1
|
Mañero Vazquez I, Labanca T, Herrero R. Double longitudinal myotomy in gender-affirming colovaginoplasty: an innovative surgical technique to prevent and treat neovaginal spasms. J Sex Med 2024; 21:342-349. [PMID: 38441522 DOI: 10.1093/jsxmed/qdae017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 12/10/2023] [Accepted: 01/15/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND Gender-affirming colovaginoplasty (GACv) presents excellent postoperative results. However, neovaginal spasms, reported as painful cramps, can affect the sexual life of patients. AIM The study sought to describe an innovative surgical technique and evaluate its impact on the prevention and treatment of neovaginal spasms. METHODS This was a single-center prospective observational study with 2 series of patients: (1) patients who underwent GACv with double myotomy (DM) for spasm prevention (series A), in which longitudinal myotomies were performed across the defunctionalized colon, transecting the taenias, and resecting 2 strips of the intestinal muscle layer of approximately 1- to 2-mm wide and tall, leaving intact colonic tissue between strips; and (2) patients who reported neovaginal spasms in whom intravaginal-DM was performed as treatment surgery (series B), in which the posterior wall of the neovagina was dissected from the rectum and transected by longitudinal myotomies, resecting 2 strips of endoluminal mucosa and submucosal muscle of approximately 1- to 2-mm wide and tall, and the colonic mucosa was subsequently closed. OUTCOMES Patient-reported outcomes and neovaginal examination were performed following standardized protocols. RESULTS In series A, 177 patients underwent GACv with the DM technique and were prospectively followed for a median time of 18 months (interquartile range, 13-60 months). No patients reported neovaginal spasms. In series B, 18 patients who reported neovaginal spasms after GACv were treated with intravaginal DM. After a median time of 35 months (interquartile range, 26-45 months), 83% (n = 15 of 18) reported remission of symptoms. CLINICAL IMPLICATIONS Double longitudinal myotomy performed on the derived portion of the colon in colovaginoplasty is an easy-to-perform and safe technique that may prevent and treat postoperative neovaginal spasms. STRENGTHS AND LIMITATIONS Our results presented certain limitations, mainly associated with a low prevalence of neovaginal spasms, which, being of personal perception, can be underdiagnosed. To the same extent, the fact that it is a monocentric experience limits the possibility of extrapolating it to other centers. Moreover, a more trained surgical team may be the cause of fewer postoperative complications. On the other hand, the fact of being a reference center for gender-affirming surgery, having our procedures protocolized, and the prospective nature of the study allowed us to obtain a certain homogeneity and granularity of the results. CONCLUSION DM is a safe procedure and appears to be highly effective for the prevention and treatment of neovaginal spasms after GACv. Routine use of this technique does not increase the operating time or postoperative complications. Multicenter, prospective studies are required to validate our results.
Collapse
Affiliation(s)
- Iván Mañero Vazquez
- Department of Plastic Surgery, IM Gender, IM CLINIC, Institute of Plastic Surgery, Barcelona, 08174, Spain
| | - Trinidad Labanca
- Department of Plastic Surgery, IM Gender, IM CLINIC, Institute of Plastic Surgery, Barcelona, 08174, Spain
| | - Roberto Herrero
- Department of Plastic Surgery, IM Gender, IM CLINIC, Institute of Plastic Surgery, Barcelona, 08174, Spain
| |
Collapse
|
2
|
Uncu G, Kasapoglu I, Aslan K. Unification and orificing of two functional noncommunicating uterine horns through the created neovagina using peritoneum. Fertil Steril 2024:S0015-0282(24)00128-6. [PMID: 38403107 DOI: 10.1016/j.fertnstert.2024.02.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 02/09/2024] [Accepted: 02/19/2024] [Indexed: 02/27/2024]
Abstract
OBJECTIVE To demonstrate the surgical approach for Müllerian agenesis with bilateral uterine remnants containing functional endometrium. DESIGN Stepwise demonstration of the technique with narrated video footage. SETTING Reproductive surgery unit of a tertiary university hospital. PATIENT An 18-year-old adolescent was admitted to a tertiary university hospital with complaints of primary amenorrhea and cyclic pelvic pain. Physical examination and magnetic resonance imaging scans suggested a complex Müllerian abnormality. The patient had uterine remnants with bilateral functional endometrium and cervicovaginal agenesis. INTERVENTION An operation was planned to reconstruct her anatomy by providing a neovagina and anastomosing the uterine remnants. Gonadotropin-releasing hormone analogs were prescribed to suppress her menstruation until the procedure. The operation was performed in the third month after the initial diagnosis. A laparoscopy was conducted, revealing approximately 5 × 6-cm bilateral uterine horns with healthy adnexa. As the first step, a neovagina was created using a modified peritoneal pull-down technique, a standard approach in our clinic. A vaginal incision was made, and a blind vaginal dissection was performed to reach the peritoneum vaginally. Subsequently, an acrylic vaginal mold was inserted. The vaginal orifice was laparoscopically incised using ultrasonic energy with guidance from the inserted vaginal acrylic mold. The orifice was gradually dilated with larger molds. The entire pelvic peritoneum was dissected circularly, and the distal part of the dissected peritoneum was pulled down using four 2.0 Vicryl sutures at 0°, 90°, 180°, and 270° from the opened vaginal orifice. The uterine cavities of both remnants were incised, and two separate Foley catheters were placed in both cavities. A mold with a hole was used to insert the catheters through the vagina. Both catheters were secured in the cavities with Prolene sutures pulled up from the anterior abdominal wall. The next step involved uterine anastomosis. The uterine remnants were unified through continuous suturing, resulting in the formation of a normally shaped uterus. In the final step, the created uterus and neovagina were anastomosed. The patient received instructions on how to perform mold exercises and follow-up care. MAIN OUTCOME MEASURE Description of laparoscopic management of a rare Müllerian abnormality. RESULTS The postoperative magnetic resonance imaging scan at 1 month revealed healed unified uterine cavities and vagina. The patient experienced spontaneous menstruation in the second month after surgery and now maintains regular menses with an approximately 9-10 cm functional vagina. Within 3 months after surgery, the visual analogue scale scores for chronic pelvic pain and dysmenorrhea decreased from 9 to 2-3. CONCLUSIONS Müllerian abnormalities are exceptionally rare, and their spectrum is broad, making it challenging to identify an exact surgical method to restore functional anatomy. Therefore, a customized surgical approach should be designed for each patient on the basis of their unique condition.
Collapse
Affiliation(s)
- Gurkan Uncu
- Bursa Uludag University Faculty of Medicine, Department of Obstetrics and Gynecology, Subdivision of Reproductive Endocrinology & Infertility, Bursa, Turkey.
| | - Isil Kasapoglu
- Bursa Uludag University Faculty of Medicine, Department of Obstetrics and Gynecology, Subdivision of Reproductive Endocrinology & Infertility, Bursa, Turkey
| | - Kiper Aslan
- Bursa Uludag University Faculty of Medicine, Department of Obstetrics and Gynecology, Subdivision of Reproductive Endocrinology & Infertility, Bursa, Turkey
| |
Collapse
|
3
|
Dzyubak O, Salman L, Covens A. Use of Rectus Flaps in Reconstructive Surgery for Gynecologic Cancer. Curr Oncol 2024; 31:394-402. [PMID: 38248111 PMCID: PMC10814897 DOI: 10.3390/curroncol31010026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 12/28/2023] [Accepted: 01/09/2024] [Indexed: 01/23/2024] Open
Abstract
The aim of this study was to explore the outcomes of pelvic reconstruction with a rectus abdominis myocutaneous (RAM) or rectus abdominis myoperitoneal (RAMP) flap following radical surgery for gynecologic malignancy. This is a retrospective case series of all pelvic reconstructions with RAM or RAMP flap performed in a gynecologic oncology service between 1998 and 2023. Reconstructions with other flaps were excluded. A total of 28 patients were included. Most patients had vulvar cancer (n = 15, 53.6%) and the majority had disease recurrence (n = 20, 71.4%). Exenteration was the most common procedure, being carried out in 20 (71.4%) patients. Pelvic reconstruction was carried out with a RAM flap in 24 (85.7%) cases and a RAMP flap in 4 (14.3%) cases. Flap-specific complications included cellulitis (14.3%), partial breakdown (17.9%), and necrosis (17.9%). Donor site complications included surgical site infection and necrosis occurring in seven (25.0%) and three (10.7%) patients, respectively. Neovaginal reconstruction was performed in 14 patients. Out of those, two (14.3%) had neovaginal stenosis and three (21.4%) had rectovaginal fistula. In total, 50% of patients were disease-free at the time of the last follow up. In conclusion, pelvic reconstruction with RAM/RAMP flaps, at the time of radical surgery for gynecologic cancer, is an uncommon procedure. In our case series, we had a significant complication rate with the most common being infection and necrosis. The development of a team approach, with input from services including Gynecologic Oncology and Plastic Surgery should be developed to decrease post-operative complications and improve patient outcomes.
Collapse
Affiliation(s)
- Oleksandra Dzyubak
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, University of Toronto, 610 University Ave., Toronto, ON M5G 2M9, Canada; (O.D.); (L.S.)
- Division of Gynecologic Oncology, Sunnybrook Health Sciences Centre, 2075 Bayview Ave., Toronto, ON M4N 3M5, Canada
| | - Lina Salman
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, University of Toronto, 610 University Ave., Toronto, ON M5G 2M9, Canada; (O.D.); (L.S.)
- Division of Gynecologic Oncology, Sunnybrook Health Sciences Centre, 2075 Bayview Ave., Toronto, ON M4N 3M5, Canada
| | - Allan Covens
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, University of Toronto, 610 University Ave., Toronto, ON M5G 2M9, Canada; (O.D.); (L.S.)
- Division of Gynecologic Oncology, Sunnybrook Health Sciences Centre, 2075 Bayview Ave., Toronto, ON M4N 3M5, Canada
| |
Collapse
|
4
|
Baby A, Pallam MC, Hayter M. Effectiveness of non-surgical interventions to improve health and well-being in women living with Mayer-Rokitansky-Kuster-Hauser syndrome: A systematic review. J Adv Nurs 2023. [PMID: 37994266 DOI: 10.1111/jan.15976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 10/03/2023] [Accepted: 11/07/2023] [Indexed: 11/24/2023]
Abstract
AIM The aim of this paper is to present the evidence on the effectiveness of non-surgical interventions to improve health and well-being in women living with Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome. DESIGN Systematic review guided by Preferred Reporting Items for Systematic Reviews checklist. DATA SOURCES The search was conducted between June and September 2022 across the following databases: CINAHL, EMBASE, Medline, PsycINFO and Cochrane. Trial registries (clinicaltrials. gov, World Health Organization International Clinical Trials Registry Platform (ICTRP), Cochrane Controlled Trials Register-CCTR), Google scholar, dissertations, conference proceedings and reference lists of included studies were also searched. Corresponding authors, formal and informal MRKH groups were contacted to obtain any significant studies or reviews. REVIEW METHODS Eligible were only English-language empirical studies of any time period. The review followed narrative synthesis. RESULTS Twenty-three studies were identified that fit the inclusion criteria which included 1540 MRKH syndrome affected women. Four studies were on psychological interventions (n = 85) and 19 studies (vaginal dilation therapy n = 897, coital dilation n = 57) focused on non-surgical vaginal dilation as a measure to vaginal agenesis in MRKH syndrome. CONCLUSIONS Clearly, vaginal dilation is a viable initial treatment option for women with MRKH syndrome. There is limited evidence that 'coital dilation' is an effective method of dilation for vaginal agenesis. The literature, however, supports the need for psychological intervention to improve health and well-being. IMPACT Women with MRKH syndrome who require dilation can receive guidance and support from their healthcare providers, particularly sexual and reproductive health nurses, clinical nurse specialists and gynaecologists. From the point of diagnosis, clinical psychologists should be involved. As much as feasible, family and partner support can be encouraged. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution.
