A female/male sex realignment surgery (SRS) is performed on transsexuals with masculinizing genitoplasty. The interventions include facial masculinization, chest masculinization, gynecologic removal of female sex organs, and genital reconstruction (scrotoplasty and phalloplasty) At a later stage, a testicular and/or penile prostheses can be inserted. Usually, such patients need several complex procedures that are not free of complications. A rare complication after SRS is a vesicovaginal fistula (VVF). The incidence of such condition is not known. Multiple methods for VVF repair have been described but none of them is considered as the most effective.
We present the case of a transgender man with a VVF that was repaired with percutaneous transvesical laparoendoscopic single-site surgery (T-LESS).In February 2017, we performed a T-LESS repair for a recurrent vesicovaginal fistula of 2mm in diameter in a 67 year old man, who underwent several operations from 2012 to 2016 because of transsexualism.
The procedure was performed through a Tri-Port+ (Olympus, Germany) device. The fistulous tract was dissected, and both the vaginal wall and the bladder openings were closed separately with absorbable 3/0 barbed running sutures (V-Loc™ 90, Covidien, USA). A 18 F Foley catheter was left in the bladder for three weeks.
The operative time was 170 min. The procedure was completed with no extra port insertion. No blood loss or complications were observed. In a ten-month follow-up, no urine leakage was observed. Vaginal and cystoscopic examination revealed no leaks and complete closure of the fistula.
Our positive experience with this approach shows that the T-LESS access for VVF repair in transsexual man is feasible, safe and efficacious. The method can be considered particularly in patients with recurrent fistulas or presenting a small vaginal remnant, in whom the standard procedures are likely to result in failure.