Objective. To optimize the outcomes of neovaginoplasty with penile inversion.

Material and methods. Analysis of the outcomes of redo surgeries in 6 patients with neovaginal stenosis after penile inversion revealed that neovaginal prolapse and stenosis was caused by incorrect technique of neovaginal laying. All patients underwent redo surgery, and neovagina was formed using sigmoid colon.

Results. To prevent postoperative complications (deformation, loss of acceptable geometry and direction), we proposed a modification of penile inversion with laparoscopic fixation of neovaginal dome. This procedure prevents neovaginal prolapse. Surgery was performed in one patient during primary penile inversion for male-to-female transsexualism. We achieved effective fixation of neovagina in neovaginal canal. The follow-up after 6 months revealed stable dimensions of neovagina without decrease of postoperative length. The patient reported favorable quality of sexual life. She was completely satisfied with postoperative result. We have a large experience in surgical and postoperative management of patients with male transsexualism with small incidence of early and late complications. An essential aspect for positive outcomes after neovaginoplasty with penile inversion is correct fixation of neovagina to perineal and pelvic tissues. Incorrect procedure increases the number of unsatisfactory results.

Conclusion. Neovaginoplasty with sigmoid colon is preferable for repeated reconstruction in patients with stenosis and deformation of neovagina after penile inversion. Local plastic surgery is ineffective.

Keywords. transsexualism, vaginoplasty, penile inversion, neovagina, perineal reconstruction