Aesthetic aspects of reconstructive clitoroplasty in females with bladder exstrophy–epispadias complex

Awareness about Vulvovaginal Aesthetics Procedures among Medical Students and Health Professionals in Saudi Arabia

OBJECTIVE

 The present study aimed to explore the opinion and ethical consideration of vulvovaginal aesthetics procedures (VVAPs) among health professionals and medical students in Saudi Arabia.

METHODS

 This is a cross-sectional study performed between January 2020 and April 2020. Data was collected through electronic media, WhatsApp, and emails. The results were analyzed by applying the Students t-test, and correlations were considered significant if they presented a p-value < 0.05.

RESULTS

 There is significant demand to educate doctors, health professionals, medical students, and gynecologists for the VVAPs to have a solid foundation, justified indications, and knowledge about various aesthetic options. Although female doctors, medical students, young doctors, and gynecologists have more knowledge about VVAPs, all health professionals ought to be aware of recent trends in vulvovaginal aesthetics (VVA). The present analysis determined that VVA should be under the domain of gynecologists, rather than under that of plastic surgeons, general surgeons, and cosmetologists. The majority of the participants considered that vaginal rejuvenation, "G-spot" augmentation, clitoral surgery, and hymenoplasty are not justifiable on medical grounds.

CONCLUSION

 The decision to opt for different techniques for vaginal tightening and revitalization should be taken very carefully, utilizing the shared decision-making approach. Ethical aspects and moral considerations are important key factors before embarking in the VVAPs purely for cosmetic reasons. Further research is required to determine the sexual, psychological, and body image outcomes for women who underwent elective VVAPs. Moreover, medical educators must consider VVAPs as part of the undergraduate and postgraduate medical curriculum.

Surgical treatment of stress urinary incontinence and vaginal prolapse for the woman with epispadia

Patient K.L., 32 years old. Menses started at thirteen years old, C 5/28. Patient had two vaginal deliveries in 2004 and 2010. Dysplasia cervicis uteri CIN2-3 was diagnosed in 2007, subsequently diathermoconisation cervicis uteri was performed. The woman was born with epispadia — extrophia of urethra to abdominal wall, without pubic bone. At the age of 8 she underwent an operation in Moscow. During the operation the neck of the bladder was formed as well as urethra, which opens in vulva, place of clitoris. When she was 8 years old, her bladder capacity was 30 ml, in teenage years — 90 ml. The patient also reported history of recurrent urinary tract infections. 2011.08.02 Patient took medical advice in out patient department Kaunas university hospital with a complaint of stress urinary incontinence: when going, coughing, sneezing, doing exercises, having sex and at rest of time. Also it was the sexual intercourse problems with orgasm. She was urinating 8 times per day but none at night. Gynecological examination: absence of pubic bone, vulva is abnormal: absence of labium major and clitoris. Urethra opens into the place of clitoris. Front and back walls of vagina are moving down (POP-Q II-III stage prolapsed). Cervix of uterus is short, epithelised (after diathermoconisation). Uterus is normal in size, in retro-versio-flexio position. — without pathology. Sonography: internal genital organs without pathology. Boney, Valsalva test are positive, Ulmstein test negative. Urodynamic study revealed a bladder capacity of 134 ml, voided volume 173 ml. Pressure of detrusor — 10cmH2O. Compliancenormal, max flow rate 13,8 ml/s, voiding time 24 s. Spontaneous contractions of detrusor were not observed. Surgical treatment: 2011.10.10 TOT (tension obturator tape). Anterior and posterior colporrhaphy and perineoplastic was performed. There were no complications during and after surgery. On the 2 day after operation patient was released from hospital.

