Ileal vaginoplasty as vaginal reconstruction in transgender women and patients with disorders of sex development: an international, multicentre, retrospective study on surgical characteristics and outcomes Wouter B. van der Sluis* , Nicola Pavan † , Giovanni Liguori † , Stefano Bucci † , Marta R. Bizic ‡ , Vladimir Kojovic ‡ , Jochen Hess § , Wilhelmus J.H.J. Meijerink ¶ **, Margriet G. Mullender*, M € ujde € Ozer*, Jan Maerten Smit*, Marlon E. Buncamper*, Susanne Krege †† , Miroslav L. Djordjevic ‡ , Carlo Trombetta † and Mark-Bram Bouman* *Department of Plastic, Reconstructive and Hand Surgery, ¶ Department of Gastro-Intestinal Surgery and Advanced Laparoscopy, VU University Medical Center, Amsterdam, The Netherlands, **Department of Operation Rooms, Radboud University Medical Centre, Nijmegen, The Netherlands, † Urology Clinic, Department of Medical, Surgical and Health Science, University of Trieste, Trieste, Italy, ‡ School of Medicine, University of Belgrade, Belgrade, Serbia, § Department of Urology, University Hospital Essen, Essen, Germany, and †† Department of Urology, Kliniken Essen Mitte, Essen, Germany Objective To describe the surgical outcomes of ileal vaginoplasty in transgender women and patients with disorders of sex development (DSD). Patients and Methods Transgender women and patients with DSD, who underwent ileal vaginoplasty at the VU University Medical Center Amsterdam, University Hospital Trieste, University Hospital Essen, and Belgrade University Hospital, were retrospectively identified. A chart review was performed, recording surgical technique, intraoperative characteristics, complications, and re-operations. Results We identified a total of 32 patients (27 transgender and five non-transgender), with a median (range) age of 35 (6–63) years. Ileal vaginoplasty was performed as the primary procedure in three and as a revision procedure in the remaining 29. The mean (SD) operative time was 288 (103) min. The procedure was performed laparoscopically (seven patients) or open (25). An ileal ‘U-pouch’ was created in five patients and a single lumen in 27. Intraoperative complications occurred in two patients (one iatrogenic bladder damage and one intraoperative blood loss necessitating transfusion). The median (range) hospitalisation was 12 (6–30) days. Successful neovaginal reconstruction was achieved in all. The mean (SD) achieved neovaginal depth was 13.2 (3.1) cm. The median (range) clinical follow-up was 35 (3–159) months. In one patient a recto-neovaginal fistula occurred, which lead to temporary ileostomy. Introital stenosis occurred in four patients (12.5%). Conclusion Ileal vaginoplasty can be performed with few intra- and postoperative complications. It appears to have similar complication rates when compared to sigmoid vaginoplasty. It now seems to be used predominantly for revision procedures. Keywords gender dysphoria, reconstructive surgical procedures, vaginoplasty, sex reassignment procedures, complications, transgender surgery Introduction Surgical reconstruction of a functional vagina is indicated in non-transgender women with vaginal absence and transgender women. The most widespread surgical method for neovaginal (re)construction in transgender women is penile inversion vaginoplasty, with or without additional (scrotal) skin grafts or flaps [1,2]. Intestinal vaginoplasty is a surgical option in women with congenital or acquired vaginal absence, in patients who underwent a previously failed © 2018 The Authors BJU Int 2018; 121: 952–958 BJU International © 2018 BJU International | doi:10.1111/bju.14155 wileyonlinelibrary.com Published by John Wiley & Sons Ltd. www.bjui.org Andrology