Surgical and functional outcomes of sigmoid vaginoplasty among patients with variants of disorders of sex development

PURPOSE:To assess the use of sigmoid colon in vaginal reconstruction of some patients with disorders of sex development. MATERIALS AND METHODS: The study included 31 patients with disorders of sex development of various causes. All were reared as females. Female gender was decided for all cases after complete medical assessment. All patients underwent sigmoid vaginoplasty. Assessment of surgical and functional outcomes was carried out in a follow up period of up to 6 years. RESULTS: The preoperative diagnoses included mullerian aplasia (16 cases), androgen insensitivity syndrome (12 cases) and previous failed vaginoplasty (3 cases). Associated surgical procedures were gonadectomy in 5 cases and gonadectomy combined with clitoroplasty and vulvoplasty in 7 cases. No intra-operative or early postoperative complications occurred. A cosmetic neovagina with adequate size was achieved in all cases. Long term follow up showed introital stenosis in 4 cases (12.9 %). Two of them responded to vaginal dilatation. The third one needed y-v plasty while the fourth one presented by acute abdomen secondary to ruptured vagina and was submitted to urgent laparotomy. Mucosal prolapse occurred in 1 case (3.2%). Reoperation rate was 9.6%. Sexual satisfaction was achieved among 9 sexually active cases. The subjective satisfaction score of the surgical outcome was 8.03. CONCLUSIONS: For patients with disorders of sex development of various etiologies, sigmoid vaginoplasty is the preferred technique for vaginal replacement. It is a safe technique that provides the patient with a cosmetic neovagina of adequate caliber and a satisfactory functional outcome.

Neocolpoplastia com alça exclusa de sigmóide / Neocolpoplasty with excluded sigmoid segment

Introdução: O emprego de alças intestinais para tratamento de agenesia de vagina remontaao início do século vinte, porém tem sido pouco popularizado. Método: Os autores apresentamsete casos em que a neocolpoplastia foi realizada com o emprego de alça exclusa desigmóide, transposta através do fundo de saco de Douglas, por incisão peritoneal, e alojadaem um túnel dissecado entre o reto e a bexiga. A extremidade inferior foi suturada ao intróitovaginal com incisão quebrada em V, e a extremidade superior fechada em fundo cego, ousuturada ao redor do colo uterino telescopado através dela, quando o útero estava presente.Resultados: A evolução é de três a dez anos. A técnica foi executada em três casos comausência de vagina associada à agenesia de útero, um caso de síndrome adrenogenital comatresia de vagina associada a útero infantil, e três casos de agenesia de vagina com presençade útero funcional. O útero foi preservado, com seu colo dentro da neovagina, permitindomenstruações normais em dois deles. Discussão: Não foram necessários, nem indicados,dilatações ou uso de moldes no período pós-operatório. Os resultados foram bons e o índicede complicações pequeno. As vaginas permitem penetração fácil. São amplas, profundas eelásticas, com lubrificação e aspecto visual normais. Conclusão: A neocolplastia mostrouseuma técnica viável com baixo índice de complicação, principalmente estenoses.

Introduction: The use of intestinal loops for treatment of vaginal agenesis remounts to thebeginning of XX century; however it has been little popularized. Methods: The authorspresent seven cases wherein the neocolpoplasty has been realized with the use of excludedsigmoid loop, transposed trough the bottom of Douglas sack by peritoneal incision andaccommodated in a dissected tunnel between the rectum and the bladder. The inferiorextremity was sutured to the vaginal introit with incision in V, and the superior extremityclosed in a blind bottom, or sutured around of the telescoped uterine cervix trough her, whenthe uterus was present. Results: The evolution is from three to ten years. The techniquewas executed in three cases with vagina absence associated to the uterus agenesis, onecase of adrenogenital syndrome with the vagina atresia associated to an infantile uterus,and three cases of vaginal agenesis with the presence of functional uterus. The uterus waspreserved with his lap inside of the neovagina, allowing normal menstruation in two ofthem. Discussion: Weren’t necessary, not even indicated, dilations or use of molds in thepostoperative period. The results were good and the index of complications was small.The vaginas allow easy penetration. They are ample, deep and elastic, with lubrication andnormal visual aspect. Conclusion: The neocolpoplasty show it to be a viable techniquewith low complication index, mainly estenoses.