Exstrophy epispadias complex- Issues beyond the initial repair

Despite advances in the management of exstrophy epispadias complex (EEC), the quality of life of these patients is far from good. The post-operative period is complicated by numerous and variable events - infection, dehiscence, upper tract dilatation with deterioration, fistulas, stone formation and incontinence to name a few of the major complications. Redo surgery for bladder closure, bladder neck reconstruction, epispadias repair and closure of fistulas are frequently required. The current focus is on limiting the frequency and morbidity of the reconstructive procedures. A successful initial closure and early satisfactory cosmetic and functional results are gratifying for the family and the health care team, but this is only the beginning of the lifelong care necessary for bladder exstrophy (BE) patients. In this article, the long-term outcome of various treatment options and the continent procedures in BE has been reviewed, tracing the journey of these patients into adolescence and adulthood.

The fate of the complete female epispadias and exstrophy bladder--is there a difference?

PURPOSE

Complete female epispadias, which occurs much more rarely than classic bladder exstrophy in females, is thought to have a more benign clinical course. We hypothesized that patients with complete female epispadias are more likely to have a larger bladder capacity and achieve voiding continence than females with classic bladder exstrophy.

MATERIALS AND METHODS

After obtaining institutional review board approval, females with complete female epispadias or classic bladder exstrophy were identified from an institutionally approved prospective database. We retrospectively reviewed the charts of 22 patients with complete female epispadias and 23 with female classic bladder exstrophy, including 3 with delayed primary closure.

RESULTS

Patients with complete female epispadias presented later and underwent the first reconstructive procedure at an older age than patients with classic bladder exstrophy. Patients with complete female epispadias had lower initial and final age adjusted bladder capacity than those with classic bladder exstrophy but the bladder growth rate did not differ between the groups. When patients with complete female epispadias were stratified by age at initial reconstruction, there was no difference in final age adjusted bladder capacity or the bladder growth rate. There was also no statistical difference between the groups in the number of surgeries, continence rate from initial reconstruction, bladder neck reconstruction success or need for a continent stoma.

CONCLUSIONS

This study suggests that females with classic bladder exstrophy who undergo successful primary closure have higher initial and final age adjusted bladder capacity than females with complete female epispadias but with a similar growth rate. This may reflect the creation of outlet resistance at a younger age than in those with complete female epispadias. However, no difference was identified between patients with complete female epispadias who initially underwent repair before vs after age 1 year. Patients with complete female epispadias undergo procedures to achieve continence that are similar to those in patients with classic bladder exstrophy.

Issues with the external and internal genitalia in postpubertal females born with classic bladder exstrophy: a surgical series

STUDY OBJECTIVE

To report our experience with surgical management of gynecological issues in postpubertal female patients born with classic bladder exstrophy (BE).

DESIGN

Retrospective review of clinical charts.

SETTING

Tertiary pediatric urology unit.

PARTICIPANTS

16 postpubertal female BE patients.

INTERVENTIONS

Cosmetic surgery to the external genitalia, widening of vaginal introitus, and treatment of pelvic organ prolapse.

MAIN OUTCOME MEASURES

patient satisfaction and additional gynecological problems during follow-up.

RESULTS

Eight cases (14-43 years old) underwent cosmetic procedures. All resulted in improved cosmesis, but one case complained of reduced erogenous sensitivity after clitoridoplasty. Five cases (17-20 years old) underwent widening of the vaginal introitus. The modification was as short as possible to avoid any foreshortening of the dorsal vaginal wall. Three cases 33-45 years old presented with pelvic organ prolapse. All were sexually active. One had already given birth. All the three had previously been submitted elsewhere to a posterior vaginal cutback and one to hysterectomy. Two are still awaiting further treatment due to recurrent prolapse.

CONCLUSION

Female BE patients can seek advice to improve the appearance of the external genitalia at any ages. Clitoridoplasty should be considered carefully, because it may harm erogenous sensitivity. Problems with the vaginal introitus typically present at around 20 years of age, probably when BE patients become sexually active. Opening too widely the introitus can cause a foreshortening of the posterior vaginal wall, predisposing to pelvic organ prolapse. Treatment of pelvic organ prolapse is difficult.