Collapse
Affiliation(s)
- Anu Baby
- Manchester University NHS Foundation Trust, Manchester, UK
| | | | - Mark Hayter
- Manchester Metropolitan University, Manchester, UK
| |
Collapse
|
5
|
Cortez JL, Turner DN, Durkin JR, Logue ME. Condyloma of the neovaginal vault successfully treated with topical cidofovir therapy. JAAD Case Rep 2023; 41:104-106. [PMID: 37920704 PMCID: PMC10618620 DOI: 10.1016/j.jdcr.2023.09.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2023] Open
Affiliation(s)
- Jose L. Cortez
- Department of Dermatology, University of New Mexico, Albuquerque, New Mexico
| | | | - John R. Durkin
- Department of Dermatology, University of New Mexico, Albuquerque, New Mexico
| | - Mary E. Logue
- Department of Dermatology, University of New Mexico, Albuquerque, New Mexico
| |
Collapse
|
6
|
Hallarn J, Bauer GR, Potter E, Wilcox H, Newfeld J, Krakowsky Y, Ravel J, Prodger JL. Gynecological concerns and vaginal practices and exposures among transfeminine individuals who have undergone vaginoplasty. J Sex Med 2023; 20:1344-1352. [PMID: 37700562 PMCID: PMC10627778 DOI: 10.1093/jsxmed/qdad109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 07/04/2023] [Accepted: 07/28/2023] [Indexed: 09/14/2023]
Abstract
BACKGROUND Vaginoplasty is a gender-affirming surgery that is medically necessary for some transfeminine individuals. Little research exists describing vaginal health after the initial recovery from surgery, and evidence-based guidelines for vaginal care practices are unavailable. AIM The study sought to describe self-reported gynecological concerns and vaginal care practices among transfeminine persons who have undergone vaginoplasty. METHODS A total of 60 transfeminine participants 18+ years of age, living in Canada, and who had undergone vaginoplasty at least 1 year prior were recruited through social media, community groups, healthcare provider referrals, and study recontact. Participants completed a cross-sectional, online questionnaire detailing demographics, gynecological concerns, and genital practices and exposures. Hierarchical clustering was used to group participants based on behavioral practices and exposures. Associations between clusters and gynecological concerns were assessed. OUTCOMES Outcomes included self-reported gynecological concerns within the past year, recent vulvar or vaginal symptoms (past 30 days), and behavioral practices/exposures, including douching with varied products and dilating. RESULTS Participants reported a variety of concerns in the past year, including urinary tract infection (13%) and internal hair regrowth (23%). More than half (57%) had experienced at least 1 recent vaginal symptom, most commonly malodor (27%) and vaginal bleeding (21%). Of participants, 48% were dilating weekly and 52% reported douching in the past 30 days. Four distinct clusters of vaginal practices/exposures were identified: limited exposures; dilating, no douching; dilating and douching; and diverse exposures. No significant associations between cluster membership and gynecological concerns were identified, though cluster membership was significantly associated with surgical center (P = .03). Open-text write-ins provided descriptions of symptoms and symptom management strategies. CLINICAL IMPLICATIONS The results provide insight for clinicians on common patient-reported gynecological concerns and current vaginal care practices and exposures, including symptom management strategies. STRENGTHS AND LIMITATIONS This was the first study to investigate vaginal health and genital practices/exposures among a community sample of transfeminine individuals. As participants self-enrolled for a detailed survey and swab collection, individuals experiencing concerns were likely overrepresented. CONCLUSION Transfeminine individuals reported a range of gynecological concerns outside of the surgical healing period. Genital practices/exposures varied across clusters, but no clear associations between clusters and symptoms were identified; instead, practice/exposure clusters were dependent on where the individual underwent vaginoplasty. There is a need for evidence to inform diagnostics, treatments, and vaginal care guidelines to support vaginal health.
Collapse
Affiliation(s)
- Jason Hallarn
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, ON N6A 3K7, Canada
| | - Greta R Bauer
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, ON N6A 3K7, Canada
- Institute for Sexual and Gender Health, University of Minnesota Medical School, Minneapolis, MN 55415, United States
| | - Emery Potter
- Women’s College Research Institute, Women’s College Hospital, Toronto, ON M5G 1N8, Canada
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON M5S 1A1, Canada
| | - Hannah Wilcox
- Department of Microbiology and Immunology, Schulich School of Medicine and Dentistry, Western University, London, ON N6A 3K7, Canada
| | - Jacy Newfeld
- Department of Ecology and Evolutionary Biology, University of Toronto, Toronto, ON M5S 1A1, Canada
- Department of Biology, University of Toronto Mississauga, Mississauga, ON L5L 1C6, Canada
| | - Yonah Krakowsky
- Women’s College Research Institute, Women’s College Hospital, Toronto, ON M5G 1N8, Canada
- Transition Related Surgery, Department of Surgery, Women’s College Hospital, University of Toronto, Toronto, ON M5G 1N8, Canada
- Division of Urology, Department of Surgery, University of Toronto, Toronto, ON M5S 1A1, Canada
| | - Jacques Ravel
- Institute for Genome Sciences, University of Maryland School of Medicine, Baltimore, MD 21201, United States
- Department of Microbiology and Immunology, University of Maryland School of Medicine, Baltimore, MD 21201, United States
| | - Jessica L Prodger
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, ON N6A 3K7, Canada
- Department of Microbiology and Immunology, Schulich School of Medicine and Dentistry, Western University, London, ON N6A 3K7, Canada
| |
Collapse
|
7
|
Bang AS, Garcia MM, Leslie KS, Amerson EH. Management of Neovaginal Secretions After Salvage Gender Affirming Right-Colon Vaginoplasty Using Glycopyrrolate. Transgend Health 2023; 8:477-480. [PMID: 37810938 PMCID: PMC10551751 DOI: 10.1089/trgh.2021.0158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Purpose We report a novel case of a transgender woman who experienced excess mucosal secretion leading to symptomatic skin irritation after her colonic vaginoplasty successfully treated with glycopyrrolate. Methods This is a case report of a 47-year-old transgender woman with symptomatic excess mucosal secretion and skin irritation from colonic vaginoplasty, and we describe her treatment course and responses. Patient consent was obtained for publication. Results The patient's chronic neovaginal discharge improved with glycopyrrolate. Conclusions Anticholinergic drugs may be helpful in treating patients who experience chronic neovaginal discharge following colonic vaginoplasty.
Collapse
Affiliation(s)
- Alexander Sydat Bang
- Department of Dermatology, University of California, San Francisco, San Francisco, California, USA
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Department of Dermatology, Weill Cornell Medicine, New York, New York, USA
| | - Maurice Marcel Garcia
- Cedars-Sinai Medical Center Transgender Surgery and Health Program, Los Angeles, California, USA
- Department of Urology, University of California, San Francisco, San Francisco, California, USA
- Department of Anatomy, University of California, San Francisco, San Francisco, California, USA
| | - Kieron Seymour Leslie
- Department of Dermatology, University of California, San Francisco, San Francisco, California, USA
| | - Erin Huiras Amerson
- Department of Dermatology, University of California, San Francisco, San Francisco, California, USA
| |
Collapse
|
8
|
Alter K, Baruch D, Ambinder D, Vaserman G, Lin N, Saji A, Bassily D, White C, Rahman M, Tang X, Ritter E, Choudhury M, Bendl R, Phillips J. Pelvic Exenteration and Abdomino-Perineal Resection in a Transgender Female with Squamous Cell Carcinoma of Unknown Origin. Urology 2023:S0090-4295(23)00188-7. [PMID: 36868412 DOI: 10.1016/j.urology.2023.02.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 02/07/2023] [Accepted: 02/13/2023] [Indexed: 03/05/2023]
Affiliation(s)
- Kevin Alter
- Department of Urology, Westchester Medical Center, Valhalla, NY.
| | - David Baruch
- Department of Urology, New York Medical College, Valhalla, NY
| | - David Ambinder
- Department of Urology, Westchester Medical Center, Valhalla, NY
| | | | - Nicole Lin
- Department of Surgery, Westchester Medical Center, Valhalla, NY
| | - Akhil Saji
- Department of Urology, Westchester Medical Center, Valhalla, NY
| | - Daniel Bassily
- Department of Urology, Westchester Medical Center, Valhalla, NY
| | - Charles White
- Department of Urology, Westchester Medical Center, Valhalla, NY
| | - Mozibur Rahman
- Department of Pathology, Westchester Medical Center, Valhalla, NY
| | - Xiaoyu Tang
- Department of Pathology, Westchester Medical Center, Valhalla, NY
| | - Edmond Ritter
- Department of Plastic Surgery, Westchester Medical Center, Valhalla, NY
| | | | - Ryan Bendl
- Department of Surgery, Westchester Medical Center, Valhalla, NY
| | - John Phillips
- Department of Urology, Westchester Medical Center, Valhalla, NY
| |
Collapse
|
9
|
Potter E, Sivagurunathan M, Armstrong K, Barker LC, Du Mont J, Lorello GR, Millman A, Urbach DR, Krakowsky Y. Patient reported symptoms and adverse outcomes seen in Canada's first vaginoplasty postoperative care clinic. Neurourol Urodyn 2023; 42:523-529. [PMID: 36630152 DOI: 10.1002/nau.25132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 12/28/2022] [Indexed: 01/12/2023]
Abstract
IMPORTANCE Vaginoplasty is a relatively common gender-affirming surgery with approximately 200 Ontarians seeking this surgery annually. Although Ontario now offers vaginoplasty in province, the capacity is not meeting demand; the majority of trans and gender-diverse patients continue to seek vaginoplasty out of province. Out-of-province surgery presents a barrier to accessing postsurgical follow-up care leaving most patients to seek support from their primary care providers or providers with little experience in gender-affirming surgery. OBJECTIVE To provide an account of the common postoperative care needs and neovaginal concerns of Ontarians who underwent penile inversion vaginoplasty out of province and presented for care at a gender-affirming surgery postoperative care clinic. DESIGN, SETTINGS, AND PARTICIPANTS A retrospective chart review of the first 80 patients presenting to a gender-affirming surgery postoperative care clinic who had undergone vaginoplasty at an outside surgical center was performed. Descriptive analyses were performed for all variables. RESULTS The sample consisted of 80 individuals with the mean age of 39 years (19-73). Most patients had surgery at another surgical center in Canada (76.3%). Many patients (22.5%) accessed care in the first 3 months after surgery, with the majority (55%) seeking care within the first perioperative year. Most patients (61.3%) were seen for more than one visit and presented with more than two symptoms or concerns. Common patient-reported symptoms during clinical visit included pain (53.8%), dilation concerns (46.3%), and surgical site/vaginal bleeding (42.5%). Sexual function concerns were also common (33.8%) with anorgasmia (11.3%) and dyspareunia (11.3%) being the most frequent complications. The most common adverse outcomes identified by health care providers included hypergranulation (38.8%), urinary dysfunction (18.8%), and wound healing issues (12.5%). CONCLUSIONS AND RELEVANCE Findings from chart review offer valuable insights into the postoperative needs and neovaginal concerns of Ontarians who have had vaginoplasty out of province. This study demonstrates the need for routine postoperative care in patients undergoing vaginoplasty. Patients experience numerous symptoms and concerns that often correlate with clinical findings and require multiple follow-up appointments. Health care providers may benefit from further education on the more common nonsurgical issues identified in this study.
Collapse
Affiliation(s)
- Emery Potter
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada.,Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | | | - Kathleen Armstrong
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
| | - Lucy C Barker
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Janice Du Mont
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Gianni R Lorello
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada.,Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Anesthesia and Pain Management, University Health Network - Toronto Western Hospital, Toronto, Ontario, Canada.,The Wilson Centre, University Health Network, Toronto, Ontario, Canada
| | - Alexandra Millman
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada.,Transition Related Surgery Program, Women's College Hospital, University of Toronto, Toronto, Ontario, Canada
| | - David R Urbach
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada.,Transition Related Surgery Program, Women's College Hospital, University of Toronto, Toronto, Ontario, Canada.,Department of Surgery, Women's College Hospital, Toronto, Ontario, Canada
| | - Yonah Krakowsky
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada.,Transition Related Surgery Program, Women's College Hospital, University of Toronto, Toronto, Ontario, Canada.,Division of Urology, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
10
|
Stepanow C, Naderer A, Alexopoulos J, Walch K, Wenzl R, Leithner K. Sexual health and sexual well-being of women with Mayer-Rokitansky-Kuester-Hauser syndrome after vaginal reconstruction: a qualitative analysis. J Sex Med 2023; 20:57-64. [PMID: 36897238 DOI: 10.1093/jsxmed/qdac011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 09/29/2022] [Accepted: 10/23/2022] [Indexed: 01/15/2023]
Abstract
BACKGROUND Contradictory findings on sexual health in women with Mayer-Rokitansky-Kuester-Hauser syndrome (MRKHS) after vaginal reconstruction point toward the need for more profound assessment of this subject, particularly as it is still unclear what constitutes sexual well-being, especially genital self-image or sexual self-esteem, in women with MRKHS and neovagina. AIM The aim of this qualitative study was to assess individual sexual health and sexual well-being in the context of MRKHS after vaginal reconstruction, with an emphasis on genital self-image, sexual self-esteem, sexual satisfaction, and coping with MRKHS. METHODS Qualitative semistructured interviews were conducted with women with MRKHS after vaginal reconstruction (n = 10) with the Wharton-Sheares-George surgical method and a matched control group without MRKHS (n = 20). Women were surveyed about their previous and current sexual activities, perception of and attitudes toward their genitals, disclosure to others, coping with the diagnosis, and perception of surgery. Data were analyzed through qualitative content analysis and compared with the control group. OUTCOMES The primary outcomes of the study were major categories, such as sexual satisfaction, sexual self-esteem, genital self-image, and dealing with MRKHS, as well as subcategories related to the content analysis. RESULTS Although half the women in the present study indicated that they were coping well with their condition and were satisfied with sexual intercourse, most felt insecure about their neovagina, were cognitively distracted during intercourse, and showed low levels of sexual self-esteem. CLINICAL IMPLICATIONS A better understanding of expectations and uncertainties regarding the neovagina might help professionals to support women with MRKHS after vaginal reconstruction to increase sexual well-being. STRENGTHS AND LIMITATIONS This is the first qualitative study focusing on individual aspects of sexual well-being, especially sexual self-esteem and genital self-image, in women with MRKHS and neovagina. The qualitative study indicates good interrater reliability and data saturation. The limitations of this study include the inherent lack of objectivity resulting from the method but also the fact that all the patients had a particular surgical technique, consequently resulting in limited generalizability of these findings. CONCLUSIONS Our data indicate that integrating the neovagina into the genital self-image is a prolonged process that is essential for sexual well-being and should thus be the focus of sexual counseling.
