Evaluation and management of vaginoplasty complications

Evaluation of Bi-layer Silk Fibroin Grafts for Inlay Vaginoplasty in a Rat Model

BACKGROUND

Autologous tissues derived from bowel, buccal mucosa and skin are primarily used to repair or replace diseased vaginal segments as well as create neovaginas for male-to-female transgenders. These grafts are often limited by scarce tissue supply, donor site morbidity and post-operative complications. Bi-layer silk fibroin (BLSF) biomaterials represent potential alternatives for vaginoplasty given their structural strength and elasticity, low immunogenicity, and processing flexibility. The goals of the current study were to assess the potential of acellular BLSF scaffolds for vaginal tissue regeneration in respect to conventional small intestinal submucosal (SIS) matrices in a rat model of vaginoplasty.

METHODS

Inlay vaginoplasty was performed with BLSF and SIS scaffolds (N = 21 per graft) in adult female rats for up to 2 months of implantation. Nonsurgical controls (N = 4) were investigated in parallel. Outcome analyses included histologic, immunohistochemical and histomorphometric evaluations of wound healing patterns; µ-computed tomography (CT) of vaginal continuity; and breeding assessments.

RESULTS

Animals in both scaffold cohorts exhibited 100% survival rates with no severe post-operative complications. At 2 months post-op, µ-CT analysis revealed normal vaginal anatomy and continuity in both graft groups similar to controls. In parallel, BLSF and SIS grafts also induced comparable constructive remodeling patterns and were histologically equivalent in their ability to support formation of vascularized vaginal neotissues with native tissue architecture, however with significantly less smooth muscle content. Vaginal tissues reconstructed with both implants were capable of supporting copulation, pregnancy and similar amounts of live births.

CONCLUSIONS

BLSF biomaterials represent potential "off-the-shelf" candidates for vaginoplasty.

Classification and treatment of vaginal strictures at the donor-recipient anastomosis after uterus transplant

OBJECTIVE

To describe the incidence and management of vaginal stricture after uterus transplantation (UTx) in the US, to propose a grading system to classify stricture severity, and to identify risk factors for stricture formation.

DESIGN

Prospective cohort study.

SETTING

University Hospital.

PATIENTS

Recipients undergoing UTx from 2016-2023 at Baylor University Medical Center in Dallas, Cleveland Clinic, the University of Pennsylvania, and the University of Alabama at Birmingham were monitored postoperatively with regular pelvic examinations. Stricture was defined as vaginal narrowing of <3 cm in patients with graft survival of at least 7 days.

INTERVENTION

Demographic and surgery characteristics.

MAIN OUTCOME MEASURES

Stricture development and severity (grade 1 for diameter 2-<3 cm, grade 2 for 1-<2 cm, or grade 3 for <1 cm).

RESULTS

Of the 45 UTx from 2016-2023 (16 deceased donors and 29 living donors), 3 were excluded from the analysis because of graft loss within 7 days. Of the 42 remaining recipients, 39 (92.9%) had Mayer-Rokitansky-Küster-Hauser syndrome and 3 (7.1%) had a prior hysterectomy. Twenty-eight (66.7%) UTx recipients developed postoperative vaginal strictures with a median time to stricture of 33 days (interquartile range 19-53 days). Most strictures were of moderate severity, with 4 (14.3%) strictures categorized as grade 1, 19 (67.9%) as grade 2, and 5 (17.9%) as grade 3. History of Mayer-Rokitansky-Küster-Hauser syndrome and preoperative recipient vaginal length were significant risk factors for stricture, after adjustment for donor and recipient age and body mass index, anastomosis technique, total ischemia time, center, and year. Patients with longer preoperative vaginal length had a lower risk of stricture (hazard ratio 0.45, 0.29-0.70). The severity grading of the stricture was associated with the effectiveness of a nonoperative treatment approach (grade 1 vs. grade 3). No patients with grade 3 strictures improved with self-dilation alone; all required surgical repair and/or dilation under anesthesia. Conversely, for grade 1 or 2 strictures, self-dilation alone was successful in 47.8% (11/23), and no grade 1 strictures required surgical repair.

CONCLUSIONS

Vaginal stricture is a common postoperative complication after UTx, affecting >65% of recipients. Short preoperative vaginal length and history of müllerian agenesis in the recipient are significant risk factors. Vaginal self-dilation was effective for some mild to moderate strictures, although dilation under anesthesia or surgical repair was required in most cases.

CLINICAL TRIAL REGISTRATION NUMBERS

Dallas UtErus Transplant Study (DUETS) at Baylor University Medical Center (NCT02656550), Uterine transplantation for the treatment of uterine factor infertility at the Cleveland Clinic (NCT02573415), The University of Pennsylvania Uterus Transplant for Uterine Factor Infertility Trial (UNTIL) (NCT03307356).

Management of vaginoplasty canal complications

PURPOSE OF REVIEW

Increasing uptake of gender affirming surgery has allowed for a wider breadth of publication examining complications associated with vaginoplasty. This review aims to provide a comprehensive overview of complications associated with vaginoplasty procedures, focusing on intraoperative, early postoperative, and delayed postoperative complications across different surgical techniques.

