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Drusany Starič K, Distefano REC, Norčič G. Sigmoid neovagina prolapse treated with Altemeier procedure: case report and systematic review of the literature. Int Urogynecol J 2023; 34:2647-2655. [PMID: 37490063 PMCID: PMC10682208 DOI: 10.1007/s00192-023-05603-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Accepted: 06/26/2023] [Indexed: 07/26/2023]
Abstract
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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Affiliation(s)
- Kristina Drusany Starič
- Department of Gynecology, Division of Gynecology and Obstetrics, University Medical Centre Ljubljana, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Rosario Emanuele Carlo Distefano
- Ist. Patologia Ostetrica E Ginecologica, Department of General Surgery and Medical Surgical Specialities, University of Catania, Via Santa Sofia 78, 95100, Catania, Italy.
| | - Gregor Norčič
- Department of Abdominal Surgery, Division of Surgery, University Medical Centre Ljubljana, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
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Bello OO, Morhason-Bello IO, Lawal OO, Abdus-Salam RA, Iyun AO, Ojengbede OA. Outcomes of surgical treatments for acquired gynatresia in a tertiary institution in Ibadan, Nigeria. J OBSTET GYNAECOL 2021; 42:1280-1285. [PMID: 34704518 DOI: 10.1080/01443615.2021.1959530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
A 16-year review of causes, clinical presentation and management outcomes of Acquired gynatresia (AG) at University College Hospital, Ibadan, Nigeria. Information was obtained using a proforma and data analysed using SPSS version 20.0. The mean age of the 31 women with AG was 35.6 ± 6.2 years. The majority (90.3%) were married and had a tertiary level of education. The mean parity was 0.74 ± 1.1 and 54.8% were nulliparous while 29.0% were primiparous women. The commonest cause of AG was the insertion of caustic substances into the vagina and this was mainly for the treatment of uterine fibroid (68.2%) and infertility (54.5%). Over three-quarters presented with dyspareunia while 54.8% had infertility. A majority (87.1%) had one-stage surgery with dissection/excision of fibrotic tissue being the commonest (45.2%) and sigmoid vaginoplasty the least performed. Postoperative complications were seen in 29.0% of cases. Acquired gynatresia remains a condition of public health interest despite an increase in female education and relatively improved health care in Nigeria.Impact statementWhat is already known on this subject? Acquired gynatresia (AG) could be of chemical and non-chemical origin and result from certain cultural beliefs and practices.What do the results of this study add? Irrespective of the women's level of education, there is inadequate awareness of the implications of inserting caustic materials into the vagina. However, there is a high success rate of treatment of AG.What the implications are of these findings for clinical practice and/or further research? There is a need to increase health education and awareness of the populace on the causes of AG and its associated complications.
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Affiliation(s)
| | | | - Olatunji Okikiola Lawal
- Department of Obstetrics and Gynaecology, University of Ibadan/University College Hospital, Ibadan, Nigeria
| | - Rukiyat Adeola Abdus-Salam
- Department of Obstetrics and Gynaecology, University of Ibadan/University College Hospital, Ibadan, Nigeria
| | - Ayodele Olukayode Iyun
- Department of Plastic, Reconstructive and Aesthetic Surgery, University College Hospital, Ibadan, Nigeria
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Yadav M, Hayashi T, Krisna R, Nutthachote P, Sawada Y, Tokiwa S, Cortes AR, Nomura M. Laparoscopic sacrocolpopexy in a patient with vault prolapse of the sigmoid stump after vaginoplasty in Mayer-Rokitansky-Küster-Hauser syndrome: A case report. Case Rep Womens Health 2021; 30:e00313. [PMID: 33981589 PMCID: PMC8082081 DOI: 10.1016/j.crwh.2021.e00313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 04/08/2021] [Accepted: 04/09/2021] [Indexed: 11/11/2022] Open
Abstract
Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome is a rare congenital anomaly that results in Müllerian agenesis that affects the uterus and upper two-thirds of the vagina. Sigmoid vaginoplasty is a surgical treatment option; however, vaginal prolapse may result as a complication of the sigmoid neovagina. There are no standards for treatment due to the rarity of this condition. We present the case of a 59-year-old woman with a history of sigmoid vaginoplasty who underwent laparoscopic sacrocolpopexy (LSC) for grade IV sigmoid stump prolapse. The patient had a successful outcome and no evidence of recurrent prolapse. This clinical case reveals the feasibility of LSC as a surgical treatment for sigmoid stump prolapses in patients with MRKH syndrome. There is no gold standard treatment for neovaginal prolapse, due to its rarity. Laparoscopic sacrocolpopexy (LSC) can be considered as an optimal treatment of choice for neovaginal prolapse. LSC for sigmoid stump prolapse in a patient with MRKH syndrome results to a good functional and anatomical outcome at 3-year follow up.
