Laparoscopic mobilization of neovagina to assist secondary ileal vaginoplasty in male-to-female transsexuals.

OBJECTIVES: To describe 3 cases of successful laparoscopically assisted vaginal reconstruction using an ileal segment in patients with complete neovaginal stenosis. METHODS: We evaluated 5 male-to-female transsexual patients who required laparoscopic-assisted vaginal replacement for complete neovaginal stenosis after sex reassignment surgery. We performed complete laparoscopic vaginal isolation and mobilization, external configuration of the vagina, and laparoscopic-assisted vaginal anastomosis. RESULTS: No intraoperative complications occurred, and laparotomy conversion was not necessary. The mean length of the neovagina at the first postoperative visit was 13 cm. At a mean follow-up of 14 months, all patients were sexually active and completely satisfied with the operation. CONCLUSIONS: Our results have confirmed the feasibility of laparoscopic perineal neovagina construction by ileal colpoplasty. The cosmetic, functional, and anatomic results were encouraging. Isolated ileal segments provided excellent tissue for vaginal replacement, resulting in excellent patient satisfaction and relatively low morbidity. Furthermore, we report a modified surgical approach to conventional ileal vaginoplasty according to the Monti channel principle.

Radiological evaluation of vaginal width and depth in male-to-female transsexuals by the use of magnetic resonance imaging.

Nowadays, the surgical treatment of male-to-female transsexuals is not rare, but few studies have reported on postoperative results. The aim of this study was to determine the role of magnetic resonance imaging (MRI) in the evaluation of the results of sex reassignment surgery (SRS) in male-to-female transsexual patients. Ten such patients (median age 28 years, range 21-47), who had undergone SRS using an inversion of combined penile and scrotal skin flaps for vaginoplasty, were examined with MRI after the operation. Turbo spin-echo T2-weighted and spin-echo T1-weighted images were obtained on sagittal, coronal, and axial planes with a 1.5 T superconducting magnet. The images were acquired on the sagittal, coronal and axial planes, by using TSE T2 weighted and SG T1 weighted images. MRI was performed within 2 weeks after the operation in six patients and after 1 year in the other four. In all cases, the images were obtained with and without an inflatable silicon vaginal tutor. The average neovaginal depth was 7.9 cm (range 6-10 cm). In four patients, MRI showed the presence of cavernosal rests, and in two there were remnants of the corpus spongiosus. In another patient, an abnormal anterior inclination of the neovagina was present. The average distance of the recto-vaginal septum was 4 mm (range 3-6 mm). No major complications were noted. Our study allowed not only a detailed assessment of the pelvic anatomy after genital reconfiguration, but also provided valuable information on possible complications.