Laparoscopic Sacrocolpopexy for Treatment of Neovaginal Prolapse Following Gender Reassignment Surgery

Background: Prolapse of the neovagina is a rarely reported complication of male-to-female transgender surgery and is not commonly encountered by gynecologists. Documented management of such cases is scarce in the literature and includes a few case reports or abstracts. This article reports the current authors' experience treating complete eversion of the neovagina successfully with laparoscopic sacrocolpopexy. Case: A 55-year-old transgender female had complete eversion of her neovagina and symptoms of obstructive defecation syndrome (ODS). Use of a ring pessary was unsuccessful. A magnetic resonance imaging proctogram revealed anismus, and paradoxical contraction of the anal canal and puborectalis muscle. At a pelvic-floor multidisciplinary meeting, biofeedback treatment was recommended for her ODS symptoms as well as laparoscopic sacrocolpopexy. The procedure posed various technical difficulties for this patient, compared to an XX female, including lack of a distinct rectovaginal septum, a narrow and shortened vagina, and more-dense and vascular tissues of Denonvilliers' fascia. A higher risk of mesh erosion was identified because of the vaginal tissue being thinner keratinized squamous epithelium; thus, the surgical technique was adapted to reduce this risk. Results: At 18-month's follow-up, good anatomical results were noted, and the patient's satisfaction was reflected in her Pelvic Organ Prolapse Quantification and International Consultation on Incontinence Modular Questionnaire-Vaginal Symptoms vaginal symptom scores. Conclusions: To the current authors' knowledge, this is the first published description of laparoscopic mesh sacrocolpopexy in the literature. The procedure is safe, with low morbidity, faster recovery, and good medium-term anatomical and functional outcomes. The need for a multidisciplinary approach when managing such complex cases is emphasized.