Utilisation of a rectal hydrogel spacer for vaginoplasty in a cadaver model

Background: A major source of complications in vaginoplasty results from injury to the rectum during dissection of the neovaginal cavity. The SpaceOAR (TM) System is a rectal hydrogel spacer mostly used as a safety technique during prostate cancer treatment. Objective: This was a feasibility study performed in a single cadaveric perineum. Methods: Prior to standard cavity dissection, SpaceOAR was injected transperineally into the Denonvilliers' fascia under guidance of transrectal ultrasound. Dissection of the neovaginal cavity with spacer gel was qualitatively assessed to be significantly easier, allowing for a blunt and quick approach. Results: A satisfactory vaginal length was achieved rapidly and safely. Conclusions: We show that transgender vaginoplasty using this adaptation of SpaceOAR is technically feasible in the cadaveric model and may reduce the incidence of rectal injury or rectovaginal fistula during neovaginal cavity creation. Future experimental endeavours should focus on the reproducibility of this approach and characterise the degree of rectal protection provided.