Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents for evaluation for metoidioplasty. Patient has been on continuous gender-affirming hormone therapy (GAHT) for [Number] years. Reports satisfactory clitoral hypertrophy secondary to testosterone. Patient desires surgical reconstruction for phallic construction, urethral lengthening, and/or scrotoplasty. No history of pelvic floor dysfunction or complex urological issues. Goals include improved standing micturition and aesthetic masculinization of the genitalia.
Clinical Examination Findings
Genitourinary examination reveals significant clitoral hypertrophy consistent with prolonged androgen exposure. Clitoral length measured at [Number] cm. Labia majora are well-developed and suitable for scrotoplasty. Labia minora are thin and pliable, appropriate for urethral lengthening flap construction. No evidence of lichen sclerosus, atrophy, or active dermatological pathology. Pelvic floor musculature tone is within normal limits.
Treatment Protocol
Proposed surgical plan: Metoidioplasty with release of clitoral suspensory ligament, urethral lengthening using buccal mucosal graft or local flap, and scrotoplasty using labia majora tissue. Vaginectomy or vaginal closure to be performed as per patient preference. Post-operative care includes urinary catheterization for [Number] days, prophylactic antibiotics, and strict hygiene protocols to prevent wound dehiscence or fistula formation.