Surgical management of constrictive penile tie with urethrocutaneous and corporeal mutilation

Due to interference of non-medical personal in circumcision as well as abarrent psychosexual behavior complications in the form of constrictive penile tie with urethrocutaneous slough and variable degrees of corporeal wasting and mutilation was encountered. Since 1990-1997, 18 patients with such a condition has been surgically corrected. 14 patients presented as postcircumcision complication by traditional circumcisers while 4 patients had altered psychosexual behavior with self-induced genital mutilation. All patients had urethrocutaneous sloughing and corporeal wasting ranging from minor to severe. Seven patients had severe corporeal wasting in such a way that the distal penile segment and glans was hanging by a very narrowstrip of tissues. End to end urethral anastomosis and skin refashioning was done to all patients. Patients with severe degree of corporeal wasting were subjected to trimming and reaproximation of the corporeal bodies. Two patients developed stricture at site of anastomosis managed by endoscopic urethrotomy, one patient developed fistula that required repair and one patient had mild ventral skin chordee that required no intervention. All our patient had achieved satisfactory functional and cosmetic results

Use of sigmoid colon for vaginal reconstruction in patients with vaginal aplasia

There is a wide range of congenital abnormalities, the most severe is vaginal aplasia. Reconstruction of the vagina using part of the bowel is a well-established technique. In this study, vagina was reconstructed using 10-15 cm of the sigmoid colon. 14 patients with absent vagina were operated upon for vaginal reconstruction using 10-15 cm of the sigmoid colon. Six patients were genetically normal females with an absent vagina syndrome. In one patient, there was an associated vesico-vaginal fistula after an attempt of vaginal augmentation. In this group of patients, only vaginal reconstruction was performed. 8 patients were male pseudohermaphrodite who were brought up as females and had inadequate penis [phallus]. In this group, total female genital reconstruction is performed including reduction phalloplasty, labioplasty and colonic vaginal reconstruction. There had been no operative morbidity. In all patients, it was easy isolating a sigmoid segment for vaginal reconstruction. We could achieve excellent functional and cosmetic results in ten patients. In three patients marked stenosis at the anastomotic site occurred necessitating V-Y plasty in two patients and simple dilation under GA in one. One case developed total occlusion of the neovaginal opening and presented with acute abdomen due to rupture of the colonic vagina from accumulated mucous. Four patients got married and have successful sexual intercourse. Vaginal replacement with sigmoid colon is an easy and successful procedure. It gives much better functional results than using skin for reconstruction. These patients need regular manual dilation until they are engaged in sexual relation