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

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.