Back to 2025 Abstracts
Management of distal Neovaginoplasty stricture with bilateral labia minora Singapore fascio-cutaneous flaps
Nicolas Munarriz, BA,
Laura Maciejko, MD, Jaromir Slama, MD, Robert Oates, MD, Ricardo Munarriz, MD.
Boston Medical Center, Boston, MA, USA.
Background: Distal vaginal strictures after penile inversion vaginoplasty is a common complication affecting 9.8% of patients. There are limited publications discussing the management of this complication. We present a case of a 36-year-old transgender female who underwent penile inversion vaginoplasty complicated by a distal vaginal stricture who underwent successful repair of the stricture using Singapore flaps. This case report demonstrates using Singapore flaps for repair of distal vaginal stricture is a safe and practical approach for repair of this complication.
Methods: At the six-week post-operative visit, the patient was found to have a distal neovaginal stricture. It was decided to attempt dilator therapy with plan for operative intervention using the Singapore flap technique if dilation alone was insufficient. The stricture was first dilated using Hegar dilators and then released using bovie electrocautery at 3:00 and 9:00. Bilateral 9x3 cm labia minora fascio-cutaneous Singapore flaps were designed laterally to the original labial incisions and extended superiorly beyond the surgical scar. The distal end of the flaps were excised to avoid ischemia. These flaps were then transposed and secured in placed into the defect using 3-0 Vicryls. After surgery, the patient worked with pelvic floor physical therapy for 8 sessions.
Results: Immediately there were not any apparent complications. The patient was able to work with pelvic floor physical therapy. At 12 months, this patient was able to use the largest dilator to full depth without pain, bleeding, or discharge. This patient reported satisfaction at the 12-month post-operative follow-up.
Conclusions: This novel technique appears to be a safe and potentially efficacious method for repairing distal neovaginal strictures. More work must be done to further study characteristics that might contribute to a successful repair using this technique.
Back to 2025 Abstracts
