A novel approach for maintaining alignment of sigmoid vaginoplasty anastomosis of urogenital sinus repair complicated with iatrogenic rectovaginal fistula: case report

TL;DR

A 5-year-old girl with a complex urogenital repair history was successfully treated using an innovative catheter stent technique during a redo surgery.

Contribution

The use of a Foley catheter as a stent to align a sigmoid interposition vaginoplasty in a complex redo urogenital repair is presented as a novel technique.

Findings

The catheter stent technique successfully maintained alignment of the sigmoid interposition vaginoplasty.

One year post-surgery, the vagina and urethra remained patent with no recurrence of fistula or stenosis.

The child achieved urinary continence after colostomy closure.

Abstract

Redo surgeries for persistent urogenital sinus repair are challenging, often requiring innovative techniques to address complications like fistula formation and vaginal stenosis. This case report describes the successful management of a complex redo persistent urogenital sinus repair in a 5-year-old girl. Her initial repair at age 1 resulted in an iatrogenic rectovaginal fistula, severe narrowing of the vagina, and required a sigmoid colostomy and tube colpostomy. At age 5, surgical reconstruction involved excising the stenosed urethra, re-anastomosing it to the introitus, and fistula closure. Due to the fragile and thin-walled vagina, a sigmoid interposition vaginoplasty was performed. Extensive pelvic adhesions made direct suturing impossible, so a Foley catheter was used innovatively as a stent to approximate the vaginal wall to the sigmoid interposition. One year later, the vagina and urethra remain patent, and the child is continent following colostomy closure. The catheter stent technique proved effective in ensuring alignment and patency.

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