Collapse
Affiliation(s)
- Clara Stepanow
- Department of Psychoanalysis and Psychotherapy, Medical University Vienna, Vienna A-1090, Austria
| | - Andrea Naderer
- Department of Psychoanalysis and Psychotherapy, Medical University Vienna, Vienna A-1090, Austria
| | - Johanna Alexopoulos
- Department of Psychoanalysis and Psychotherapy, Medical University Vienna, Vienna A-1090, Austria
| | - Katharina Walch
- Department of Obstetrics and Gynaecology, Medical University Vienna, Vienna A-1090, Austria
| | - Rene Wenzl
- Department of Obstetrics and Gynaecology, Medical University Vienna, Vienna A-1090, Austria
| | - Katharina Leithner
- Department of Psychoanalysis and Psychotherapy, Medical University Vienna, Vienna A-1090, Austria
| |
Collapse
|
11
|
Lynch NB, Malik RD. Sigmoid conduit- neovaginal fistula: a case report and literature review. Can J Urol 2022; 29:11194-11197. [PMID: 35691044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Total pelvic exenterations (TPE) are high morbidity procedures, with up to 38% of patients experiencing a major complication after TPE surgery. We report the case of a 69-year-old woman with a sigmoid conduit-neovaginal fistula who presented with new onset continuous vaginal leakage and decreased urostomy output 3 months post-op from a TPE. We highlight the presentation, diagnosis, conservative management, and surgical management of conduit-vaginal fistulas.
Collapse
Affiliation(s)
- Niccola B Lynch
- Department of Urology, Columbia University Irving Medical Center, New York, New York, USA
| | - Rena D Malik
- Division of Urology, Department of Surgery, University of Maryland Medical Center, Baltimore, Maryland, USA
| |
Collapse
|
12
|
Van Gerwen OT, Aryanpour Z, Selph JP, Muzny CA. Anatomical and sexual health considerations among transfeminine individuals who have undergone vaginoplasty: A review. Int J STD AIDS 2022; 33:106-113. [PMID: 34615399 PMCID: PMC9713597 DOI: 10.1177/09564624211046997] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
As acceptance of transgender and gender diverse individuals continues to increase, gender-affirming surgery, a cornerstone in the management of gender dysphoria, is becoming more readily available. HIV and sexually transmitted infections (STIs) disproportionately affect these populations, but there are limited epidemiologic and management data on STIs in people who have undergone gender-affirming genital surgery such as vaginoplasty. This review will provide clinicians with anatomical details about the various vaginoplasty procedures currently being performed, complications associated with these procedures, and an overview of the current literature describing HIV/STI epidemiology among transfeminine individuals who have undergone vaginoplasty.
Collapse
Affiliation(s)
- Olivia T Van Gerwen
- Department of Medicine, Division of Infectious Diseases, 9968University of Alabama at Birmingham, Birmingham, AL, USA
| | - Zain Aryanpour
- Department of Medicine, 9967University of Alabama School of Medicine, Birmingham, AL, USA
| | - John P Selph
- Department of Urology, 9968University of Alabama at Birmingham, Birmingham, AL, USA.Increase
| | - Christina A Muzny
- Department of Medicine, 9967University of Alabama School of Medicine, Birmingham, AL, USA
| |
Collapse
|
13
|
Krakowsky Y, Potter E, Hallarn J, Monari B, Wilcox H, Bauer G, Ravel J, Prodger JL. The Effect of Gender-Affirming Medical Care on the Vaginal and Neovaginal Microbiomes of Transgender and Gender-Diverse People. Front Cell Infect Microbiol 2022; 11:769950. [PMID: 35127550 PMCID: PMC8814107 DOI: 10.3389/fcimb.2021.769950] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 12/14/2021] [Indexed: 01/07/2023] Open
Abstract
Transgender and gender diverse individuals may seek gender-affirming medical care, such as hormone therapy or surgery, to produce primary and/or secondary sex characteristics that are more congruent with their gender. Gender-affirming medical care for transmasculine individuals can include testosterone therapy, which suppresses circulating estrogen and can lead to changes in the vaginal epithelium that are reminiscent of the post-menopausal period in cisgender females. Among transfeminine individuals, gender-affirming medical care can include vaginoplasty, which is the surgical creation of a vulva and neovaginal canal, commonly using penile and scrotal skin. The effect of gender-affirming medical care on the vagina of transmasculine individuals and on the neovagina of transfeminine individuals is poorly characterized. This review summarizes what is known of the epithelium and local microbiota of the testosterone-exposed vagina and the neovagina. We focus on potential pathogens and determinants of gynecological health and identify key knowledge gaps for future research.
Collapse
Affiliation(s)
- Yonah Krakowsky
- Division of Urology, Department of Surgery, Women’s College Hospital and Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada,Transition Related Surgery, Department of Surgery, Women’s College Hospital, University of Toronto, Toronto, ON, Canada
| | - Emery Potter
- Transition Related Surgery, Department of Surgery, Women’s College Hospital, University of Toronto, Toronto, ON, Canada
| | - Jason Hallarn
- Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Bern Monari
- Program in Molecular Medicine, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Hannah Wilcox
- Department of Microbiology and Immunology, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Greta Bauer
- Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Jacques Ravel
- Institute for Genome Sciences, University of Maryland School of Medicine, Baltimore, MD, United States,Department of Microbiology & Immunology, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Jessica L. Prodger
- Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada,Department of Microbiology and Immunology, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada,*Correspondence: Jessica L. Prodger,
| |
Collapse
|
14
|
Flor-Lorente B, Rosciano JG, Pérez-Pérez T, Sancho-Muriel J, García-Granero Á, Nohales-Alfonso FJ, Primo-Romaguera V, Simón-Sanz EA. Gender dysphoria: laparoscopic sigmoid vaginoplasty. Another utility of indocyanine green. Colorectal Dis 2021; 23:3272-3275. [PMID: 34653305 DOI: 10.1111/codi.15952] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 08/30/2021] [Accepted: 09/24/2021] [Indexed: 12/24/2022]
Abstract
AIM Gender dysphoria is the disagreement between the gender of birth and the one with which the patient identifies. For its management it is mandatory to have a multidisciplinary team. Gender confirmation surgery with penoscrotal skin flap is the procedure of choice, and a sigmoid vaginoplasty is a feasible alternative. The new technologies and the help of indocyanine green (ICG) fluorescence can help to guarantee a correct neovagina vascularization. The objective of this paper is to present the surgical technique of laparoscopic sigmoid vaginoplasty assisted by ICG. METHODS We present two patients with gender dysphoria and a history of stricture of the penoscrotal skin flap vaginoplasty. We performed sigmoid vaginoplasty by the laparoscopic approach. We began the procedure with the mobilization and section of 30 cm of sigmoid colon, selective ligation of the vessels assisted by ICG, 180° sigmoid rotation, externalized on antiperistaltic position, construction of colovestibular anastomosis and promontory fixation. We finished the procedure with virtual ileostomy construction and drain placement. RESULTS Patients recovered satisfactorily and were discharged on the seventh day after surgery without complications. CONCLUSION Sigmoid vaginoplasty is a safe and feasible procedure. ICG has great value, contributing to the selective ligation of the vessels, allowing 180° sigmoid rotation and guaranteeing the irrigation of the neovagina.
Collapse
Affiliation(s)
- Blas Flor-Lorente
- Colorectal Surgery Unit, Hospital Universitario y Politécnico la Fe, Valencia, Spain
| | | | - Teresa Pérez-Pérez
- General Surgery Unit, Hospital Lluis Alcanyis de Xativa, Valencia, Spain
| | - Jorge Sancho-Muriel
- Colorectal Surgery Unit, Hospital Universitario y Politécnico la Fe, Valencia, Spain
| | - Álvaro García-Granero
- Colorectal Surgery Unit, Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | | | | | | |
Collapse
|
15
|
Kisu I, Iida M, Nakamura K, Banno K, Shiraishi T, Tokuoka A, Yamaguchi K, Tanaka K, Iijima M, Senba H, Matsuda K, Hirao N. Laparoscopic Vaginoplasty Procedure Using a Modified Peritoneal Pull-Down Technique with Uterine Strand Incision in Patients with Mayer-Rokitansky-Küster-Hauser Syndrome: Kisu Modification. J Clin Med 2021; 10:5510. [PMID: 34884214 DOI: 10.3390/jcm10235510] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 11/23/2021] [Accepted: 11/24/2021] [Indexed: 11/16/2022] Open
Abstract
Various vaginoplasty procedures have been developed for patients with Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome. Here, we describe a novel laparoscopic vaginoplasty procedure, known as the Kisu modification, using a pull-down technique of the peritoneal flaps with additional structural support to the neovaginal apex using the incised uterine strand in patients with MRKH syndrome. Ten patients with MRKH syndrome (mean age at surgery: 23.9 ± 6.5 years, mean postoperative follow-up period: 17.3 ± 3.7 months) underwent construction of a neovagina via laparoscopic vaginoplasty. All surgeries were performed successfully without complications. The mean neovaginal length at discharge was 10.3 ± 0.5 cm. Anatomical success was achieved in all patients, as two fingers were easily introduced, the neovagina was epithelialized, and the mean neovaginal length was 10.1 ± 1.0 cm 1 year postoperatively. No obliteration, granulation tissue formation at the neovaginal apex, or neovaginal prolapse was recorded. Five of the 10 patients attempted sexual intercourse and all five patients were satisfied with the sexual activity, indicating functional success. Although the number of cases in this case series is few, our favorable experience suggests that the Kisu modification of laparoscopic vaginoplasty procedure is an effective, feasible, and safe approach for neovaginal creation in patients with MRKH syndrome.
Collapse
|
16
|
Chatterjee US, Basu AK, Das S, Mitra D. Abdominoperineal Tunnel Crafted with Alken's Telescopic Dilators: A Novel Technique! J Indian Assoc Pediatr Surg 2021; 26:334-335. [PMID: 34728920 PMCID: PMC8515534 DOI: 10.4103/jiaps.jiaps_129_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 07/23/2020] [Accepted: 08/04/2020] [Indexed: 11/04/2022] Open
Abstract
Background Abdomino-perineal pull through procedure needs perineal dissection and for that swap of supine to prone may be necessary. To avoid that as well as to avoid neuro-muscular damage; we are describing a simple minimal invasive procedure with help of Alken's telescopic dilators. Patients & Methods We created abdomino-perineal tunnel with Alken's telescopic dilators to bring down the lumen of intestine in perineum in eight patients. Results Operative time happened to be less and procedure found to be less traumatic. All the eight patients had satisfactory outcome. Conclusions Actually, we have repurposed the Alken's dilator for creation of abdomino-perineal tunnel or track to get benefit of minimal dissection of perineum during pull-through procedure as well as to avoid neuro-muscular damage.
Collapse
Affiliation(s)
| | - Ashoke Kumar Basu
- Department of Pediatric Surgery, Park Clinic, Kolkata, West Bengal, India
| | - Sachchidananda Das
- Department of Pediatric Surgery, Park Clinic, Kolkata, West Bengal, India
| | - Debashis Mitra
- Department of Pediatric Surgery, Park Clinic, Kolkata, West Bengal, India
| |
Collapse
|
17
|
Kim JK, Na W, Cho JH, Ahn EJ, Kim E, Song IG, Han EC, Lee DW, Park BK, Park YG, Kim BG. Refinement of recto-sigmoid colon vaginoplasty using a three-dimensional laparoscopic technique. Medicine (Baltimore) 2021; 100:e27042. [PMID: 34477135 PMCID: PMC8416006 DOI: 10.1097/md.0000000000027042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 08/11/2021] [Indexed: 01/18/2023] Open
Abstract
To investigate the feasibility, safety, and outcomes of three-dimensional (3D) laparoscopic vaginoplasty with a rectosigmoid colon flap for vaginal reconstruction.Following appropriate preoperative patient counseling, 17 consecutive patients underwent vaginoplasty using a 3D laparoscopic system. Perioperative and postoperative outcomes were retrospectively evaluated.Between September 2016 and February 2020, 17 patients underwent 3D laparoscopic vaginoplasty with a rectosigmoid colon flap. Of them, 15 (88%) were transgender female patients, and 2 (12%) were cisgender female patients with congenital deformities. Among the 15 transgender patients, 12 (80%) underwent de novo surgeries and 3 (20%) underwent re-do surgeries. The mean age at the time of operation was 33.0 years, and the mean total operation time was 529 ± 128 minutes. The initial intraoperative mean vaginal depth was 15.2 ± 1.3 cm, and the 30-day readmission rate was 5.9% (1/17 cases). The mean follow-up duration was 24.8 months.Perioperative and postoperative outcomes suggest that 3D laparoscopic rectosigmoid colon vaginoplasty is a potentially acceptable, effective, and safe method for vaginal reconstruction.
Collapse
Affiliation(s)
- Jeong-ki Kim
- Department of Surgery, National Medical Center, Seoul, Republic of Korea
- Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Woong Na
- Department of Urology, National Medical Center, Seoul, Republic of Korea
| | - Jeong Hyun Cho
- Department of Urology, National Medical Center, Seoul, Republic of Korea
| | - Eun Jung Ahn
- Department of Surgery, National Medical Center, Seoul, Republic of Korea
| | - Eunyoung Kim
- Department of Surgery, National Medical Center, Seoul, Republic of Korea
| | - In-Gyu Song
- Department of Surgery, National Medical Center, Seoul, Republic of Korea
| | - Eon Chul Han
- Department of Surgery, Dongnam Institute of Radiological and Medical Sciences, Busan, Republic of Korea
| | - Dong Woon Lee
- Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Republic of Korea
| | - Byung Kwan Park
- Department of Surgery, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Yong-Gum Park
- Department of Surgery, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Beom Gyu Kim
- Department of Surgery, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| |
Collapse
|
18
|
Abstract
OBJECTIVE Evaluation of the quality of sexual life of women with Mayer-Rokitansky-Küster-Hauser syndrome (MRKHS) after neovagina creation using dilation and surgical techniques. METHODS Literature search of articles published in the years 2000–2021 using the databases Web of Science, Google Scholar and PubMed by key words: Mayer-Rokitansky-Küster-Hauser syndrome, neovagina, female sexuality and Female Sexual Function Index. We used a standardized international Female Sexual Function Index and other quantitative and qualitative parameters of sexual satisfaction to assess sexual function and overall satisfaction in women with neovagina. RESULTS It is possible to develop functional neovagina in women with MRKHS by either conservative or surgical techniques. The choice of the method used depends on the experience and skill of the surgeon, on the technical possibilities and equipment of the department, and on the anatomical predispositions and preferences of the patient. Satisfaction with sexual life also depends on the psychosexual maturity and sexual demands of both partners as well as on regular vaginal rehabilitation and quality of long-term psychological support. The functional results of dilation and surgical methods are comparable according to objective criteria. They only differ in individual aspects which correspond to the overall personality traits as well as to the character and quality of cohabitation. CONCLUSION Women with MRKHS are primarily handicapped by coital insufficiency and inability to reproduce naturally. Creating a neovagina technically allows them to realize satisfactory coitus, but in most cases, they are still frustrated by the primary problem of „physical indisposition“ and complicated path to motherhood.
