V07-06 PROSTATO-NEOVAGINAL FISTULA REPAIR IN A PATIENT WITH PRIOR TRANSURETHRAL RESECTION OF THE PROSTATE

Abstract

You have accessJournal of UrologyLower-Tract Reconstruction II: ED/Infertility & Transgender Surgery (V07)1 Apr 2020V07-06 PROSTATO-NEOVAGINAL FISTULA REPAIR IN A PATIENT WITH PRIOR TRANSURETHRAL RESECTION OF THE PROSTATE Rebecca Sager*, Daniela Kaefer, Natasha Ginzburg, and Dmitriy Nikolavsky Rebecca Sager*Rebecca Sager* More articles by this author , Daniela KaeferDaniela Kaefer More articles by this author , Natasha GinzburgNatasha Ginzburg More articles by this author , and Dmitriy NikolavskyDmitriy Nikolavsky More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000897.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Vaginoplasties for gender affirmation are becoming increasingly common and are reported to carry a risk of serious urological complications such as urethro-neovaginal fistulae. Our objective was to demonstrate a technique for repair of prostatic urethro-neovaginal fistula in a transgender female with prior transurethral resection of the prostate (TURP). METHODS: A 65-year-old transgender female presented with a complaint of severe incontinence and was diagnosed with a prostato-neovaginal fistula. She had undergone TURP for symptomatic benign prostatic hyperplasia (BPH) prior to penile inversion vaginoplasty at another institution. Following vaginoplasty, she had severe incontinence of urine after the initial vaginal packing removal. Cystoscopy and vaginoscopy identified fistulae from the urethra, just proximal to the verumontanum, to the neovagina. The options for repair were considered ensuring that the neovagina remained patent. Surgical technique: The urethra was dissected laterally away from neovagina, and the prostatic and membranous urethral plate was incised dorsally. An Asopa-type dorsal inlay urethroplasty with buccal mucosa graft was performed. The lateral urethral edges were rotated ventrally, approximated and the adjacent tissue flaps were brought over in layers to cover ventral urethral anastomosis. A 16 French urethral catheter and vaginal packing were left in place at the conclusion of the case. Patient was followed with imaging, cystoscopy and questionnaires. RESULTS: Voiding cystourethrogram was performed 3 weeks post-operatively with no evidence of fistula. On follow up visits at 4- and 8-months patient reported no recurrent incontinence, no difficulty with vaginal dilations or penetrative vaginal intercourse. Cystoscopy and pelvic exam at the 8-months follow-up demonstrated no evidence of fistula or stricture and no stress incontinence with cough or Valsalva. CONCLUSIONS: Surgical treatment of BPH by TURP prior to gender affirmation surgery in transgender female patients may lead to complicated fistulae in a setting of incompetent bladder neck. The close proximity of the neovaginal dissection to a thinned prostate capsule and external sphincter may predispose this group of patients to fistula formation and incontinence. Traditional interposition flaps such as gracilis could create significant bulk compromising the neovaginal space. Asopa-type urethroplasty with dorsal inlay of buccal mucosa graft and ventral urethral closure can be used for a novel application in repair of complex prostato-neovaginal fistula. Source of Funding: none © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e644-e645 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Rebecca Sager* More articles by this author Daniela Kaefer More articles by this author Natasha Ginzburg More articles by this author Dmitriy Nikolavsky More articles by this author Expand All Advertisement PDF downloadLoading ...