You have accessJournal of UrologySexual Function/Dysfunction/Andrology: Surgical Therapy1 Apr 2014PD20-11 RESULTS OF VAGINOPLASTY christoper wright and Moneer Hanna christoper wrightchristoper wright More articles by this author and Moneer HannaMoneer Hanna More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.1701AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail Introduction and Objectives The use of bowel for vaginal construction is a well established procedure. The purpose of this presentation is to review the outcomes of vaginoplasty using either a segment of small bowel or the sigmoid colon, in the form of a pedicled tube or in a detubularized reconfigured fashion. We will discuss the lessons learned from 35 vaginoplasties over a 32 year period. Methods Between 1980 and 2012 thirty-five children and young adults between 1-21 years old underwent vaginal construction. The diagnoses were Meyer-Rokitansky Syndrome (19), micropenis (5), complete androgen insensitivity (3), 46XY cloacal exstrophy (3), aphallia (3), 46XY bladder exstrophy (1) and true hermaphrodite (1). The sigmoid colon was used in (22), small bowel (12) and urothelium (1). In 12 patients (5 ileum and 7 sigmoid) the bowel segments were detubularized and reconfigured into a pouch. This technique was advocated in cases where the mesentery was short and did not allow the distal end of the bowel to reach the perineum without tension. This surgical method was helpful in avoiding traction on the vascular mesenteric pedicle, but added some operative time. An inverted V-shaped perineal skin flap was incorporated into the posterior wall of the neo-vagina in 26/35 patients. In 9 patients the sigmoid colon was anastomosed in a circumferential manner to the short blind ending vaginal dimple. Results 28 patients were followed for at least one year, 10 for 5 years, 7 for 17 years and 1 for 30 years. Seven patients from abroad were followed by their local surgeon for at least 1 year. 2/9 sigmoid vaginas in which the perineal skin flap was omitted developed stenosis. Both underwent Y-V plasty, one restenosed and a second revision was done followed by daily dilation. Both had patent introitus when last seen. One patient with an ileal pouch vagina developed stenosis 10 years after the onset of puberty and was successfully corrected. One child developed mucosal prolapse and is awaiting revision. 19/28 are sexually active and report no dyspareunia. Conclusions Intestinal segments can be used to provide a cosmetic self-lubricating neovagina. Detubularization and reconfiguration to form a pouch reduces the traction on the mesentery of the bowel segment, which ensures adequate blood supply to the distal entero-cutaneous junction. The inverted V-shaped perineal skin flap should be incorporated in the anastomosis to avoid circumferential suture line and introital stenosis. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e615 Advertisement Copyright & Permissions© 2014MetricsAuthor Information christoper wright More articles by this author Moneer Hanna More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...