Word on Ring Metas
Despite the possibility of potential complications, I am continuing to offer ring metas. I am seeing continued incremental success and believe this is a surgery that should be available to guys seeking to be able to stand to urinate. It is a necessary surgery in high demand, which very few surgeons take on. I am happy to offer this option to our FTM patients, and confident of continued good outcomes.
The Ring Metoidiopasty (RM) is similar to the SM in that the testosterone-enlarged clitoris/phallus is released from the labia minora and sewn along the midline to create a convincing penis.
However, beyond the SM, the RM mobilizes mucosa from the inner labia to create a urinary tube in combination with a flap from the canal/upper vagina. This results in a partial closure of the vagina although can be limited for those who desire retention of the vagina. For those who desire more closure without vaginectomy, RM can leave the vagina with a small dimple or more female in diameter to allow sexual utilization.
Vaginectomy, in our opinion, does NOT reduce the risk of stricture or fistula when urethral extension is performed. Thus, retention of the vagina does remain a viable option for some. For those who do not wish to retain the vagina, a vaginectomy is now offered very inexpensively at the time of SM, RM or hysterectomy. The advantage of vaginectomy is to allow closure of the perineum, a more masculine appearing scrotum and no cleft. Most gentlemen should be able to urinate while standing. We expect former complications such as stricture (narrowing) or fistula (leaking) to occur markedly less frequently following our August 2014 visit with Dr. Djordjevic and the Belgrade Gender Team. We expect to see future complications at a rate of 5% or less.
Limitations of the procedure:
- Slight risk of fistula and/or stricture
- Clefted scrotum if no vaginectomy
Cost is less than $17K. Discuss with Robin.
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