after the tissues have fully stabilized.

The overall incidence of urethral fistula and urethral stricture is approximately 15%.

It is worth noting that most patients do not require another surgery.

Even if urethral fistula or urethral stricture occurs, it does not mean that the surgery has failed. In most cases, improvement can still be achieved through subsequent treatment.

A urinary catheter is usually left in place for about 4-6 weeks after surgery to protect the urethral anastomosis and promote healing.

During this period, pulling on the catheter should be avoided, and adequate fluid intake should be maintained.

Because our center uses tissue adhesive for wound closure, most patients can shower normally and allow the wound to come into contact with water after surgery, without the need for daily dressing changes.

However, within 6-8 weeks after surgery, it is still recommended to avoid:

After catheter removal, observe for:

If persistent leakage or difficulty urinating occurs, return for follow-up evaluation as soon as possible.

It is recommended to resume sexual activity approximately 8-12 weeks after surgery.

The actual timing of recovery should still be assessed by the physician according to the wound healing condition.

If any of the following conditions occur, seek medical care as soon as possible:

The greatest advantage of clitoral release surgery is that it preserves the original sexual sensation and natural erectile function, while also providing lower invasiveness and a faster recovery speed.

If a larger penile size, stable standing urination ability, or penetrative intercourse is desired, further evaluation of treatment options such as a wearable prosthesis or penile reconstruction surgery (Phalloplasty) may be considered.