Secondary Logo

Institutional members access full text with Ovid®

Rectoneovaginal Fistula in a Transgender Woman Successfully Repaired Using a Buccal Mucosa Graft

Elmer-DeWitt, Molly Abbott, MD*; Wood, Hadley M., MD*; Hull, Tracy, MD; Unger, Cecile A., MD, MPH

Female Pelvic Medicine & Reconstructive Surgery: March/April 2019 - Volume 25 - Issue 2 - p e43–e44
doi: 10.1097/SPV.0000000000000490
Case Reports

Background Rectoneovaginal fistulae (RnVFs) are abnormal connections between the rectum and a surgically created neovagina. Although very uncommon, they confer significant morbidity in patients and may require a multidisciplinary team approach to the repair. Risk factors for RnVF include rectal injury at the time of neovaginoplasty, malignancy in the neovagina, trauma (iatrogenic or otherwise), radiation, and neovaginal revision surgery.

Case Description The patient is a 64-year-old transgender woman with recurrent RnVF following penile skin inversion neovaginoplasty, which was complicated by an intraoperative rectal injury. After failing an initial attempt at repair, the fistula was successfully repaired with a buccal mucosa graft.

Conclusions In some cases, RnVFs following vaginoplasty surgery for gender affirmation may be repaired successfully with a buccal mucosa graft.

We discuss a transgender woman with recurrent rectoneovaginal fistula successfully repaired using buccal mucosa graft.

From the *Department of Urology, Glickman Urologic and Kidney Institute,

Department of Colorectal Surgery, Digestive Disease Institute, and

Center for Urogynecology & Pelvic Reconstructive Surgery; Obstetrics, Gynecology & Women’s Health Institute, Cleveland Clinic, Cleveland, OH.

Reprints: Molly Abbott Elmer-DeWitt, MD, Q-10, 9500 Euclid Ave, Cleveland, OH 44195. E-mail:;

The authors have declared they have no conflicts of interest.

Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.