Collapse
|
19
|
Kisu I, Banno K, Iida M, Matsuda K, Shiraishi T, Iijima M, Nakamura K, Hirao N. Successful trachelectomy and re-vaginoplasty for cervico-vaginal stenosis following unsuccessful uterovaginal anastomosis and vaginoplasty in congenital cervical and vaginal aplasia: description of technique and a case report. BJOG 2021; 128:1997-2002. [PMID: 34021948 DOI: 10.1111/1471-0528.16770] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2021] [Indexed: 11/28/2022]
Abstract
We describe a successful surgical technique of abdominal trachelectomy and re-vaginoplasty for cervico-vaginal stenosis following unsuccessful uterovaginal anastomosis and vaginoplasty in a patient with congenital cervical and vaginal aplasia. After the surgical procedure, cervico-vaginal stenosis was resolved and periodic menstruation without dysmenorrhoea resumed. While long-term follow-up is essential to ensure successful pregnancy and delivery, we conclude that this novel surgical procedure is a promising alternative for improvement of the quality of life and normal sexual function, and for preservation of fertility in patients with cervical and vaginal aplasia.
Collapse
Affiliation(s)
- I Kisu
- Department of Obstetrics and Gynaecology, Federation of National Public Service Personnel Mutual Aid Associations, Tachikawa Hospital, Tokyo, Japan.,Department of Obstetrics and Gynaecology, Keio University School of Medicine, Tokyo, Japan
| | - K Banno
- Department of Obstetrics and Gynaecology, Keio University School of Medicine, Tokyo, Japan
| | - M Iida
- Department of Obstetrics and Gynaecology, Keio University School of Medicine, Tokyo, Japan
| | - K Matsuda
- Department of Obstetrics and Gynaecology, Federation of National Public Service Personnel Mutual Aid Associations, Tachikawa Hospital, Tokyo, Japan
| | - T Shiraishi
- Department of Obstetrics and Gynaecology, Federation of National Public Service Personnel Mutual Aid Associations, Tachikawa Hospital, Tokyo, Japan
| | - M Iijima
- Department of Obstetrics and Gynaecology, Federation of National Public Service Personnel Mutual Aid Associations, Tachikawa Hospital, Tokyo, Japan
| | - K Nakamura
- Department of Obstetrics and Gynaecology, Federation of National Public Service Personnel Mutual Aid Associations, Tachikawa Hospital, Tokyo, Japan
| | - N Hirao
- Department of Obstetrics and Gynaecology, Federation of National Public Service Personnel Mutual Aid Associations, Tachikawa Hospital, Tokyo, Japan
| |
Collapse
|
20
|
Erculiani M, Zanatta C, Vidal E, Martelossi S, Midrio P. Ulcerative Colitis of the Neovagina in a Toddler with Cloaca and Chronic Kidney Disease. European J Pediatr Surg Rep 2021; 9:e33-e36. [PMID: 34026418 PMCID: PMC8131128 DOI: 10.1055/s-0041-1726868] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 11/04/2020] [Indexed: 12/20/2022] Open
Abstract
The case of a toddler with long-channel cloaca, mild chronic kidney disease (CKD) due to renal dysplasia, and early onset of ulcerative colitis (UC) is herein reported. The patient underwent definitive repair of cloaca, that included vaginal elongation with colon, at 5 months of age and was admitted for episodes of vaginal bleeding at 22 months of age. A vaginoscopy revealed a severe inflammation of the colonic neovagina. As rectal bleeding was also noticed, she underwent a colonscopy that showed the same macroscopic inflammatory picture. Neovaginal and colonic biopsies confirmed UC. The mother turned out to be affected by UC since adolescence. The patient is now on oral therapy with mesalazine and topical steroid and mesalazine in the neovagina. The association between cloaca and inflammatory bowel disease (IBD) is anecdotal, but the family history of IBD should be considered when planning the surgical reconstruction of patients with cloaca. In this patient, the occurrence of UC may require a new neovagina in the future and the concomitance of CKD may complicate the overall management due to the potential nephrotoxicity of drugs used for UC therapy.
Collapse
Affiliation(s)
- Marta Erculiani
- Division of Pediatric Surgery, Presidio Ospedaliero di Treviso, Treviso, Veneto, Italy
| | - Cinzia Zanatta
- Division of Pediatric Surgery, Presidio Ospedaliero di Treviso, Treviso, Veneto, Italy
| | - Enrico Vidal
- Division of Pediatrics, Presidio Ospedaliero Universitario Santa Maria della Misericordia, Udine, Friuli-Venezia Giulia, Italy
| | - Stefano Martelossi
- Division of Pediatrics, Presidio Ospedaliero di Treviso, Treviso, Veneto, Italy
| | - Paola Midrio
- Division of Pediatric Surgery, Presidio Ospedaliero di Treviso, Treviso, Veneto, Italy
| |
Collapse
|
21
|
Grimstad F, McLaren H, Gray M. The gynecologic examination of the transfeminine person after penile inversion vaginoplasty. Am J Obstet Gynecol 2021; 224:266-273. [PMID: 33039391 DOI: 10.1016/j.ajog.2020.10.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 09/11/2020] [Accepted: 10/02/2020] [Indexed: 01/11/2023]
Abstract
As more transfeminine patients (transgender and gender-diverse persons, sex assigned male at birth, who identify on the feminine spectrum of gender) are undergoing gender-affirming penile inversion vaginoplasty, gynecologists, as providers of vaginal care for both native and neovaginas, should be prepared to welcome these patients into their practice and offer long-term pelvic healthcare. Many parts of the anatomy, clinical examination, and aftercare differ from both native vaginas and other neovaginal surgical techniques. Transgender and gender-diverse patients cite a lack of clinician knowledge as a barrier to accessing affirming and competent healthcare. Although publications are emerging regarding this procedure, most focus on intraoperative and postoperative complications. These studies are not positioned to provide long-term pelvic health guidance or robust instruction on typical examination findings. This clinical opinion aims to address that knowledge gap by describing the gynecologic examination in the transfeminine person who has undergone a penile inversion vaginoplasty. We review the anatomic changes with surgery and the neovagina's physiology. We describe the examination of the vulva, vagina, and urethra and discuss special considerations for performing pelvic examinations on patients with a penile inversion vaginoplasty neovagina. We will also address common pathologic findings and their initial management. This clinical opinion originates from the expertise of gynecologists who have cared for high volumes of transfeminine patients who have undergone penile inversion vaginoplasties at tertiary care centers performing gender-affirming genital surgery, along with existing research on postpenile inversion vaginoplasty outcomes. Gynecologists should be familiar with the anatomic changes that occur with penile inversion vaginoplasty gender-affirming surgery and how those changes affect care. Providing transgender patients with comprehensive care including this sensitive examination can and should be part of the gynecologist's scope of practice.
Collapse
Affiliation(s)
- Frances Grimstad
- Division of Gynecology, Department of Surgery, Boston Children's Hospital, Boston, MA; Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston, MA.
| | - Hillary McLaren
- Department of Obstetrics and Gynecology, University of Kansas Medical Center, Kansas City, KS
| | - Meredith Gray
- Department of Obstetrics and Gynecology, University of Kansas Medical Center, Kansas City, KS
| |
Collapse
|
22
|
Faehnle-Schiegg I, Christmann-Schmid C. Surgical Techniques for the Prolapse of Neovagina in Women: Case Report and Review of Literature. Int J Womens Health 2021; 13:81-86. [PMID: 33469386 PMCID: PMC7812039 DOI: 10.2147/ijwh.s285474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Accepted: 11/25/2020] [Indexed: 11/23/2022] Open
Abstract
Introduction A neovaginal prolapse is a rare condition. Only a few cases have been reported and described in literature. The surgical management is complex and depends on the initial surgical techniques for the reconstruction of a neovagina applied. We present a case of a stage IV prolapse of a sigmoid vaginal prolapse and a review of surgical procedures in literature. Methods We describe the case of a 41-year-old woman with a stage IV prolapse of a sigmoid neovagina who presented 20 years after the initial reconstruction due to a botryoid sarcoma of the pelvis in the childhood. The initial surgical repairs with a fixation of the apex of the sigmoid vagina to the sacral promontory with resorbable suture and consecutively in a second procedure with a polypropylene mesh failed. The interdisciplinary approach with the colorectal team which included a significant shortening of the neovagina prior to the mesh fixation led to a stable repair of the prolapse. Conclusion Only a few cases of women with a prolapse of a sigmoid neovagina are published. An interdisciplinary approach including a significant shortening of the neovagina and the fixation with a non-absorbable mesh was necessary to achieve a successful repair. The surgical techniques to create a sigmoid neovagina are crucial in order to perform successful later reconstructive surgery if indicated. Our experience in this case is consistent with the findings from our literature review.
Collapse
|
23
|
Romanski PA, Bortoletto P, Pfeifer SM. Creation of a novel inflatable vaginal stent for McIndoe vaginoplasty. Fertil Steril 2020; 115:804-806. [PMID: 33272624 DOI: 10.1016/j.fertnstert.2020.09.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 09/02/2020] [Accepted: 09/08/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To describe how to create an inflatable vaginal stent for use in McIndoe vaginoplasty that can be constructed using standard operating room supplies. DESIGN Step-by-step video instructions that demonstrate how to construct and use an inflatable vaginal stent. (This video article was exempt from institutional review board approval.) SETTING: Academic hospital. PATIENT(S) A woman presenting with vaginal agenesis requiring a McIndoe vaginoplasty for the creation of a neovagina. INTERVENTION(S) A novel inflatable vaginal stent compliant with operating room procedures that is radio-opaque, functional, and can be used for patients with or without a functional uterus. The device is modeled after the effective inflatable vaginal stent that was previously commercially available but is no longer produced. Although a vaginal stent may be created in the operating room by placing surgical sponges inside a sterilized condom, many operating rooms have restrictions on equipment that can be brought into the operating room and special criteria for how to sterilize this equipment, and there are also restrictions against leaving non-radio-opaque objects "inside" the patient. The novel inflatable vaginal stent we have developed has multiple advantages compared with a rigid dilator: it is deflatable, so it does not cause trauma or interrupt the delicate tissue graft during insertion, removal, or repositioning; it is firm enough to conform and circumferentially press the tissue graft against the dissected vaginal space but is soft enough to decrease the risk of pressure necrosis or damage to the urethra; and it has a drainage port to prevent the buildup of a fluid pocket that could interfere with graft adherence. Our stent incorporates all these unique properties and can be easily constructed using sterile operating room supplies. The construction of this device requires a silicone Foley catheter, sterile foam sponges from a vaginal prep kit, a sterile radio-opaque sponge, a sterile vaginal ultrasound probe cover, a long Kelly, a 60-cc catheter tip syringe, a ruler, scissors, 0-vicryl suture, and sterile gloves. MAIN OUTCOME MEASURE(S) Effectiveness of a self-made inflatable vaginal stent using standard operating room supplies that meets operating room protocol standards. RESULT(S) A standard dose of prophylactic antibiotics should be administered preoperatively to prevent surgical site infection. After placement of the tissue graft in the dissected neovagina cavity, the vaginal stent is placed and slowly inflated to circumferentially apply the tissue graft against the dissected vaginal space. The stent remains in place for 7 days and then should be removed in the operating room to allow for an examination under anesthesia, which provides the ideal setting to best evaluate the initial graft adherence. After careful inspection of the neovagina and tissue graft, a standard silicone vaginal mold is placed to maintain vaginal patency and prevent stricture of the tissue graft. The silicone mold should remain in place continuously until complete graft adherence occurs (approximately 4 to 6 weeks), and then it can be worn nightly until the patient is regularly sexually active. If at any point the patient discontinues nightly use of the silicone mold before regular sexual activity, vaginal stricture and a decrease in vaginal caliber will occur. CONCLUSION(S) Our novel inflatable vaginal stent is useful to surgeons performing a McIndoe vaginoplasty for vaginal agenesis with or without a uterus. It is compliant with operating room protocols and restrictions, as it is constructed from operating room supplies and is radio-opaque. Moreover, it is adjustable in size and effective in applying circumferential pressure for graft adherence. When used for segmental vaginal agenesis, the Foley catheter may be advanced through the cervix, then the balloon can be inflated, to stabilize the position of the stent during the first week postoperatively. The main limitation of this device is that it must be constructed by the surgeon, but the advantage of self-constructing the stent is that the size and shape can be tailored to conform to each individual patient. We prefer this inflatable vaginal stent to a rigid vaginal dilator in the first week of tissue healing to allow for easy insertion and removal of the stent without disrupting the tissue graft, to help prevent tissue necrosis, and to provide a fluid drainage port during graft adherence. We recommend this device as an ideal option for surgeons to consider when performing a McIndoe vaginoplasty.
