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Treatment in Clifton, NJ

Metoidioplasty

Personalized Gender-Affirming Reconstruction

Introduction to Metoidioplasty

Metoidioplasty is a gender-affirming genital operation that creates a small phallus using hormonally enlarged clitoral tissue. For patients who want urethral lengthening, the urinary channel can be extended so that urine exits through the tip of the reconstructed phallus, with the goal of allowing standing urination when healing is successful.

Dr. Karl Coutinho provides the urologic and urethral-reconstruction portions of metoidioplasty in collaboration with gender-affirming plastic surgeons. Because the genital soft-tissue reconstruction and the urinary reconstruction are closely connected, the procedure is planned as a team and tailored to each patient’s anatomy and goals.

Dr. Coutinho is also a member of the multidisciplinary surgical team at Gender Affirming Medical and Microsurgical Associates (GAMMA), where he works alongside gender-affirming plastic and reconstructive surgeons. In many gender-affirming procedures, Dr. Coutinho focuses on the urologic and urethral portions of reconstruction while the plastic surgery team performs the complementary reconstructive portions. This collaborative approach allows each part of a complex, often staged reconstruction to be managed by a surgeon with focused expertise.

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What Is Metoidioplasty?

Metoidioplasty uses existing genital tissue, including the hormonally enlarged clitoris, to create a phallus while preserving native erectile tissue and sensation. Depending on a patient’s goals, the overall operation can include release of tethering tissues, urethral lengthening, scrotoplasty, vaginectomy or closure procedures, and later placement of testicular prostheses. Not every patient chooses every component.

When urethral lengthening is part of the plan, Dr. Coutinho focuses on creating and connecting the new urinary channel. Tissue from the genital region and, in selected situations, graft tissue may be used to build a well-supported urethra. Dr. Coutinho commonly works with the plastic surgery team to use vascularized tissue, including a gracilis muscle flap when appropriate, as an extra protective layer around the urethral reconstruction.

Who Are the Best Candidates for Metoidioplasty?

Metoidioplasty may be considered by transmasculine patients who want genital reconstruction using native clitoral tissue and understand the size and functional differences compared with phalloplasty. Candidates for urethral lengthening should also understand that fistulas and strictures can occur and sometimes require additional surgery.

Patients who may be candidates for metoidioplasty include those who:

  • Have goals that are compatible with the size and function expected after metoidioplasty
  • Want to preserve native erectile tissue and sensation
  • May want urethral lengthening and the possibility of standing urination
  • Understand that the operation may be staged
  • Are able to follow postoperative catheter and wound-care instructions
  • Are prepared for close urologic follow-up if urethral lengthening is performed

What Are the Benefits of Metoidioplasty?

Potential benefits depend on the surgical components selected and may include:

  • Creation of a phallus using the patient’s own erectile and sensory tissue
  • Preservation of native sexual sensation and the ability of the tissue to become naturally firm
  • Urethral lengthening with the goal of urinating from the tip of the phallus
  • Potential ability to urinate while standing
  • A genital reconstruction that generally does not require a large free-flap donor site
  • Ability to stage additional procedures based on healing and individual goals
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How to Begin Your Metoidioplasty Journey

A metoidioplasty consultation should address both the overall gender-affirming reconstruction and the urologic details. Dr. Coutinho coordinates the urinary portion of care with the plastic surgery team. Your evaluation may include:

  • Discussion of your goals for appearance, urination, sexual function, and future procedures
  • Review of hormone therapy and prior genital or pelvic surgery
  • Physical examination and assessment of tissue available for urethral reconstruction
  • Discussion of whether urethral lengthening is desired
  • Review of the planned role of the urologist and plastic surgeon
  • Planning for postoperative urinary drainage with a urethral catheter and/or suprapubic tube when appropriate

What to Expect on the Day of Metoidioplasty

Metoidioplasty is performed under anesthesia. The plastic surgery and urology portions are coordinated during the operation. Dr. Coutinho commonly focuses on urethral lengthening, urethral connections, urinary drainage, and other urologic aspects of the reconstruction.