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Affiliation(s)
- Manisha Yadav
- Urogynecology Center, Kameda Medical Center, Kamogawa, Chiba, Japan
| | - Tokumasa Hayashi
- Urogynecology Center, Kameda Medical Center, Kamogawa, Chiba, Japan
| | - Ratih Krisna
- Urogynecology Center, Kameda Medical Center, Kamogawa, Chiba, Japan
| | | | - Yogo Sawada
- Urogynecology Center, Kameda Medical Center, Kamogawa, Chiba, Japan
| | - Shino Tokiwa
- Urogynecology Center, Kameda Medical Center, Kamogawa, Chiba, Japan
| | | | - Masayoshi Nomura
- Urogynecology Center, Kameda Medical Center, Kamogawa, Chiba, Japan
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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] [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.
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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. ROYAL SOCIETY OPEN SCIENCE 2018. [PMID: 30225072 DOI: 10.5061/dryad.2bg877b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [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.
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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
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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. ROYAL SOCIETY OPEN SCIENCE 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] [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.
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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
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Huebner M, DeLancey JOL, Reisenauer C, Brucker SY, Preibsch H, Fleischer S, Schoeller D, Stefanescu D, Rall K. Magnetic resonance imaging of vaginal support structure before and after Vecchietti procedure in women with Mayer-Rokitansky-Küster-Hauser syndrome. Acta Obstet Gynecol Scand 2018; 97:830-837. [PMID: 29603118 DOI: 10.1111/aogs.13350] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 03/20/2018] [Indexed: 11/27/2022]
Abstract
INTRODUCTION It is unclear how pelvic floor supporting structures might be affected by the absence of the vagina. It was the aim of this prospective study to analyze the magnetic resonance imaging morphology of pelvic support prior and after a Vecchietti procedure in women suffering Mullerian agenesis (Mayer-Rokitansky-Küster-Hauser syndrome). MATERIAL AND METHODS 26 women with a diagnosis of Mayer-Rokitansky-Küster-Hauser syndrome associated vaginal agenesis were recruited prospectively prior to the laparoscopic creation of a neovagina according to the Vecchietti procedure. The primary outcome measure was the magnetic resonance imaging morphology of supporting structures. Secondary outcome measures were anatomical and functional vaginal length. Follow up was conducted six months after surgery. RESULTS Twenty-six women were analyzed. Mean age was 19.8 ± 4.4 years (±SD) and mean body mass index was 23.7 ± 4.3 kg/m2 (±SD). All were Caucasian. Supporting structures consistent with cardinal and uterosacral ligaments were visible on magnetic resonance imaging in all cases (100%). There were no levator ani defects. The vaginal apex could be visualized postoperatively in 12 women (46.2%) reaching up to Level I. The vagina was visible in both Level II and III with normal relations to the pelvic walls in all cases. On gynecological examination, vaginal length was 8.8 ± 2.1 cm (mean ± SD) anatomically and 10.2 ± 2.2 cm (mean ± SD) functionally. CONCLUSIONS The preoperative presence of pelvic support structures into which the vagina is lengthened by the surgery likely explains the uncommon occurrence of vaginal prolapse in women who had the Vecchietti procedure.
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Affiliation(s)
- Markus Huebner
- Department of Women's Health, University Hospital of Tuebingen, Tuebingen, Germany
| | - John O L DeLancey
- Department of Obstetrics and Gynecology, Pelvic Floor Research Group, University of Michigan, Ann Arbor, MI, USA
| | - Christl Reisenauer
- Department of Women's Health, University Hospital of Tuebingen, Tuebingen, Germany
| | - Sara Y Brucker
- Department of Women's Health, University Hospital of Tuebingen, Tuebingen, Germany
| | - Heike Preibsch
- Department of Diagnostic and Interventional Radiology, University Hospital of Tuebingen, Tuebingen, Germany
| | - Sabrina Fleischer
- Department of Diagnostic and Interventional Radiology, University Hospital of Tuebingen, Tuebingen, Germany
| | - Dorit Schoeller
- Department of Women's Health, University Hospital of Tuebingen, Tuebingen, Germany
| | - Diana Stefanescu
- Department of Women's Health, University Hospital of Tuebingen, Tuebingen, Germany
| | - Katharina Rall
- Department of Women's Health, University Hospital of Tuebingen, Tuebingen, Germany
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Hao Z, Yang S. Neovaginal Prolapse Treated with Sacrospinous Ligament Suspension: A Case Report and Review of the Literature. J Pediatr Adolesc Gynecol 2017; 30:505-507. [PMID: 28065727 DOI: 10.1016/j.jpag.2016.12.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2016] [Revised: 12/11/2016] [Accepted: 12/28/2016] [Indexed: 11/16/2022]
Abstract
Neovaginal prolapse (NP) is a rare event and limited cases have been reported in the literature. After surgical management, NP recurs in some cases, posing a great challenge to gynecologists. Fixing neovagina to sacrospinous ligament would appear to be a good option for preventing the recurrence of NP, but too few cases have been reported to establish this technique as the standard management of NP. Herein, we present a case of severe mucosal prolapse of sigmoid neovagina and conduct a review of the literature regarding the etiology, prevention, and management of NP.