Collapse
Affiliation(s)
- Phillip A Romanski
- Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medical College, New York, New York.
| | - Pietro Bortoletto
- Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medical College, New York, New York
| | - Samantha M Pfeifer
- Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medical College, New York, New York
| |
Collapse
|
24
|
Sanchez-Ferrer ML, Grimbizis G, Nisolle M, Salmeron-González E, Gómez-Pérez L, Sánchez del Campo F, Acién M. Could Training in an Anatomical Model Be Useful to Teach Different Neovagina Surgical Techniques? A Descriptive Study about Knowledge and Experience of Techniques for Neovagina Surgery. J Clin Med 2020; 9:jcm9113722. [PMID: 33228242 PMCID: PMC7699514 DOI: 10.3390/jcm9113722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 11/11/2020] [Accepted: 11/17/2020] [Indexed: 11/16/2022] Open
Abstract
Neovagina surgery in patients with vaginal agenesis is rare. No consensus exists regarding the best surgical technique. The aims of the current study were to show a new Thiel-embalmed cadaveric model to teach the surgical steps for different techniques of neovagina surgery and to evaluate opinions of this surgical teaching procedure. Four techniques-modified McIndoe, Vecchietti, Davydov, and vulvoperineal pediculated flaps-were recorded using an external camera and/or laparoscopic vision during their execution in a dissection room on "feminized" male cadavers. To determine the opinion of this teaching model, we designed an anonymous online survey that was available to participants via a computer application. After watching the video, more than 92% of participants agreed that feminized male cadavers were an excellent procedure for teaching these surgical techniques. Before watching this video, the most employed techniques were the McIndoe and Vecchietti procedures. After watching the video, modified McIndoe and vulvoperineal flaps were preferred by participants because they were considered to be easier to perform. It was considered that this model was useful for training neovagina techniques and, moreover, it should be recommended before techniques were performed on a real patient. Further investigation is needed to validate this model.
Collapse
Affiliation(s)
- María Luísa Sanchez-Ferrer
- Department of Obstetrics & Gynecology, “Virgen de la Arrixaca” University Clinical Hospital, 30120 El Palmar (Murcia), Spain
- Institute for Biomedical Research of Murcia, IMIB-Arrixaca, 30120 El Palmar (Murcia), Spain
- Correspondence: ; Tel.: +34-(86)-8889486
| | - Grigoris Grimbizis
- First Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece;
| | - Michele Nisolle
- Department of Obstetrics and Gynecology, University of Liège, CHR Liège, 4000 Liège, Belgium;
| | - Enrique Salmeron-González
- Plastic Surgery and Burns Service, University and Polytechnic Hospital La Fe, 46026 Valencia, Spain;
| | - Luis Gómez-Pérez
- Department of Urology, “San Juan” University Clinical Hospital, University Miguel Hernández, 03550 Alicante, Spain;
| | | | - Maribel Acién
- Department of Obstetrics & Gynecology, “San Juan” University Clinical Hospital, University Miguel Hernández, 03550 Alicante, Spain;
| |
Collapse
|
25
|
Abstract
Objective To evaluate the newly formed epithelium that develops following a neovaginoplasty performed with Amniotic Membrane. Methods A retrospective study conducted at the University Hospital of the Federal University, in Curitiba, Paraná, Brazil. A group of 33 patients with Vaginal Agenesis, most of them amenorrhoeic, either incapable of or having difficulty to perform sexual activity, were separated in Subgroup A (27 patients) with Mayer-Rokitansky-Kuster-Hauser Syndrome, and Subgroup B (six patients) with Androgenic Insensitivity Syndrome (Morris Syndrome). Intervention: Banister-McIndoe neovaginoplasty was performed using amniotic membrane graft in 33 patients of Subgroups A and B and evaluated 60-90 days later by vaginal epithelium biopsies. Main Outcome Measure(s): Transmission Electronic Microscopy (TEM) performed Biopsies of neovaginal epithelium in 10 patients. In 20 patients, we analyzed the levels of intensity and presence of Estrogenic Receptors. Results Vaginal length was measured (vaginometry) before and after surgery. Before surgery, the vagina was absent in 5 patients (15.15%), vaginal length was 1 cm in 19 patients (57.58%) and in 9 patients (27.27%), it was between 2-3 cm. After surgery, all patients had a vaginal length greater or equal to 5 cm and, in 26 patients (78.8%), vaginal length was 7-8 cm. Seven to eight centimeters average neovagina length allowed patients to have a satisfactory sexual activity after all the surgical procedures to dilate, widen and distend the neomucosa lining. The ERs presented different levels of intensity in the three layers of the neovaginal mucosa. TEM analysis of the vaginal neoepithelium obtained from the amniotic membrane graft revealed all the characteristics of a trophic vaginal epithelium. Conclusions In a developing country like Brazil, neovaginoplasty with amniotic membrane graft is considered a great option, being an inexpensive, safe, and easy technique, not requiring any special materials. After a few days (60-90 days), or months, a new epithelium and vagina are obtained allowing patients to have proper sexual activity.
Collapse
Affiliation(s)
- Mauri José Piazza
- Gynecology-Tocogynechology Department, Universidade Federal do Paraná (UFPR), Curitiba, PR, Brazil
| |
Collapse
|
26
|
Fontoura Oliveira A, Ferreira H. Neovagina creation in congenital vaginal agenesis: New mini-laparoscopic approach applying intraoperative indocyanine green fluorescence. Surg Innov 2020; 28:24-32. [PMID: 33124521 DOI: 10.1177/1553350620968990] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background. There is still no standardized treatment for vaginal agenesis; surgical repair using a minimally invasive technique is a good option, as it offers rapid results along with a fast postoperative recovery. Objective. To describe a new modified Vecchietti procedure by a mini-laparoscopic approach with intraoperative use of indocyanine green fluorescence technology for the creation of a neovagina in the setting of congenital vaginal agenesis. Methods. Retrospective review of all cases of congenital vaginal agenesis submitted to a mini-laparoscopic modified Vecchietti procedure with intraoperative use of indocyanine green (ICG) fluorescence (between June and September 2019). Patient relevant medical history, surgical technique, postoperative care, outcomes, and complications are described. Results. Four patients with Mayer-Rokitansky-Küster-Hauser syndrome (mean age: 19 years; mean preoperative vaginal length: 1.5 cm) were included in the study. The procedure was completed successfully and uneventfully in all patients. External traction device was removed 5-7 days after surgery and replaced by external vaginal silicone dilators. This technique was able to create 10-11 cm neovaginas in 1 week; six weeks after surgery all patients had an epithelized 10.5-12 cm length and 2.5-3 cm diameter neovagina. Complications consisted of one case of isolated fever at the ninth postoperative day, solved with empiric antibiotic treatment. Conclusion. The mini-laparoscopic modified Vecchietti approach, associated with ICG fluorescence imaging, is feasible and effective in the treatment of congenital vaginal agenesis, as it is a simple and safe procedure with promising outcomes.
Collapse
Affiliation(s)
- Andreia Fontoura Oliveira
- Minimally Invasive Gynecology Department, 522166Centro Hospitalar Universitário do Porto EPE-Centro Materno Infantil do Norte, Portugal.,Department of Gynecology and Obstetrics, 466971Centro Hospitalar do Médio Ave EPE, Santo Tirso, Porto, Portugal
| | - Hélder Ferreira
- Minimally Invasive Gynecology Department, 522166Centro Hospitalar Universitário do Porto EPE-Centro Materno Infantil do Norte, Portugal.,89239University of Porto-Instituto de Ciências Biomédicas Abel Salazar, Portugal
| |
Collapse
|
27
|
Ogliari KCM, Rios SDS, Chen ACR, Chen JR, Resende CN, Araujo Júnior E. An alternative approach to vaginal dilation in patients with Meyer-Rokitanski-Küster-Hauser syndrome: two case reports. Gynecol Endocrinol 2020; 36:746-748. [PMID: 31994956 DOI: 10.1080/09513590.2020.1719061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Vaginal dilation, currently considered as the first-line therapy for vaginal aplasia in patients with Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome, is a safe and effective treatment that aims to create a functional neovagina. However, rigid vaginal dilators classically described in the literature usually cause physical discomfort and side effects that can lead to vaginal necrosis. Here, we present two cases of MRKH syndrome patients with vaginal agenesis whose main complaint was the inability to have sexual intercourse with their partners. Considering unavailability of acrylic dilators and previous studies reporting good responses with the use of silicone dilators in women with post-radiotherapy vaginal stenosis, the medical team and patients opted for creation of a neovagina through the daily use of silicone vaginal dilators. Patient 1 developed an 8-cm vagina after 6 months of treatment and had a satisfactory sex life with her partner. Patient 2 developed a 7-cm vagina and reported significant symptom improvement. None of the patients developed side effects after the treatment. The use of inexpensive and easily accessible silicone vaginal dilators may be an effective and noninvasive alternative with few side effects for women with vaginal agenesis, particularly in the developing countries.
Collapse
Affiliation(s)
| | - Salete da Silva Rios
- Department of Gynecology and Obstetrics, University of Brasília (UnB), Brasília-DF, Brazil
| | - Ana Carolina Rios Chen
- Department of Gynecology and Obstetrics, University of Brasília (UnB), Brasília-DF, Brazil
| | - Juliana Rios Chen
- Department of Gynecology and Obstetrics, University of Brasília (UnB), Brasília-DF, Brazil
| | - Ceres Nunes Resende
- Department of Gynecology and Obstetrics, University of Brasília (UnB), Brasília-DF, Brazil
| | - Edward Araujo Júnior
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo-SP, Brazil
- Medical Course, Bela Vista Campus, Municipal University of São Caetano do Sul (USCS), São Paulo-SP, Brazil
| |
Collapse
|
28
|
Radix AE, Harris AB, Belkind U, Ting J, Goldstein ZG. Chlamydia trachomatis Infection of the Neovagina in Transgender Women. Open Forum Infect Dis 2019; 6:ofz470. [PMID: 32395566 PMCID: PMC7200138 DOI: 10.1093/ofid/ofz470] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 10/29/2019] [Indexed: 11/30/2022] Open
Abstract
We report 2 cases of neovaginal Chlamydia trachomatis infection in transgender women who underwent penile-inversion vaginoplasty procedures with integrated peritoneum and urethral grafts. These tissue types may have facilitated C. trachomatis infection. Medical providers should implement neovaginal screening for bacterial sexually transmitted infections in transgender patients at risk for infection.
Collapse
Affiliation(s)
- Asa E Radix
- Department of Medicine, Callen-Lorde Community Health Center, New York, USA
- Correspondence: A. Radix, MD, MPH, Department of Medicine, Callen-Lorde Community Health Center, Department of Medicine, 356 West 18th Street, New York, NY 10011 ()
| | - Alexander B Harris
- Department of Research and Education, Callen-Lorde Community Health Center, New York, USA
| | - Uri Belkind
- Department of Medicine, Callen-Lorde Community Health Center, New York, USA
| | - Jess Ting
- Center for Transgender Medicine and Surgery, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Zil G Goldstein
- Department of Medicine, Callen-Lorde Community Health Center, New York, USA
| |
Collapse
|
29
|
Vladimiros L, Tsoucalas G, Thomaidis V, Kakagia D. The Greek Surgeon-Gynecologist Savvas Georgiadis (1857-1942) and the First Vaginal Reconstruction in Smyrna. Surg Innov 2019; 26:630-632. [PMID: 31043119 DOI: 10.1177/1553350619842760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The Greek surgeon-gynecologist Savvas Georgiadis from Phocaea in Asia Minor had performed in 1897 an innovative surgical operation in a young female patient, reconstructing her vagina. Having been educated both in Greece and France, specialized in gynecology, he became a famous surgeon in the Hellenic Hospital of Smyrna "Agios Charalampos," where the operation was masterfully executed. Although among the pioneers in neovagina techniques, Georgiadis still is searching his place among the important figures in the history of plastic surgery.
Collapse
|
30
|
Mundluru SN, Larson AR. Medical dermatologic conditions in transgender women. Int J Womens Dermatol 2018; 4:212-215. [PMID: 30627619 PMCID: PMC6322154 DOI: 10.1016/j.ijwd.2018.08.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 08/20/2018] [Accepted: 08/23/2018] [Indexed: 12/11/2022] Open
Abstract
Many previous reviews and studies on transgender dermatology have highlighted the expected dermatologic manifestations of hormone affirmation therapy in transgender patients. Others have highlighted attitudes and practices of both transgender patients and medical professionals taking care of these patients. This review compiles data from other, lesser known aspects of transgender dermatology, including neovaginal concerns, neoplastic concerns (both neovaginal and cutaneous), autoimmune conditions, and the sequelae of injectable substances that have not been approved by the U.S. Food and Drug Administration. This review, like others, will be a stepping-stone and serve as an impetus for future research in transgender dermatology.