When urethral lengthening is performed, the new channel is created from available well-vascularized tissue and connected to the native urethra. Additional vascularized tissue, including a gracilis flap when appropriate, may be placed around the repair to add coverage between suture lines and support healing.

A urethral catheter is generally used after surgery, and selected patients may also need a suprapubic tube. The exact drainage plan is individualized.

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Metoidioplasty and Staged Gender-Affirming Care

Metoidioplasty can include several different procedures, and they do not all need to be performed at the same time. Staging can be useful when additional healing is desired before later urinary, scrotal, or prosthetic procedures.

Urethral Follow-Up

If urethral lengthening is performed, Dr. Coutinho follows the new urethra closely. Direct visualization, including cystoscopy when appropriate, may be performed during early recovery to look for narrowing, breakdown, or fistula formation. Additional testing is based on urinary symptoms and the details of the reconstruction.

Metoidioplasty Recovery

Your Guide to Post-Metoidioplasty Care

Recovery depends on which parts of metoidioplasty are performed. Swelling, bruising, and discomfort are expected early in recovery. If urethral lengthening is included, a catheter remains in place while the new urinary channel heals.

Dr. Coutinho and the plastic surgery team will provide individualized instructions for catheter care, wound care, activity, hygiene, and follow-up. Return to exercise, sexual activity, and travel depends on healing and the exact procedures performed.

How Much Does Metoidioplasty Cost in New Jersey?

The cost of metoidioplasty in Clifton, NJ, and the greater New York metropolitan area varies because the procedure can include different surgical components and may involve more than one surgeon and more than one stage. Insurance coverage also varies. Our office can help review the urologic portion of the treatment plan and anticipated insurance responsibility.

Why Choose Dr. Coutinho?

Dr. Karl Coutinho is a fellowship-trained reconstructive urologist with advanced training in genitourinary trauma, urethral reconstruction, and prosthetic surgery. He is a founding member of the Society of Gender Surgeons and is part of the multidisciplinary Gender Affirming Medical and Microsurgical Associates (GAMMA) surgical team, where he works alongside gender-affirming plastic and reconstructive surgeons.

In many masculinizing genital procedures, Dr. Coutinho focuses on the urologic and urethral portions of reconstruction while the plastic surgery team performs complementary reconstructive portions. This collaborative model is particularly important because urethral reconstruction, soft-tissue coverage, flap blood supply, wound healing, and future prosthetic surgery all affect one another. Every patient’s anatomy, prior operations, and goals are different, so care is individualized and often staged.

For metoidioplasty, Dr. Coutinho commonly focuses on urethral lengthening, urinary drainage, and preventing or treating urethral complications. His reconstructive practice includes management of urethral strictures and fistulas after masculinizing genital surgery, allowing him to plan the initial urinary reconstruction with long-term follow-up in mind.

As a founding member of the Society of Gender Surgeons and a member of the GAMMA team, Dr. Coutinho’s gender-affirming work occurs within a multidisciplinary surgical environment rather than as isolated urologic care.

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Metoidioplasty FAQ’S

For more information on Gender Affirming Care, please visit our partners at Gamma

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Patient Reviews

  • My surgery was life changing and the recovery period was better than I ever expected. I would highly recommend Dr Coutinho , he is the best.

    View Gallery Claude R.

  • I had an outstanding experience with Dr. Coutinho and their entire urology team. They truly go above and beyond.

    View Gallery Jenney S.

  • Dr Karl Coutinho is an excellent doctor in his field. He made me feel whole again after doing two procedures for me.

    View Gallery Keith A.

  • I’ve never met a doctor so empathetic

    I’ve never met a doctor so empathetic, professional and Knowledgeable Dr Coutinho performed a very difficult surgery on me. I had absolutely no pain.

    View Gallery
Patient Reviews

East Coast Advanced Urology

Schedule Your Consultation

If you are considering metoidioplasty and want a reconstructive urologist involved in the urethral portion of surgery, schedule a consultation with Dr. Karl Coutinho at East Coast Advanced Urology in Clifton, NJ. Coordination with your gender-affirming plastic surgeon is an important part of developing the surgical plan. Dr. Coutinho welcomes patients from throughout the greater New York metropolitan area.

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