UroToday- Different modalities for vaginal reconstruction are available for children with forms of ambiguous genitalia such as aplasia of Mullerian ducts, testicular feminization and androgen insensitivity syndromes as well as Mayer-Rokitansky-Kuster-Hauser Syndrome. This study by Ekinci, et al report the outcomes in 6 adolescent patients who underwent sigmoid vaginoplasty. The 6 patients had the following diagnoses: 3 with 5-alpha-reductase deficiency, 2 with testicular feminization, and 1 with vaginal atresia. The group utilized a 15-20 cm segment of sigmoid colon that was transferred down to the perineum for vaginal reconstruction. The proximal end was closed in two layers and distal anastomosis was carried out to the vaginal plate.

Postoperatively, the patients were informed to perform vaginal irrigation on a daily basis. The patients were then taken back to the operating room and the neovagina was examined and calibrated under anesthesia. No routine vaginal dilation was recommended by the group. All but one patient had an uneventful postoperative course and was discharged within a week. That one patient developed a deep venus thombosis with subsequent embolism, renal failure and sepsis resulting in death. All the other patients had an excellent cosmetic result with appropriate vaginal length. One patient did develop a late stenosis of the introitus which responded to dilators. The patients reported that the mucus discharge was not a significant problem.

The group concluded that sigmoid colon vaginoplasty is an appropriate method for the construction of a neovagina in children. They feel in their study the colonic neovagina met all the necessary criteria after vaginoplasty to deem it successful. It is difficult to truly say when is the best time for surgery in these patients. Some feel that early intervention is best because it is easier to operate in the pediatric pelvis than it is in an adult pelvis. Other are proponents that children do not need their vaginas and this should be held off until adulthood when they can be part of the decision making and accept any consequences that come from that surgery.

Ekinci, S.; Karnak, İ; Ciftci, A. O.; Şenocak, M. E.; Tanyel, F. C.; Büyükpamukçu, N.:
European Journal of Pediatric Surgery 16(3): 182-187, June 2006.

Reviewed by UroToday Contributing Editor Pasquale Casale, MD

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