Gender reassignment surgery is progressing as part of the treatment of transsexuality.  Unfortunately, very few data about complications as neovagina stricture and prolapse post gender reassignment surgery are available. The inverted penile skin technique has been shown as the most accepted nowadays. Our patient, in the other hand, had undergone to a different technique, which preserved the whole glans at the top of the neovagina to keep her sensibility. The aim of this video is to demonstrate our technique for correction of recurrent anterior neovagnal wall plus glans prolapse post inverted penile skin neovaginoplasty and creation of a neoclitoris.

A 46 years old male-to-female transexual patient is refered to our service with complains of painful prolapsed glans and anterior neovaginal wall, post inverted penile skin neovaginoplasty, after unsuccessful sacrocolpopexy. She has been in estrogen  therapy since 2005, when she underwent the sex reassignment surgery. A MRI exam showed the almost entire penis shift including the glans at the top of the neovagina. First, cystoscopy was done in order to state the urethral length and prostate and bladder anatomy. Then, a circuncision was performed 0.5 cm from the edge of the glans, and the skin is carefully released from the underlying dartos layer. The neurovascular bundle was identified at the dorsal of the glans and preserved. Glans´s ventral portion is excised and the remaining dorsal part was used for the creation of a neoclitoris with ininterrupted polyglactin 3.0  stitiches. A blunt dissection extended downwards through the left side of the urethral meatus allowing the transposition of the neoclitoris to the supraurethral area, and fixed at the proper place with absorbable interrupted polyglactin 3.0 sutures. Then, The prolapsed anterior wall of neovagina was anchored to the periosteum of ascending pubic ramus bilaterally. Finally, vaginal wall was closed with individual absorbable interrupted polyglactin 2.0 sutures so that a total vaginal length of 9 cm and a genital hiatus of 3 cm was obtained at the end of procedure. A 16 Fr Foley catheter as well as a vaginal pack embedded on neomicin-bacitracin cream were kept for 5 days.

Antibiotictherapy was conducted for 7 days after surgery. After 3 month follow-up, the patient is satisfied without any complain and no prolapse.

This video highlighted several key points of sex reassignment surgery and demonstrated an original strategy to deal with  reccurrent anterior prolapse in a male to female transgender patient after sacrocolpopexy fail, using the general principles of pelvic reconstructive surgery.