>>20744143A 24-year-old male-to-female transgender adult with a body mass index of 25.8 kg/m2 who underwent gender reassignment surgery through penoscrotal flap vaginoplasty in an external center was admitted to our clinic with the complaint of fecal incontinence through the vagina.
His medical history revealed no comorbidities or previous surgery, although he was using numerous psychiatric drugs. After the initial surgery, neovaginal dilatation was performed using specifically designed dilators to prevent neovaginal stenosis, and fecal incontinence through the neovagina occurred seven days after the initial surgery. The patient was followed for a couple of months; however, no spontaneous closure of the fistula was noted.
In our clinic, physical examination was performed in the lithotomy position under the supervision of a gynecologist, and methylene blue dye was given via the transanal route, which was fistulized to the neovagina through the anterior wall. A fecal diversion was decided to prevent fecal contamination of the fistula tract and to provide secondary healing. Transverse end colostomy was performed.
Three months after the surgery, the patient was reexamined in the lithotomy position. However, the methylene blue dye, which was given via the transanal route was found to be fistulized to the neovagina through the anterior wall. As a result, restorative perineal graciloplasty was planned.
