Penile Inversion Vaginoplasty With Transrectal Ultrasound Guided Hydrodistension

J. Hess, N. von Ostau

Vaginoplasty, Hydrodistension, AMAB, Transgender, Urethral Flap

This video shows the first operation of a planned two-stage vaginoplasty with urethral flap of a transgender patient assigned male at birth. The second stage procedure with only minor corrections of the outward appearance is usually done three months later.

We present our transrectal ultrasound-guided hydrodistension technique for establishing the future vaginal canal, as well as a step-by-step description of the surgical procedure itself.

Hydrodistension is performed using a TSK-Supra-Needle, that is placed under direct TRUS-guided visual control between Denonvillier`s fascia and the anterior rectal wall. Normal saline is administered using a perineal approach to separate Denonvillier`s fascia from the anterior rectal. For better intraoperative visualization the hydrodissected space is dyed with methylenblue while retracting the needle.

The hydrodissection is a feasible procedure, which facilitates a safe preparation of the neovaginal canal during vaginoplasty.

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