Fistula to the Neovagina After Gender-Affirming Surgery: Understanding, Management, and Postoperative Care

Abstract

Gender-affirming surgery (GAS) represents a significant step for many transgender individuals, facilitating alignment of physical anatomy with gender identity. With the growing availability of gender-affirming surgical care, it is essential that we are prepared to discuss and manage postoperative complications. Multidisciplinary care is warranted in the setting of both rectal injury as well as the development of a rectovaginal fistula. By understanding the intricacies of fistula formation and employing effective repair techniques, healthcare providers can significantly improve outcomes for patients facing this challenging complication.

Keywords

Gender-affirming surgery - rectovaginal fistula - neovagina - transgender health

Publication History

Article published online:
05 March 2025

• References

• 1 Nolan IT, Kuhner CJ, Dy GW. Demographic and temporal trends in transgender identities and gender confirming surgery. Transl Androl Urol 2019; 8 (03) 184-190
• 2 Wright JD, Chen L, Suzuki Y, Matsuo K, Hershman DL. National estimates of gender-affirming surgery in the US. JAMA Netw Open 2023; 6 (08) e2330348
• 3 Bustos SS, Bustos VP, Mascaro A. et al. Complications and patient-reported outcomes in transfemale vaginoplasty: an updated systematic review and meta-analysis. Plast Reconstr Surg Glob Open 2021; 9 (03) e3510
• 4 Stark T, Celtik K, Ting J, Purohit RS. Rectal injury during penile inversion vaginoplasty. Urology 2024; 192: 141-145
• 5 Horbach SER, Bouman MB, Smit JM, Özer M, Buncamper ME, Mullender MG. Outcome of vaginoplasty in male-to-female transgenders: a systematic review of surgical techniques. J Sex Med 2015; 12 (06) 1499-1512
• 6 Ferrando CA. Vaginoplasty complications. Clin Plast Surg 2018; 45 (03) 361-368
• 7 Gaither TW, Awad MA, Osterberg EC. et al. Postoperative complications following primary penile inversion vaginoplasty among 330 male-to-female transgender patients. J Urol 2018; 199 (03) 760-765
• 8 Levy JA, Edwards DC, Cutruzzula-Dreher P. et al. Male-to-female gender reassignment surgery: an institutional analysis of outcomes, short-term complications, and risk factors for 240 patients undergoing penile-inversion vaginoplasty. Urology 2019; 131: 228-233
• 9 Guevara-Martínez J, Barragán C, Bonastre J, Zarbakhsh S, Cantero R. Rectoneovaginal fistula after sex reassignment surgery. Description of our experience and literature review. Actas Urol Esp (Engl Ed) 2021; 45 (03) 239-244
• 10 Morris MP, Wang CW, Holan C. et al. Rectal injury during penile inversion vaginoplasty: an algorithmic approach to prevention and management. Plast Reconstr Surg 2023; 152 (02) 326e-337e
• 11 van der Sluis WB, Bouman MB, Buncamper ME, Pigot GLS, Mullender MG, Meijerink WJHJ. Clinical characteristics and management of neovaginal fistulas after vaginoplasty in transgender women. Obstet Gynecol 2016; 127 (06) 1118-1126
• 12 Hontscharuk R, Alba B, Hamidian Jahromi A, Schechter L. Penile inversion vaginoplasty outcomes: complications and satisfaction. Andrology 2021; 9 (06) 1732-1743
• 13 Toby Meltzer M. Vaginoplasty procedures, complications and aftercare. UCSF Transgender Care. June 17, 2016 . Accessed November 2, 2024 at: https://transcare.ucsf.edu/guidelines/vaginoplasty
• 14 Pansritum K, Thomrongdullaphak S, Suwajo P. A rectoprostatic fascia reinforcement flap for rectal injury and rectoneovaginal fistula in gender-affirmation surgery. Plast Reconstr Surg 2022; 150 (04) 909-913
• 15 Omarov N, Tatar S. The repairing of the recto-neovaginal fistula in a male-to-female transgender through perineal graciloplasty. Cureus 2021; 13 (06) e15784
• 16 Lavryk OA, Justiniano CF, Bandi B, Floruta C, Steele SR, Hull TL. Turnbull-Cutait pull-through procedure is an alternative to permanent ostomy in patients with complex pelvic fistulas. Dis Colon Rectum 2023; 66 (12) 1539-1546