Collapse
Affiliation(s)
- S N Mundluru
- Department of Internal Medicine, Kaiser Permanente Oakland Medical Center, Oakland, California
| | - A R Larson
- Department of Dermatology, Boston University School of Medicine, Boston, Massachusetts
| |
Collapse
|
31
|
Rall KK, Schoenfisch B, Schoeller D, Stefanescu D, Koelle A, Henes M, Huebner M, Taran FA, Seeger H, Iftner A, Iftner T, Brucker SY. Vaginal prevalence of human papillomavirus infections in women with uterovaginal aplasia before and after laparoscopically assisted creation of a neovagina: a prospective epidemiological observational study. BJOG 2018; 126:65-72. [PMID: 29992731 DOI: 10.1111/1471-0528.15404] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/19/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To study vaginal as opposed to cervical human papillomavirus (HPV) acquisition with regard to true prevalence, HPV types, and the role of co-factors in virgins and after their sexual debut. DESIGN Prospective epidemiological observational study. SETTING University hospital specialised in genital malformations. POPULATION Women diagnosed with Mayer-Rokitansky-Küster-Hauser syndrome (MRKHS) and undergoing neovaginoplasty between November 2011 and July 2017. METHODS This is a prospective study including 186 women with MRKHS before and after sexual debut. MAIN OUTCOME MEASURES Conventional vaginal cytology and different HPV tests were performed at surgery and during routine gynaecological follow-up 1, 3, 6 and ≥ 11 months after surgery and risk factors were documented. RESULTS The mean age of all women at surgery was 20.1 years (SD 5.4), mean body mass index (BMI) was 22.1 kg/m2 (SD 4.6). In 83 vaginal samples from 41 different women at least one of the HPV tests was positive. Thirty-three different HPV types were detected. The prevalence of 41/186 = 22.0% as well as type distribution are comparable with those found in a young German female population. The overall rate of acquisition was clearly associated with sexual activity and smoking habits. Out of 367 Papanicolaou smears only six were abnormal with Pap IIID (MN II) and no obvious vaginal lesion was detected. CONCLUSIONS Vaginal HPV prevalence and HPV types in previously virgin women after creation of a neovagina are not different from the acquisition of cervical infections in the general population and is clearly associated with sexual activity and with smoking habits. However, abnormal Papanicolaou smears are rarely seen. TWEETABLE ABSTRACT Vaginal HPV prevalence after creation of a neovagina is similar to that on the cervix in the general population.
Collapse
Affiliation(s)
- K K Rall
- Department of Women's Health, Women's University Hospital, Tübingen University Hospital, Tübingen, Germany
| | - B Schoenfisch
- Department of Women's Health, Research Centre for Women's Health, University Tübingen, Tübingen, Germany
| | - D Schoeller
- Department of Women's Health, Women's University Hospital, Tübingen University Hospital, Tübingen, Germany
| | - D Stefanescu
- Department of Women's Health, Women's University Hospital, Tübingen University Hospital, Tübingen, Germany
| | - A Koelle
- Department of Women's Health, Women's University Hospital, Tübingen University Hospital, Tübingen, Germany
| | - M Henes
- Department of Women's Health, Women's University Hospital, Tübingen University Hospital, Tübingen, Germany
| | - M Huebner
- Women's Centre Bern, Lindenhofgruppe, Bern, Switzerland
| | - F A Taran
- Department of Women's Health, Women's University Hospital, Tübingen University Hospital, Tübingen, Germany
| | - H Seeger
- Department of Women's Health, Research Centre for Women's Health, University Tübingen, Tübingen, Germany
| | - A Iftner
- Institute of Medical Virology, University Hospital Tübingen, Tübingen, Germany
| | - T Iftner
- Institute of Medical Virology, University Hospital Tübingen, Tübingen, Germany
| | - S Y Brucker
- Department of Women's Health, Women's University Hospital, Tübingen University Hospital, Tübingen, Germany.,Department of Women's Health, Research Centre for Women's Health, University Tübingen, Tübingen, Germany
| |
Collapse
|
32
|
Sartoneva R, Kuismanen K, Juntunen M, Karjalainen S, Hannula M, Kyllönen L, Hyttinen J, Huhtala H, Paakinaho K, Miettinen S. Porous poly-l-lactide-co-ɛ-caprolactone scaffold: a novel biomaterial for vaginal tissue engineering. R Soc Open Sci 2018. [PMID: 30225072 DOI: 10.5061/dryad.2bg877b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
The surgical reconstruction of functional neovagina is challenging and susceptible to complications. Therefore, developing tissue engineering-based treatment methods for vaginal defects is important. Our aim was to develop and test a novel supercritical carbon dioxide foamed poly-l-lactide-co-ɛ-caprolactone (scPLCL) scaffold for vaginal reconstruction. The scaffolds were manufactured and characterized for porosity (65 ± 4%), pore size (350 ± 150 µm) and elastic modulus (2.8 ± 0.4 MPa). Vaginal epithelial (EC) and stromal cells (SC) were isolated, expanded and characterized with flow cytometry. Finally, cells were cultured with scPLCL scaffolds in separate and/or co-cultures. Their attachment, viability, proliferation and phenotype were analysed. Both cell types strongly expressed cell surface markers CD44, CD73 and CD166. Strong expression of CD326 was detected with ECs and CD90 and CD105 with SCs. Both ECs and SCs attached and maintained viability on scPLCL. Further, scPLCL supported the proliferation of especially ECs, which also maintained epithelial phenotype (cytokeratin expression) during 14-day assessment period. Interestingly, ECs expressed uroplakin (UP) Ia, UPIb and UPIII markers; further, UPIa and UPIII expression was significantly higher on ECs cultured on scPLCL than on cell culture plastic. In conclusion, the scPLCL is potential scaffold for vaginal tissue engineering and the results of this study further illustrate the excellent biocompatibility of PLCL.
Collapse
Affiliation(s)
- Reetta Sartoneva
- Adult Stem Cell Research Group, BioMediTech, Faculty of Medicine and Life Sciences, University of Tampere, Arvo Ylpönkatu 34, 4th Floor, 33520 Tampere, Finland
- Science Centre, Tampere University Hospital, Tampere, Finland
| | - Kirsi Kuismanen
- Science Centre, Tampere University Hospital, Tampere, Finland
- Department of Obstetrics and Gynaecology, Tampere University Hospital, Tampere, Finland
- Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
| | - Miia Juntunen
- Adult Stem Cell Research Group, BioMediTech, Faculty of Medicine and Life Sciences, University of Tampere, Arvo Ylpönkatu 34, 4th Floor, 33520 Tampere, Finland
- Science Centre, Tampere University Hospital, Tampere, Finland
| | - Sanna Karjalainen
- Biomaterials and Tissue Engineering Group, BioMediTech, Faculty of Biomedical Sciences and Engineering, Tampere University of Technology, Tampere, Finland
| | - Markus Hannula
- Computational Biophysics and Imaging Group, BioMediTech, Faculty of Biomedical Sciences and Engineering, Tampere University of Technology, Tampere, Finland
| | - Laura Kyllönen
- Adult Stem Cell Research Group, BioMediTech, Faculty of Medicine and Life Sciences, University of Tampere, Arvo Ylpönkatu 34, 4th Floor, 33520 Tampere, Finland
- Science Centre, Tampere University Hospital, Tampere, Finland
| | - Jari Hyttinen
- Computational Biophysics and Imaging Group, BioMediTech, Faculty of Biomedical Sciences and Engineering, Tampere University of Technology, Tampere, Finland
| | - Heini Huhtala
- Faculty of Social Sciences, University of Tampere, Tampere, Finland
| | - Kaarlo Paakinaho
- Biomaterials and Tissue Engineering Group, BioMediTech, Faculty of Biomedical Sciences and Engineering, Tampere University of Technology, Tampere, Finland
| | - Susanna Miettinen
- Adult Stem Cell Research Group, BioMediTech, Faculty of Medicine and Life Sciences, University of Tampere, Arvo Ylpönkatu 34, 4th Floor, 33520 Tampere, Finland
- Science Centre, Tampere University Hospital, Tampere, Finland
| |
Collapse
|
33
|
Sartoneva R, Kuismanen K, Juntunen M, Karjalainen S, Hannula M, Kyllönen L, Hyttinen J, Huhtala H, Paakinaho K, Miettinen S. Porous poly-l-lactide-co-ɛ-caprolactone scaffold: a novel biomaterial for vaginal tissue engineering. R Soc Open Sci 2018; 5:180811. [PMID: 30225072 PMCID: PMC6124079 DOI: 10.1098/rsos.180811] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 07/09/2018] [Indexed: 05/12/2023]
Abstract
The surgical reconstruction of functional neovagina is challenging and susceptible to complications. Therefore, developing tissue engineering-based treatment methods for vaginal defects is important. Our aim was to develop and test a novel supercritical carbon dioxide foamed poly-l-lactide-co-ɛ-caprolactone (scPLCL) scaffold for vaginal reconstruction. The scaffolds were manufactured and characterized for porosity (65 ± 4%), pore size (350 ± 150 µm) and elastic modulus (2.8 ± 0.4 MPa). Vaginal epithelial (EC) and stromal cells (SC) were isolated, expanded and characterized with flow cytometry. Finally, cells were cultured with scPLCL scaffolds in separate and/or co-cultures. Their attachment, viability, proliferation and phenotype were analysed. Both cell types strongly expressed cell surface markers CD44, CD73 and CD166. Strong expression of CD326 was detected with ECs and CD90 and CD105 with SCs. Both ECs and SCs attached and maintained viability on scPLCL. Further, scPLCL supported the proliferation of especially ECs, which also maintained epithelial phenotype (cytokeratin expression) during 14-day assessment period. Interestingly, ECs expressed uroplakin (UP) Ia, UPIb and UPIII markers; further, UPIa and UPIII expression was significantly higher on ECs cultured on scPLCL than on cell culture plastic. In conclusion, the scPLCL is potential scaffold for vaginal tissue engineering and the results of this study further illustrate the excellent biocompatibility of PLCL.
Collapse
Affiliation(s)
- Reetta Sartoneva
- Adult Stem Cell Research Group, BioMediTech, Faculty of Medicine and Life Sciences, University of Tampere, Arvo Ylpönkatu 34, 4th Floor, 33520 Tampere, Finland
- Science Centre, Tampere University Hospital, Tampere, Finland
- Author for correspondence: Reetta Sartoneva e-mail:
| | - Kirsi Kuismanen
- Science Centre, Tampere University Hospital, Tampere, Finland
- Department of Obstetrics and Gynaecology, Tampere University Hospital, Tampere, Finland
- Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
| | - Miia Juntunen
- Adult Stem Cell Research Group, BioMediTech, Faculty of Medicine and Life Sciences, University of Tampere, Arvo Ylpönkatu 34, 4th Floor, 33520 Tampere, Finland
- Science Centre, Tampere University Hospital, Tampere, Finland
| | - Sanna Karjalainen
- Biomaterials and Tissue Engineering Group, BioMediTech, Faculty of Biomedical Sciences and Engineering, Tampere University of Technology, Tampere, Finland
| | - Markus Hannula
- Computational Biophysics and Imaging Group, BioMediTech, Faculty of Biomedical Sciences and Engineering, Tampere University of Technology, Tampere, Finland
| | - Laura Kyllönen
- Adult Stem Cell Research Group, BioMediTech, Faculty of Medicine and Life Sciences, University of Tampere, Arvo Ylpönkatu 34, 4th Floor, 33520 Tampere, Finland
- Science Centre, Tampere University Hospital, Tampere, Finland
| | - Jari Hyttinen
- Computational Biophysics and Imaging Group, BioMediTech, Faculty of Biomedical Sciences and Engineering, Tampere University of Technology, Tampere, Finland
| | - Heini Huhtala
- Faculty of Social Sciences, University of Tampere, Tampere, Finland
| | - Kaarlo Paakinaho
- Biomaterials and Tissue Engineering Group, BioMediTech, Faculty of Biomedical Sciences and Engineering, Tampere University of Technology, Tampere, Finland
| | - Susanna Miettinen
- Adult Stem Cell Research Group, BioMediTech, Faculty of Medicine and Life Sciences, University of Tampere, Arvo Ylpönkatu 34, 4th Floor, 33520 Tampere, Finland
- Science Centre, Tampere University Hospital, Tampere, Finland
| |
Collapse
|
34
|
Abstract
Among surgical procedures for constructing a neovagina, positive outcomes are reported in literature for bowel vaginoplasty for male-to-female transgenders and patients with vaginal aplasia. This systematic review shows outcomes of bowel vaginoplasty procedures, and rates the quality of evidence of the included studies. A search of the literature was performed in PubMed, Medline, Cochrane Library and SveMed+, in accordance with the PRISMA statement, between January 2016 and February 2018. The PICOS (patients, intervention, comparator, outcomes and study design) approach was used as inclusion criteria. Among 251 analyzed studies only 34 met inclusion criteria. Quality of evidence and methodology were rated according to GRADE and MINORS, respectively. Data from the included studies were extracted based on study characteristics, participants? specifics, type of intervention/treatment and type of outcome measures into data extraction forms. All studies were non-randomized with a high risk of bias and very low quality of evidence according to GRADE. Vaginal reconstruction with isolated bowel segments provides a self-lubricating neovagina with low rates of failure and revision, and without routine dilatation need. Furthermore, the use of laparoscopic techniques offers a better postoperative cosmetic appearance of the abdomen and a shorter hospital stay. Vaginoplasty using bowel segment is a safe and effective procedure that obtains excellent long-term results as reported by the included studies. Despite that further researches are needed improving methodology with larger populations, retrospective qualitative studies and report of outcome measurements using standardized evaluation tools as the Female Sexual Function Index.
