Abstract Introduction Some transgender and gender diverse persons do not require surgical treatment to express their gender identity. For others, surgery is an essential and medically necessary step to alleviate gender dysphoria. Although vaginoplasty can be considered a standardised procedure for transgender and gender divers persons assigned male at birth (AMAB), there are still many differences in surgical details. Objective To present our surgical details of hydrodistension technique and vaginoplasty with urethral flap. Methods This video shows the first operation of a planned two-stage procedure. The second stage procedure with minor corrections of the outward appearance is done three months later. Hydrodistension is performed using a TSK-Supra-Needle, that is placed under direct TRUS-guided visual control between Denonvillier`s fascia and the anterior rectal wall. Normal saline is administered using a perineal approach to separate Denonvillier`s fascia from the anterior rectal. For better intraoperative visualization the hydrodissected space is dyed with methylenblue while retracting the needle. Results In the presented video we show in detail our technique of transrectal ultrasound-guided hydrodissection for establishing the vaginal canal, as well as a step-by-step description of the vaginoplasty procedure itself. Conclusions The hydrodissection is a feasible procedure, which facilitates a safe preparation of the neovaginal canal during vaginoplasty. Disclosure No
Hess et al. (Mon,) studied this question.