Prolapse of the Neovagina 40 Years After Vaginoplasty Using Sigmoid Colon Graft: Case Report on a 61-Year-Old Woman

Tanaka, Yoshihiro; Nozaki, Masahiro; Ariyoshi, Kazuya; Koganemaru, Yasuko; Shigematsu, Toshiyuki; Nakano, Hitoo

doi:10.1089/104240603763487168

Cited by 1 publication

(1 citation statement)

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“…Most authors looked at SNP cases as normal vaginal prolapses, and consider the lack of preventive fixation to the first support level structures to be the root of the problem [ 12 , 23 ]. Tanaka, on the contrary, theorizes that the prolapse may be caused by hyperplasia of the colonic mucosa based on the histopathology report of the resected sigmoid [ 6 ]. No other authors reported similar histological findings, and in our case, there were no signs of hyperplasia but only non-specific inflammatory changes that could be explained by friction between the patient’s clothes and the prolapsed mucosa [ 24 ].…”

Section: Discussionmentioning

confidence: 99%

Sigmoid neovagina prolapse treated with Altemeier procedure: case report and systematic review of the literature

Drusany Starič,

Distefano,

Norčič

2023

Int Urogynecol J

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Background Bowel vaginoplasty is a surgical method for neovagina construction that, despite its advantages over other techniques, is still burdened by complications such as prolapse. The incidence of sigmoid neovagina prolapse (SNP) is difficult to determine, and there are no evidence-based recommendations for treatment. We present a case of SNP and a systematic review of previous cases. Case A 73-year-old woman presented with stage III prolapse of her sigmoid neovagina constructed 51 years prior. Dynamic pelvic MRI revealed that the majority of the prolapse was due to the mucosa’s loss of support. Due to the presence of numerous pelvic adhesions, an alternative to the laparoscopic approach was evaluated by a multidisciplinary team which led to the patient being treated using a modification of Altemeier’s procedure. Systematic review After PROSPERO Registration (CRD42023400677), a systematic search of Medline and Scopus was performed using specific search terms. Study metadata including patient demographics, prolapse measurements, reconstruction techniques, recurrence rates, and timing were extracted. Fourteen studies comprising 17 cases of SNP were included. Vaginal resection of the redundant sigmoid, comprising Altemeier’s procedure, was the most definitive surgery, but it was also associated with recurrences in three cases. Laparoscopic sacropexy was the second most definitive surgery with no recurrence reported. Conclusion Our review shows that the recurrence after correction of sigmoid neovagina prolapses is higher than previously reported. Laparoscopy colposacropexy appeared to be the best approach, but it’s not always feasible. In these scenarios, a mucosal resection using the Altemeier’s procedure is the most effective surgery.

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