Total vaginal replacement with sigmoid colon experience at Gaza European hospital

Absence of the vagina in the pediatric population most commonly results from congenital abnormalities.Vaginal replacement may be achieved by several techniques.We reiew our experience in the efficacy of using a segment of the sigmoid colon for primary vaginal replacement. From 2001 to 2005 we evaluated five patients who required vaginal replacement. In 4 patients the abnormality was suspected because of absent menstruation,one patient was discovered after marriage at the initial sexual approach.The diagnoses exclusively was Mayer-Rokitansky syndrome. The vagina was reconstructed using a 14 cm isolated sigmoid segment. A minimum of 1 year of followup is available.The vagina had a good appearing introitus. Three patients already had an active sexual life[married] all reported to be satisfactory by the husband and wife when asked separately.Stenosis at the mucocutaneous junction in one patient was treated withY-V plasty. We conclude that our Experience with this group of patients leads us to believe that isolated sigmoid segments provides a cosmetic, self-lubricating neovagina with low rates of failure and revision, and without the need for routine dilation

Complicaciones metabólicas encontradas en pacientes sometidos a derivación urinaria del tipo Indiana / Metabolic complications found in patients with Indiana-type urinary deviation

Se efectuó un estudio prospectivo, descriptivo, analítico y aleatorio de un total de 32 pacientes a quienes se les realizó derivación urinaria de tipo Indiana por diferentes trastornos patológicos, los más frecuentes cáncer vesical (37.5 por ciento) y mielomeningocele (21.8 por ciento), entre otras causas. En los 32 pacientes se determinaron las alteraciones metabólicas desde el punto de vista clínico y de laboratorio, así como por la presencia de litiasis e infección de vías urinarias. Entre los datos sobresalientes se encontraron hipocalcemia 42.5 por ciento), acidosis metabólica compensada (33.3 por ciento) y acidosis metabólica acompañada de hipercloremia en 20.8 por ciento de los casos. No se observó elevación de azoados en ningún paciente. Sólo en uno de ellos ocurrió litiasis en el reservorio urinario

Enterocistoplastia para el tratamiento y la reconstrucción vesical en el niño con vejiga neurogénica / Enterocystoplasty for the treatment and the bladder reconstruction in the child with neurogenic bladder

Se revisaron 20 pacientes con vejiga neurogénica de alto riesgo sometidos a enterocistoplastia. En 16 pacientes (80 por ciento) se realizó aumento vesical con colon sigmoideo, en tres (15 por ciento) con íleo y en uno (5 por ciento) con uréter. Todos experimentaban deterioro preoperatorio de las vías urinarias superiores, que en siete (35 por ciento) mejoró y en 13 (65 por ciento) se estabilizó, y en ninguno progresó. Tenían reflujo 16 pacientes (80 por ciento), que pudo curarse en 15 (94 por ciento). Otros 15 pacientes (80 por ciento) tenían incontinencia urinaria, y actualmente se conservan secos durante periodos de 31/2 a 4 horas. Los estudios cistométricos indicaron mejoría de 300 por ciento en la capacidad vesical, y disminución de 50 por ciento de la presión vesical. La función renal se estabilizó o mejoró en todos los pacientes. Se presentaron complicaciones sólo en cinco casos (20 por ciento), en dos por suboclusión intestinal, en otros dos por infección de vías urinarias sintomática y en uno por litiasis vesical. Estos resultados corroboran que la enterocistoplastia es la mejor opción de tratamiento en vejigas de alto riesgo y deterioro de vías urinarias superiores

Total bladder replacement by detubularised sigmoid colon segment.

A preliminary report of 3 cases of carcinoma bladder is presented in whom, after radical cystoprostatectomy, a low pressure neobladder is created from detubularised pelvic colon, with subsequent colo-urethral anastomosis. In selected cases, this is a feasible procedure with good patient acceptance as the normal body image is maintained. Also the low pressure neobladder ensures protection to the upper urinary tract from backpressure damage.