Collapse
Affiliation(s)
- Konstantinos Georgas
- a Department of Plastic Surgery , Sahlgrenska Universitetssjukhuset , Göteborg , Sweden
| | - Valerio Belgrano
- b Department of Surgery, Institute of Clinical Sciences , Sahlgrenska Academy at the University of Gothenburg, Sahlgrenska University Hospital , Gothenburg , Sweden
| | - My Andreasson
- c Department of Plastic Surgery , Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg , Göteborg , Sweden
| | - Anna Elander
- d Department of Plastic Surgery , Institute of Clinical Sciences , Göteborg , Sweden
| | - Gennaro Selvaggi
- e Department of Plastic Surgery , Sahlgrenska Akademin , Gothenburg , Sweden
| |
Collapse
|
35
|
Bhaskar V, Sinha RJ, Mehrotra S, Mehrotra CN, Singh V. Long-term outcomes of sigmoid vaginoplasty in patients with disorder of sexual development - our experience. Urol Ann 2018; 10:185-190. [PMID: 29719332 PMCID: PMC5907329 DOI: 10.4103/ua.ua_88_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Introduction To report our experience with sigmoid vaginoplasty in patients with different forms of disorder of sexual development and their long-term follow-up. Materials and Methods This is a retrospective study of patients who underwent sigmoid vaginoplasty between July 2004 and June 2015 at our center. Follow-up included a physical examination to assess vaginal length and width, cosmetic appearance of the neovagina, and occurrence of any complications. Results The current study included eight patients with mean age 19.5 years. The mean operative time was 164 min. No significant intraoperative or immediate postoperative complications occurred. Follow-up period ranges from 21 months to 12 years with mean of 7.5 years. In all patients, the neovagina was found to have a satisfactory cosmetic appearance. Seven patients are sexually active and satisfied. Conclusion Sigmoid vaginoplasty is safe and acceptable procedure in patients having vaginal agenesis. Sigmoid vaginoplasty has acceptable cosmetic results and complication rate.
Collapse
Affiliation(s)
- Ved Bhaskar
- Department of Urology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Rahul J Sinha
- Department of Urology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Seema Mehrotra
- Department of Urology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - C N Mehrotra
- Department of Urology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Vishwajeet Singh
- Department of Urology, King George's Medical University, Lucknow, Uttar Pradesh, India
| |
Collapse
|
36
|
Slater MW, Vinaja X, Aly I, Loukas M, Terrell M, Schober J. Neovaginal Construction with Pelvic Peritoneum: Reviewing an Old Approach for a New Application. Clin Anat 2017; 31:175-180. [PMID: 29178543 DOI: 10.1002/ca.23019] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 11/22/2017] [Indexed: 11/12/2022]
Abstract
Transgender reassignment surgeries have become a major topic of interest within the last decade. Although there are numerous surgical techniques for male-to-female reassignment, a physician must assess each patient's anatomy and past medical history to determine the most suitable technique. Additionally, patient preference is important. The neovaginal constructive technique most commonly used in male-to-female reassignment surgery is penile skin inversion, but various other techniques and tissues can also be used including pelvic peritoneum, buccal mucosa, and bowel. Surgical text descriptions were enhanced by creating new anatomical illustrations. Donor and recipient site anatomies, and the surgical technique leading to creation of the neovagina, are demonstrated in detail with relevant illustrations. A review of the literature concerning the anatomy, procedure development, and outcomes is presented. The pelvic peritoneum was originally used in neovaginal construction for females with vaginal agenesis as a result of MRKH syndrome. The use of this technique to create a neovagina in male-to-female transgender reassignment surgery has become appealing owing to the relative ease of the procedure, low complication rates, and overall high patient satisfaction. This technique offers a potential new choice for transgender male-to-female neovaginal construction, but further studies are needed to confirm its successful use in transgender surgery. Clin. Anat. 31:175-180, 2018. © 2017 Wiley Periodicals, Inc.
Collapse
Affiliation(s)
- Michael W Slater
- Lake Erie College of Osteopathic Medicine-Bradenton, Bradenton, Florida
| | - Xochitl Vinaja
- St. George's University School of Medicine Grenada, West Indies
| | - Islam Aly
- Lake Erie College of Osteopathic Medicine-Bradenton, Bradenton, Florida
| | - Marios Loukas
- St. George's University School of Medicine Grenada, West Indies
| | - Mark Terrell
- Lake Erie College of Osteopathic Medicine, Erie, Pennsylvania
| | - Justine Schober
- Department of Pediatric Urology, Hamot Medical Center, Erie, Pennsylvania
| |
Collapse
|
37
|
Saylor L, Bernard S, Vinaja X, Loukas M, Schober J. Anatomy of genital reaffirmation surgery (male-to-female): Vaginoplasty using penile skin graft with scrotal flaps. Clin Anat 2017; 31:140-144. [PMID: 29178326 DOI: 10.1002/ca.23015] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 11/22/2017] [Indexed: 11/10/2022]
Abstract
Gender reaffirmation surgery is the final step in an individual's transition to their preferred gender. A clear understanding of the anatomy pertinent to this procedure is essential by the surgeon and patient. In male-to-female transgenders, female genitalia is constructed using the individual's penile skin to form the neovaginal canal and their scrotal skin folds post orchiectomy to create the labia majora. The surgical precursors of the remaining anatomical structures of the female genitalia are as follows: the clitoris is crafted from the glans penis and hence retains its innervation, the labia minora is formed using excess penile skin tissue, and the long male urethra is shortened to that of its feminine counterpart. The main goal of these reconstructive methods is to create a functionally and aesthetically acceptable vagina and vulva, as well as normal voiding function and satisfactory sexual function. Surgical text descriptions were enhanced by the creation of new anatomic illustrations. Review of the relevant literature regarding the anatomy, procedure development, and outcomes is presented. Vaginoplasty utilizing penile skin grafts with scrotal flaps provides an aesthetically acceptable and psychologically satisfying results with normal voiding and sexual function. An advantage includes preserved erogenous sensation. Complications can arise, including chronic inflammation and fistula formation. The anatomy of vaginoplasty using penile skin grafts with scrotal flaps supports patients seeking male-to-female gender reaffirmation surgery. Clin. Anat. 31:140-144, 2018. © 2017 Wiley Periodicals, Inc.
Collapse
Affiliation(s)
- Leah Saylor
- Lake Erie College of Osteopathic Medicine, Erie, Pennsylvania
| | - Shenell Bernard
- St.George's University School of Medicine, St George's Grenada
| | - Xochitl Vinaja
- St.George's University School of Medicine, St George's Grenada
| | - Marios Loukas
- St.George's University School of Medicine, St George's Grenada
| | - Justine Schober
- Department of Pediatric Urology, Hamot Medical Center, Erie, Pennsylvania
| |
Collapse
|
38
|
Ketheeswaran A, Morrisey J, Abbott J, Bennett M, Dudley J, Deans R. Intensive vaginal dilation using adjuvant treatments in women with Mayer-Rokitansky-Kuster-Hauser syndrome: retrospective cohort study. Aust N Z J Obstet Gynaecol 2017; 58:108-113. [PMID: 28960241 DOI: 10.1111/ajo.12715] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Accepted: 08/15/2017] [Indexed: 01/09/2023]
Abstract
AIMS To evaluate the effect of adjuvants during intensive vaginal dilator therapy for functional and anatomical neovagina creation in women with Mayer-Rokitansky-Kuster-Hauser syndrome (MRKH). METHODS This retrospective cohort study included 75 women with MRKH undergoing intensive vaginal dilator treatment between 2000 and 2014. One specialist nurse performed non-surgical vaginal dilation aided by adjuvants, during inpatient admissions for several dilation sessions per day. Following discharge, women continued dilation at home and were advised to attend fortnightly follow-up appointments. RESULTS Outcomes from 68 women were analysed. The median age of starting treatment was 18 years (range: 13-36). There was a mean of 3 days per admission (range 1-5) with a median of 10 dilation sessions per admission. Adjuvant treatment was used by 48/68 (71%) women: oestriol cream 29/68 (43%), 50:50 nitrous oxide and oxygen 44/68 (65%), diazepam 8/68 (12%), lidocaine ointment 26/68 (39%), paracetamol 35/68 (51%) and naproxen 2/68 (3%). There were no statistically significant differences for changes in vaginal parameters. Women receiving adjuvants had a median increase of 4.5 cm (0.5-7 cm) in neovaginal length compared with women not receiving adjuvants who had a median increase of 3.25 cm (0-7 cm) during intensive treatment. Women who received adjuvants tolerated more dilation sessions per day (10 vs 6.5 median sessions respectively) than those who did not (P < 0.001). Of those with documented length at discharge, 42/56 (75%) women had an anatomical neovagina of 7 cm or greater length. CONCLUSIONS Vaginal dilation delivered by intensive treatment and supplemented by adjuvant treatments in a multi-disciplinary centre is a rapid and effective method for creation of a neovagina in women with MRKH.
Collapse
Affiliation(s)
| | - Jennifer Morrisey
- Paediatric and Adolescent Gynaecology, Royal Hospital for Women, Sydney, New South Wales, Australia
| | - Jason Abbott
- University of New South Wales, Sydney, New South Wales, Australia.,Paediatric and Adolescent Gynaecology, Royal Hospital for Women, Sydney, New South Wales, Australia
| | - Michael Bennett
- University of New South Wales, Sydney, New South Wales, Australia
| | - Jan Dudley
- Paediatric and Adolescent Gynaecology, Royal Hospital for Women, Sydney, New South Wales, Australia
| | - Rebecca Deans
- University of New South Wales, Sydney, New South Wales, Australia.,Paediatric and Adolescent Gynaecology, Royal Hospital for Women, Sydney, New South Wales, Australia
| |
Collapse
|
39
|
Vatsa R, Bharti J, Roy KK, Kumar S, Sharma JB, Singh N, Singhal S, Meena J. Evaluation of amnion in creation of neovagina in women with Mayer-Rokitansky-Kuster-Hauser syndrome. Fertil Steril 2017. [PMID: 28624115 DOI: 10.1016/j.fertnstert.2017.05.026] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To assess the outcome of amnion vaginoplasty in cases of vaginal agenesis due to Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome managed at the authors' institution. DESIGN Retrospective study. SETTING Tertiary care hospital. PATIENT(S) Fifty women with MRKH who underwent neovaginoplasty. INTERVENTION(S) Modified McIndoe's vaginoplasty was done in all the patients, using human amnion graft. MAIN OUTCOME MEASURE(S) Functional status assessed by Female Sexual Function Index, anatomic status (length and width of neovagina), and epithelialization of vagina. RESULT(S) Mean (±SD) vaginal length after surgery was 8.2 ± 1 cm. Mean vaginal length at 6-month follow-up in sexually active patients was significantly longer as compared with the patients who were not sexually active after surgery (8.4 ± 1.04 cm vs. 6.6 ± 2.4 cm). Mean Female Sexual Function Index score was 30.8 ± 2.1. Vaginal biopsy showed complete epithelialization of vaginal mucosa. CONCLUSION(S) In a developing nation like India, McIndoe's method with amnion graft seems to be a promising option owing to its low cost, easy availability, and safety, ease of the procedure not requiring any special instrument, physiologic outcome with respect to epithelialization of the vagina without hair growth, and satisfying functional outcome.
Collapse
Affiliation(s)
- Richa Vatsa
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Juhi Bharti
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India.
| | - Kallol Kumar Roy
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Sunesh Kumar
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Jai Bhagwan Sharma
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Neeta Singh
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Seema Singhal
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Jyoti Meena
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| |
Collapse
|
40
|
Reyes Claret A, Martín Jiménez Á, Robles Gourley AA, Ibarra de la Rosa JM, Vicens Vidal M. Microinvasive squamous carcinoma of neovagina created with peritoneal flap (Davidov): Case report and literature review. J OBSTET GYNAECOL 2016; 37:131-135. [PMID: 27866418 DOI: 10.1080/01443615.2016.1234445] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Carcinoma of the vagina is a rare disease, and it is even more rare when it appears in a neovagina, having its incidence and optimum treatment constantly discussed. The aim of this article was to review the cases described in the currently available literature and describe the second documented case of carcinoma in a neovagina created with peritoneal flaps, and also list the possible pathways and risk factors for its development. The case we present is a 49-year-old female who after undergoing a laparoscopic colpectomy of the upper two-thirds of the vagina, with an immediate reconstruction with peritoneal flaps by laparoscopy, at a 4 months follow up presented a focal microinvasive squamous carcinoma in the vault of the neovagina. After reviewing the literature, we conclude that excisional treatment is the preferable option to avoid the progression to an invasive carcinoma. However, this case demonstrates the importance of the necessity to do regular cito-vulvovaginoscopic examinations after the complete surgical treatment because of the chance of persistent or recurrent lesions on the transplanted tissue.
