Long-Term Outcome of Vaginoplasty With the Bilateral Labioscrotal Flap

Abstract

We report the long-term outcome of vaginoplasty with the bilateral labioscrotal flap with special emphasis on vaginal stenosis. Of 23 children with ambiguous genitalia and low vaginal entry who underwent vaginoplasty between January 1985 and July 2003 with the bilateral labioscrotal flap 13 followed more than 5 years after surgery who were 10 years old or older at the most recent evaluation were included in this long-term outcome study. Vaginal caliber was estimated according to a previously described assessment system adopted for vaginoplasty results. The underlying disease was congenital adrenal hyperplasia in 11 cases, mixed gonadal dysgenesis in 1 and ovotesticular sexual development disorder in 1. Mean age at vaginoplasty and at the most recent evaluation was 3.8 (range 2.0 to 12.9) and 14.6 years (range 10.9 to 21.5), respectively. Vaginal caliber at the most recent evaluation was adequate in 6 patients (46%), stenotic in 5 (39%) and strictured in 2 (15%). Three of the 7 patients diagnosed with stricture or stenosis were diagnosed at age less than 12 years. One of these patients diagnosed with stricture was treated with dilation and the other 2 patients were observed. These patients had no trouble with menstruation. Four patients diagnosed with stricture or stenosis at age 14 years or older were treated surgically with dilation in 1 and perineal flap vaginoplasty in 3. They showed adequate vaginal caliber at 3 to 31 months of followup. In 7 patients evaluated at the beginning of puberty and several years later vaginal caliber had enlarged in 5 but remained unchanged in 2. To our knowledge this is the first report of the long-term outcome of vaginoplasty with the bilateral labioscrotal flap. Although vaginal stenosis/stricture was observed at puberty in about half of the patients, severe stricture was uncommon. Serial evaluation for vaginal stenosis/stricture at the beginning of puberty for menstruation and several years later for vaginal intercourse is recommended in patients treated with vaginal reconstruction.