We present a refinement to our original technique in MtF gender reassignment surgery. Our goal was to construct a neoclitoris, which is wet and covered with urethral neoprepuce. Since 1995 more than 300 transgender MtF
patients have been operated at our institution. Our refinement has been applied to 12 cases and showed both excellent functional and cosmetic results during
midterm follow-up.
PATIENTS AND METHODS: During 2010 several sex reassignment surgeries have been performed using our new technique that includes: bilateral orchiectomy, removal of corpora cavernosa of the penis, formation of the neourethra with neomeatus, neovaginoplasty by inversion of penoscrotal skin flaps, construction of the
neoclitoris with preservation of the neurovascular bundle and exterior vulva formation. The refinement consists in creating a neoclitoris embedded in urethral mucosa using urethral flaps. These flaps are in continuity with the previously spatulated urethra. The urethral plate is further incised distally in a Y fashion. The urethral flaps are sutured around the neoclitoris to form a
neo-urethroclitoris covered by urethral neoprepuce, which resembles a real female clitoris. The neoclitoris is positioned in the anatomical position of the male
suspensory ligament of the penis that is also the natural anatomical position of the female clitoris.
RESULTS: With this method we are able to construct a clitoris with a normal sensitivity embedded in urethral mucosa that remains wet and hairless. It can be
easily stimulated during sexual intercourse, as most of the patients reported great satisfaction and ability to reach orgasm.
DISCUSSION: We want to emphasize how both the cosmetic results and functionality of the neovagina and neoclitoris are important in this type of surgery for the
quality of life of our patients. We are still far from a perfect surgical solution, but we are further improving our technique and follow our aims step by step.