Collapse
Affiliation(s)
- Albert Reyes Claret
- a Department of Obstetrics and Gynaecology , Son Llàtzer Hospital , Palma de Mallorca , Spain
| | - Ángel Martín Jiménez
- a Department of Obstetrics and Gynaecology , Son Llàtzer Hospital , Palma de Mallorca , Spain
| | | | | | - Margalida Vicens Vidal
- a Department of Obstetrics and Gynaecology , Son Llàtzer Hospital , Palma de Mallorca , Spain
| |
Collapse
|
41
|
Kuessel L, Wenzl R, Marschalek ML, Slavka G, Doerfler D, Husslein H. Using the Wharton-Sheares-George method to create a neovagina in patients with Mayer-Rokitansky-Küster-Hauser syndrome: a step-by-step video tutorial. Fertil Steril 2016; 106:e20-e21. [PMID: 27678038 DOI: 10.1016/j.fertnstert.2016.08.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Revised: 08/12/2016] [Accepted: 08/12/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To provide a review of the literature regarding this technique as well as a step-by-step description with the goal of increasing its use as a safe surgical option. Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome is characterized by vaginal agenesis and a variety of mullerian duct anomalies. To date, a variety of procedures have been described for creating a neovagina, but the best treatment remains debated. The Wharton-Sheares-George method, a minimally invasive surgical approach for the creation of a neovagina, is remarkably simple to perform. DESIGN Surgical video tutorial. SETTING University hospital and referral center for pediatric and adolescent gynecology. PATIENT(S) A 20-year-old woman with MRKH syndrome who underwent Wharton-Sheares-George neovaginoplasty. INTERVENTION(S) With the Wharton-Sheares-George neovaginoplasty the rudimentary müllerian ducts are dilated incrementally by pushing Hegar dilators in the direction of the pelvic axis, and the resulting median raphe is then intersected using diathermy. Subsequently a vaginal mold is inserted into the newly created cavity and held in position by two sutures. MAIN OUTCOME MEASURE(S) Discussion of the surgical steps according to the Wharton-Sheares-George method and review of the anatomic and functional results. RESULTS Reviewing the existing literature shows that a mean vaginal length and width of 8.3 and 3.3 cm, respectively, can be achieved, and so far no major intraoperative or postoperative complications or prolapse of the neovagina has been reported. Patients can achieve a high degree of general well-being as well as sexual and psychosocial functioning. However, as with most other methods, the presented method requires diligent patient compliance due to the lifelong need to actively avoid contraction of the neovagina. Also, as revealed by vaginal cultures and biopsies, the neovaginas remarkably resemble natural vaginas with regard to type of bacterial colonization and structure of epithelium. The process of spontaneous epithelialization of the neovagina is not fully understood, but has been observed to begin at the vaginal orifice and take several months to reach the apex. This leads to the assumption that the nonkeratinizing, stratified squamous epithelium originates from the preexisting vaginal epithelium of the vaginal dimple and migrates in a cranial direction. Alternatively, epithelialization might arise from pluripotent stem cells located in the obliterated müllerian ducts. CONCLUSION(S) The creation of a neovagina using the Wharton-Sheares-George method does not require allogenic or autologous transplants, nor does it require traction devices or specialized surgical equipment. Furthermore, the procedure is comparatively simple to perform and easy to learn. By following our step-by-step description of this technique, surgeons can offer a minimally invasive, quick, and safe surgical option that provides long-term results that are both functionally and anatomically satisfying. We believe that this technique represents a valuable alternative for the creation of a neovagina in patients with MRKH syndrome and thus should be investigated on a broader scale in the future.
Collapse
Affiliation(s)
- Lorenz Kuessel
- Department of Gynecology and Obstetrics, Medical University of Vienna, Vienna, Austria
| | - René Wenzl
- Department of Gynecology and Obstetrics, Medical University of Vienna, Vienna, Austria.
| | | | - Georg Slavka
- Department of Laboratory Medicine, Wilhelminen Hospital, Vienna, Austria
| | - Daniela Doerfler
- Department of Gynecology and Obstetrics, Medical University of Vienna, Vienna, Austria
| | - Heinrich Husslein
- Department of Gynecology and Obstetrics, Medical University of Vienna, Vienna, Austria
| |
Collapse
|
42
|
Torres-de la Roche LA, Devassy R, Gopalakrishnan S, de Wilde MS, Herrmann A, Larbig A, De Wilde RL. Plastic neo-vaginal construction in Mayer-Rokitansky-Küster-Hauser syndrome: an expert opinion paper on the decision-making treatment process. GMS Interdiscip Plast Reconstr Surg DGPW 2016; 5:Doc08. [PMID: 26904393 PMCID: PMC4740437 DOI: 10.3205/iprs000087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Vaginal agenesis is a congenital anomaly that affects the life of one of each four thousand women around the world. There is a trend that patients request immediate surgical correction, instead of passive vaginal dilatation. Therefore a differentiated counselling should be provided. We present a comparative chart, based on published evidence, with aspect to the available techniques, which will facilitate the decision-making process in the clinical practice. From our point of view, the best results are achieved with techniques that combine the advantages of the minimal-invasive surgery with those derived of the use of peritoneum as covering tissue of the neovagina. Nevertheless there is a lack on interdisciplinary consensus about the best option to restore the physical and sexual quality of life.
Collapse
Affiliation(s)
- Luz Angela Torres-de la Roche
- Clinic of Gynecology, Obstetrics and Gynecological Oncology, University Hospital for Gynecology, Pius-Hospital Oldenburg, Medical Campus University of Oldenburg, Germany
| | - Rajesh Devassy
- Dubai-London Specialty Hospital, Jumeirah, Dubai, United Arab Emirates
| | | | - Maya Sophie de Wilde
- Clinic of Gynecology, Obstetrics and Gynecological Oncology, University Hospital for Gynecology, Pius-Hospital Oldenburg, Medical Campus University of Oldenburg, Germany
| | - Anja Herrmann
- Clinic of Gynecology, Obstetrics and Gynecological Oncology, University Hospital for Gynecology, Pius-Hospital Oldenburg, Medical Campus University of Oldenburg, Germany
| | - Angelika Larbig
- Clinic of Gynecology, Obstetrics and Gynecological Oncology, University Hospital for Gynecology, Pius-Hospital Oldenburg, Medical Campus University of Oldenburg, Germany
| | - Rudy Leon De Wilde
- Clinic of Gynecology, Obstetrics and Gynecological Oncology, University Hospital for Gynecology, Pius-Hospital Oldenburg, Medical Campus University of Oldenburg, Germany
| |
Collapse
|
43
|
Abstract
The congenital aplasia or severe hypoplasia of mullerian structures is infrequent. However, the features of normal female endocrine function paired with the absence of a functional uterus and vagina makes it a fascinating entity. The diagnosis and work-up in these patients has become very efficient, thanks to the use of imaging, and there are multiple successful procedures for the creation of a neovagina. In recent years, infertility treatment options through in vitro fertilization have also become available as part of the long-term care of these patients.
Collapse
Affiliation(s)
- Laura Londra
- Division of Reproductive Endocrinology and Infertility, Department of Gynecology and Obstetrics, Johns Hopkins University, Baltimore, MD, USA
| | - Farah S Chuong
- Division of Reproductive Endocrinology and Infertility, Department of Gynecology and Obstetrics, Johns Hopkins University, Baltimore, MD, USA
| | - Lisa Kolp
- Division of Reproductive Endocrinology and Infertility, Department of Gynecology and Obstetrics, Johns Hopkins University, Baltimore, MD, USA
| |
Collapse
|
44
|
Kajikawa MM, Jármy-Di Bella ZIK, Dornelas J, Crema LC, Takano CC, Focchi GRDA, Rolo LC, Araujo Júnior E, Castro RA, Girão MJBC, Sartori MGF. Oestrogen receptor alpha expression in neovaginal tissue of women following modified Abbé-McIndoe technique and in premenopausal women. Gynecol Endocrinol 2015; 31:327-31. [PMID: 25561399 DOI: 10.3109/09513590.2014.995618] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The aim of the study was to compare the expression of oestrogen receptor alpha (ERα) in neovaginal tissue of patients with vaginal agenesis following neovaginoplasty using regenerated, oxidised cellulose in premenopausal women. A prospective, observational case-control study was performed on eight patients with vaginal agenesis following modified Abbé-McIndoe neovaginoplasty and 10 control premenopausal women following benign gynaecologic surgery. 6F11 monoclonal antibody was used to determine ERα expression in the vaginal mucosa. Quantitative and qualitative evaluations were performed, respectively, in vaginal epithelium and stroma. The thickness of the vaginal epithelium was determined as the vertical distance between the basal layer cells and the apical surface of the superficial layer. The percentage of ERα-expressing cells was higher in the control group, except in the superficial zone of the epithelium. In the stromal tissue, ERα was detected in only one patient from the neovagina group compared with nine women in the control group. The neovagina group had a statistically thinner epithelium. Our study suggests that women with vaginal agenesis following modified Abbé-McIndoe neovaginoplasty using regenerated oxidised, cellulose experience relatively local hypo-oestrogenism in the first year after surgery, with repercussion in vaginal trophism.
Collapse
Affiliation(s)
- Marcio Masashi Kajikawa
- Department of Gynaecology at Paulista School of Medicine - São Paulo Federal University (EPM-UNIFESP) , São Paulo-SP , Brazil
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
45
|
Abstract
Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome is a disorder in women that presents as Mullerian agenesis. These patients present internal genitalia abnormalities that include the absence of a uterus and the upper two-thirds of the vagina. In this review, current diagnostic methods, accompanying complications (congenital and psychological) and non-surgical and surgical treatments are summarized. Ultrasound and MRI have been the most documented options in MRKH syndrome diagnosis. Many women with MRKH syndrome have renal, skeletal, hearing or cardiac congenital anomalies and increased levels of psychological distress. Non-surgical interventions can be used to create a sexually functional neovagina through vaginal dilation, and surgical interventions provide alternate methods of creating a neovagina. Additionally, vaginal tissue engineering and gene therapy might provide more effective approaches in solving MRKH syndrome.
Collapse
Affiliation(s)
- David S Bombard
- Pharmaceutical Research Institute, Albany College of Pharmacy and Health Sciences , Rensselaer, NY , USA
| | | |
Collapse
|
46
|
Guarino N, Scommegna S, Majore S, Rapone AM, Ungaro L, Morrone A, Grammatico P, Marrocco GA. Vaginoplasty for disorders of sex development. Front Endocrinol (Lausanne) 2013; 4:29. [PMID: 23483838 PMCID: PMC3593621 DOI: 10.3389/fendo.2013.00029] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2012] [Accepted: 02/25/2013] [Indexed: 11/13/2022] Open
Abstract
One of the most common problem found in patients with Disorders of Sexual Developments is the absence or extreme hypoplasia of the vagina. The type of patients presenting this anomaly may belong to completely different groups: (1) Patients with a urogenital sinus with urethra and vagina fusing together to form a common channel. (2) Patients with absent Müllerian structures and different degrees of external virilization. (3) Complex malformations. Treatment options: treatment of these patients is under discussion and may consist, basically, in non-operative dilation methods or surgical creation of a neovagina. Consensus is far to be reached among the various surgical subspecialties regarding the optimal method of vaginal replacement. Adequate number of long-term follow up patients are still non-available so that most conclusions are based on small number series. The authors describe the different treatment options in detail.
Collapse
Affiliation(s)
- Nino Guarino
- Department of Pediatric Surgery, S. Camillo-Forlanini HospitalRome, Italy
| | - Salvatore Scommegna
- Department of Pediatrics and Hematology, S. Camillo-Forlanini HospitalRome, Italy
| | - Silvia Majore
- Department of Medical Genetics, Molecular Department, University “La Sapienza”Rome, Italy
| | | | - Luciana Ungaro
- Psychology Department, S. Camillo-Forlanini HospitalRome, Italy
| | - Aldo Morrone
- Healthcare Administration, S. Camillo-Forlanini HospitalRome, Italy
| | - Paola Grammatico
- Department of Medical Genetics, Molecular Department, University “La Sapienza”Rome, Italy
| | - Giacinto A. Marrocco
- Department of Pediatric Surgery, S. Camillo-Forlanini HospitalRome, Italy
- *Correspondence: Giacinto A. Marrocco, Department of Pediatric Surgery, S. Camillo-Forlanini Hospital, Via Antonio Bennicelli, 45, 00151 Rome, Italy. e-mail:
| |
Collapse
|
47
|
Abstract
INTRODUCTION The Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome is one of the most common causes of primary amenorrhoea and is associated with vaginal atresia and absent uterus despite the presence of normal ovaries and external genitalia. Various techniques have been used, with many disadvantages, to create a neovagina. AIMS AND OBJECTIVES Our aim is to create a neovagina with a simple and safe method. MATERIALS AND METHODS We have operated 18 cases of MRKH syndrome with the Sheares' method of vaginoplasty, in which the space between the two labia is dilated with a Hegar's dilator along the vestigial Mullerian ducts. Thus, two tunnels are created and the central septum is excised to form a single vagina. A mould covered with amnion is placed in the neovagina. All cases are followed up for six months. They have all had a good length of vagina with regular manual dilatation. CONCLUSIONS The Sheares' method of vaginoplasty is an easy and safe method to create a neovagina with least complications, like injury to urinary bladder, rectum or bleeding.
Collapse
Affiliation(s)
- Somajita Chakrabarty
- Department of Obstetrics and Gynecology, NRS Medical College and Hospital, Kolkata and PGMER and SSKM Hospital and Medical College, Kolkata, India
| | | | | |
Collapse
|
48
|
Miller PB, Forstein DA. Creation of a neovagina by the Vecchietti procedure in a patient with corrected high imperforate anus. JSLS 2009; 13:221-3. [PMID: 19660220 PMCID: PMC3015920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Vaginal atresia is often associated with high imperforate anus. Because the commonly used methods of surgical vaginal creation (eg, McIndoe, intestinal segment interposition) may adversely affect urinary and fecal continence, the less-invasive Vecchietti procedure was selected for a young adult with a successfully corrected high imperforate anus. METHODS A 21-year-old was born with a high imperforate anus, vaginal atresia, right hemi-uterus, and left renal agenesis. A colostomy was done at birth, a pull-through procedure at 9 months, and a stoma closure 3 months later. At age 13, an obstructed and dilated right hemiuterus and fallopian tube were resected. A laparoscopic version of the Vecchietti procedure was used for creation of a neovagina. RESULTS After the patient had been in the hospital for 2 days, traction was gradually advanced every other day in the office. At 2 weeks postoperatively, the bead was removed revealing a 7-cm vagina. Further elongation was achieved using the Frank method, while continence remained intact. CONCLUSION The Vecchietti procedure is an attractive, minimally invasive alternative for creation of a neovagina in patients at risk for compromise to their vesico-anorectal continence.
Collapse
|