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Affiliation(s)
- Zhimin Hao
- Department of Gynecology, Affiliated Hospital, School of Medicine, Ningbo University, Ningbo, China
| | - Sufen Yang
- Department of Gynecology, Affiliated Hospital, School of Medicine, Ningbo University, Ningbo, China.
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Primary Total Laparoscopic Sigmoid Vaginoplasty in Transgender Women with Penoscrotal Hypoplasia: A Prospective Cohort Study of Surgical Outcomes and Follow-Up of 42 Patients. Plast Reconstr Surg 2017; 138:614e-623e. [PMID: 27673532 DOI: 10.1097/prs.0000000000002549] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND In young transgender women previously treated with puberty-suppressing hormones, penoscrotal hypoplasia can make penoscrotal inversion vaginoplasty unfeasible. The aim of this study was to prospectively assess surgical outcomes and follow-up of total laparoscopic sigmoid vaginoplasty as primary reconstruction in a cohort of transgender women with penoscrotal hypoplasia. METHODS Baseline demographics, surgical characteristics, and intraoperative and postoperative complications of all performed total laparoscopic sigmoid vaginoplasty procedures were prospectively recorded. RESULTS From November of 2007 to July of 2015, 42 transgender women underwent total laparoscopic sigmoid vaginoplasty as primary vaginal reconstruction. The mean age at the time of surgery was 21.1 ± 4.7 years. Mean follow-up time was 3.2 ± 2.1 years. The mean operative duration was 210 ± 44 minutes. There were no conversions to laparotomy. One rectal perforation was recognized during surgery and immediately oversewn without long-term consequences. The mean length of hospitalization was 5.7 ± 1.1 days. One patient died as a result of an extended-spectrum beta-lactamase-positive necrotizing fasciitis leading to septic shock, with multiorgan failure. Direct postoperative complications that needed laparoscopic reoperation occurred in three cases (7.1 percent). In seven cases (17.1 percent), long-term complications needed a secondary correction. After 1 year, all patients had a functional neovagina with a mean depth of 16.3 ± 1.5 cm. CONCLUSIONS Total laparoscopic sigmoid vaginoplasty seems to have a similar complication rate as other types of elective laparoscopic colorectal surgery. Primary total laparoscopic sigmoid vaginoplasty is a feasible gender-confirming surgical technique with good functional outcomes for transgender women with penoscrotal hypoplasia. CLINICAL QUESTIO/LEVEL OF EVIDENCE Therapeutic, IV.
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Cornelisse VJ, Jones RA, Fairley CK, Grover SR. The medical care of the neovagina of transgender women: a review. Sex Health 2017; 14:442-450. [DOI: 10.1071/sh17044] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 07/05/2017] [Indexed: 11/23/2022]
Abstract
For transgender women, genital adjustment surgery involves removal of the natal reproductive organs and creation of a neovagina, vulva and clitoris. We conducted a review of the medical literature in order to summarise the issues that can affect the health of the neovagina in the long term, and to make recommendations on how to manage these issues.
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Horton J, Phillips C. Laparoscopic Sacrocolpopexy for Treatment of Neovaginal Prolapse Following Gender Reassignment Surgery. J Gynecol Surg 2016. [DOI: 10.1089/gyn.2015.0060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Joanne Horton
- University Hospital Southampton, and Department of Obstetrics and Gynaecology, Princess Anne Hospital, Southampton, Hampshire, United Kingdom
| | - Christian Phillips
- Basingstoke and North Hampshire Hospital, Basingstoke, Hampshire, United Kingdom
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Neron M, Ferron G, Vieille P, Letouzey V, Fatton B, de Tayrac R. Treatment of neovaginal prolapse: case report and systematic review of the literature. Int Urogynecol J 2016; 28:41-47. [DOI: 10.1007/s00192-016-3009-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Accepted: 03/11/2016] [Indexed: 10/22/2022]
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Kisku S, Varghese L, Kekre A, Sen S, Karl S, Mathai J, Thomas RJ, Kishore R. Bowel vaginoplasty in children and young women: an institutional experience with 55 patients. Int Urogynecol J 2015; 26:1441-8. [DOI: 10.1007/s00192-015-2728-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Accepted: 04/21/2015] [Indexed: 11/30/2022]
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