Metoidioplasty: A Review of Techniques and Focus on Urethral Reconstruction

Metoidioplasty is a gender-affirming genital reconstructive procedure for transmasculine and nonbinary individuals that involves creation of a neophallus from hormonally hypertrophied clitoral tissue. Over the past three decades, the procedure has undergone substantial evolution with respect to surgical technique, aesthetic objectives, functional outcomes and postoperative management. A central driver of this evolution has been refinement of urethral lengthening and construction techniques, which represent the most technically challenging and complication-prone aspects of metoidioplasty and are critical for achieving the ability to void in the standing position. This review synthesizes contemporary evidence regarding indications, operative approaches with particular focus on methods of urethral reconstruction reported complication profiles and areas in need of further investigation. Although metoidioplasty offers several advantages over phalloplasty, including preservation of erogenous sensation, reduced operative time and faster recovery, it remains limited by achievable neophallus length and inconsistent capacity for penetrative intercourse. Urethral complications such as fistulae and strictures continue to significantly influence patient outcomes and satisfaction, underscoring the importance of ongoing technical innovation and long-term outcome reporting in this field.