V07-03 ROBOTIC SIGMOID VAGINOPLASTY AND URETHRAL RECONSTRUCTION FOR PROSTATONEOVAGINAL FISTULA

摘要

You have accessJournal of UrologySexual Dysfunction & Transgender (V07)1 Sep 2021V07-03 ROBOTIC SIGMOID VAGINOPLASTY AND URETHRAL RECONSTRUCTION FOR PROSTATONEOVAGINAL FISTULA James Young, Marissa Kent, Peter Wiklund, Miroslav Djordjevic, and Rajveer Purohit James YoungJames Young More articles by this author , Marissa KentMarissa Kent More articles by this author , Peter WiklundPeter Wiklund More articles by this author , Miroslav DjordjevicMiroslav Djordjevic More articles by this author , and Rajveer PurohitRajveer Purohit More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002034.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Prostatoneovaginal fistula is a rare but feared complication after penile inversion vaginoplasty in transgender women. In this video, we present a 2-team, step-by-step approach and tips for robotic sigmoid vaginoplasty with urethral reconstruction. Goals of surgery were to correct the fistula, provide a neovagina of adequate depth, and preserve the bladder neck for urinary continence. METHODS: A 23-year-old transgender female presented with a large prostatoneovaginal fistula with neovaginal stenosis after penile-inversion vaginoplasty. She previously failed an attempt at repair with a peritoneal flap. Pre-operatively, cystoscopy demonstrates the location and size of the fistula. The patient is placed in a dorsal lithotomy position, with 4 robotic ports and 1 assistant port created for access. The sigmoid arteries are isolated, approaching the vessels medially. A 60 mm bowel stapler harvests a 15 cm segment for the neovagina. We confirm the absence of vascular tension by pulling down the segment to the neovaginal opening, before re-anastomosing the colon with a circular stapler. To correct the patient’s introital stenosis, an inverted U-flap is advanced superiorly. Scar tissue surrounding the introitus and vaginal wall is excised to improve visualization and placement of the neovagina. The fistula could not be closed primarily, necessitating the use of a local skin flap for urethroplasty. The sigmoid neovagina is brought down to the vaginal fossa and sutured in place. RESULTS: Six months after surgery, the patient was noted to be continent and had 6 inches of depth on the neovagina with no fistula seen on cystoscopy. CONCLUSIONS: Robotic sigmoid vaginoplasty with urethral reconstruction by 2-team approach is an effective option for complex prostatoneovaginal fistulae after vaginoplasty. Technical expertise and understanding of anatomy are mandatory to optimize outcomes. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e551-e552 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information James Young More articles by this author Marissa Kent More articles by this author Peter Wiklund More articles by this author Miroslav Djordjevic More articles by this author Rajveer Purohit More articles by this author Expand All Advertisement PDF downloadLoading ...