BACKGROUND: Preliminary results of a specific semi-rigid prosthesis for metoidioplasty (ZSI AIM: The objective of the present study was to report the updated surgical results of metoidioplasty with implantation of the ZSI METHODS: All individuals who underwent a metoidioplasty with implantation of the ZSI RESULTS: Twenty-one individuals were included and followed-up during a median [IQR] period of 19.5 months [12.8-24.2]. Most individuals ( CONCLUSION: Implantation of a semi-rigid prosthesis in a metoidioplasty seems a safe procedure, with no reported complications related to the prosthesis. Overall, satisfaction regarding genitals, sexual and urinary function are favorable.