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

Abstract

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

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“…However, surgeons must still be aware of how to perform other surgical procedures for vaginoplasty in case the intended procedure fails. The first recommended way is laparoscopic vaginoplasty using sigmoid colon for cases where the previous operation was a failure [ 30 – 32 ]. The William technique is suitable in case of the vagina operation failure, pelvic radical operation or radiotherapy, and the vulva development is good without urethral dilatation [ 33 ].…”

Vaginoplasty using Inguinal Flap in a Tertiary Care Center

“…The is no handling of the colon or rectum, or any other organ that may increase morbidity, as reported by other authors [10,11].…”

Surgical and functional outcome of sigmoid colon-vaginoplasty in Mayer-Rokitansky-Kuster-Hauser syndrome

“…stenosis of the neovagina, prolapse of the neovagina, malodor of the vaginal secretions, postcoital bleeding. 13,14 None of the patients in our series had any major postoperative or chronic complications. None of the patients complained of local irritation and dryness.…”