Total Laparoscopic Colocolpopoiesis in a Kidney Transplant Recipient With Frasier Syndrome

Background: The absence of a normal functioning vagina can have a profound impact on women's quality of life and psychological well being. Frasier syndrome is a rare autosomal recessive disorder which presents with male pseudohermaphroditism with gonadal dysgenesis, renal failure in early adulthood and increased risk of developing gonadoblastoma. Kidney transplant recipients are reported to have a high complication rate after colorectal surgery, most probably resulting from immunosuppressive therapy. Case: A 25-year-old female kidney transplant recipient with Frasier syndrome consulted our department to discuss the possibilities of surgically constructing a functional vagina. She successfully underwent a total laparoscopic colocolpopoiesis without any complications. A sigmoid segment of 16 cm long was isolated laparoscopically and transferred caudally in a dissected pouch between bladder and rectum on its vascular pedicle. There was no short-term morbidity and no complications up to 3 years postoperatively. She experienced no neovaginal symptoms and was able to engage in neovaginal penetration by means of vibrator or neovaginal dilatator. Conclusions: The positive results in this patient lead us to recommend laparoscopic colocolpopoiesis in kidney transplant patients who are seeking vaginoplasty. We advocate considering a total laparoscopic approach whenever rectosigmoid colocolpopoiesis is indicated, even after a kidney transplantation.