RECENT FINDINGS

Intraoperative complications such as bleeding, injury of the rectum, urethra and prostate, and intra-abdominal injury are discussed, with insights into their incidence rates and management strategies. Early postoperative complications, including wound dehiscence, infection, and voiding dysfunction, are highlighted alongside their respective treatment approaches. Moreover, delayed postoperative complications such as neovaginal stenosis, vaginal depth reduction, vaginal prolapse, rectovaginal fistula, and urinary tract fistulas are assessed, with a focus on their etiology, incidence rates, and management options.

SUMMARY

Vaginoplasty complications range from minor wound issues to severe functional problems, necessitating a nuanced understanding of their management. Patient counseling, surgical approach, and postoperative care optimization emerge as crucial strategies in mitigating the impact of complications. Standardizing complication reporting and further research are emphasized to develop evidence-based strategies for complication prevention and management in vaginoplasty procedures.

Understanding Physician Practices and Preferences Using Vaginal Stents to Prevent Postoperative Vaginal Stenosis in Pediatric and Adolescent Patients

STUDY OBJECTIVE

The purpose of this study is to describe practices to prevent vaginal stenosis in pediatric and adolescent patients and to evaluate the strengths and weaknesses of available vaginal stents.

METHODS

An online survey was distributed to North American Society for Pediatric and Adolescent Gynecology (NASPAG) members with an optional follow-up focus group. Quantitative and qualitative data were synthesized to highlight physician practices and preferences using vaginal stents, strengths and weakness of stents, and ideal stent properties.

RESULTS

Twenty physicians completed at least 50% of the survey, and 4 participated in the focus group. Most were pediatric and adolescent gynecology specialists (95%) with fellowship training (60%) and experience in managing Müllerian anomalies (80%). Physicians reported they "always" used a vaginal stent when performing vaginoplasty for distal vaginal agenesis with a graft (62.5%) or without a graft (37.5%) and for transverse vaginal septa (57.1%). The most common type of stents used were packed condoms (60%), tracheobronchial stents (40%), Foley catheters (35%), and custom stents (35%). Participants described an ideal vaginal stent as something that would stay in place, cause little discomfort, expand, and come in a variety of lengths.

CONCLUSION

There are limited vaginal stent options for the pediatric and adolescent gynecology population. Participants reported variability in stents used to prevent vaginal stenosis, with commonly used vaginal stents having significant weaknesses. Future efforts are needed to identify and develop postoperative clinical guidelines to prevent vaginal stenosis.

International Experiences with Vaginal Lengthening Treatment Among Individuals with Müllerian Agenesis: A Mixed-Methods Study

STUDY OBJECTIVE

To understand variations and experiences of vaginal lengthening internationally in individuals with congenital underdevelopment of the uterus, cervix, and upper vagina or Müllerian agenesis METHODS: In this study, we used a cross-sectional mixed-methods design incorporating quantitative and qualitative questionnaires. Adults with Müllerian agenesis completed questionnaires with quantitative and open-ended qualitative questions about their vaginal lengthening experiences. Data were analyzed using descriptive statistics and inductive thematic analysis.

RESULTS

Of 616 respondents meeting inclusion criteria (representing 40 countries), 46% (n = 284) reported no vaginal lengthening intervention. Vaginal lengthening was commonly reported by participants from North America and Europe (59%) and less commonly by participants from Africa, Asia, and South America (16%). Of those who had undergone vaginal lengthening, 72% reported dilator use, 34% coital dilation, and 39% surgery. Four major themes were identified in response to the open-ended vaginal lengthening experience question: (1) difficult physical symptoms, (2) practical and psychosocial challenges, (3) intimate relationships and sexual satisfaction, and (4) impact of experiences with healthcare providers.

CONCLUSION

This study highlights vaginal lengthening practices internationally and shared themes related to significant challenges and positive experiences. The findings show room for improvement in the counseling and care surrounding vaginal lengthening. Future research should investigate factors that influence decision-making about vaginal lengthening and work toward international consensus on best care practices in Müllerian agenesis.

A Review of Aesthetic Gynecologic Procedures for Women

Aesthetic gynecologic surgery is gaining popularity among women and physicians. Aesthetic genital surgery for women encompasses both minimally invasive and open surgical procedures. Cosmetic genital procedures for women described in this article include perineoplasty, vaginoplasty, vaginal rejuvenation, labiaplasty, G-spot enlargement, Bartholin gland surgery, clitoral hoodoplasty, clitroplasty, hymenoplasty, and mons pubis plastic surgery. Based on a review of the literature for each procedure, the article discusses procedural methods and techniques, indications for implementation, potential consequences and side effects of the procedure, nursing implications, patients' motives for undergoing the procedure, and positions of scientific institutions relative to the procedure.

Cervical and endometrial cancers of intestinal origin diagnosed 18 years after vaginal replacement with a sigmoid colon segment: a case report and review of the literature

Background

Sigmoid colpoplasty is a surgical method for the treatment of vagina agenesis. Malignant tumors of neovaginas derived from sigmoid colons are rare.

Case presentation

We report a 33-year-old woman who underwent sigmoid colpoplasty for vaginal agenesis and presented 18 years later with vaginal bleeding. Examination revealed cancer of the neovagina with involvement of the cervix and endometrium. The patient was administered four cycles of chemotherapy because she refused surgery.

Conclusions

Patients with a history of colpoplasty should undergo long-term comprehensive testing after reconstruction, including regular gynecological, colposcopic, and gastrointestinal examinations. In patients with cancer of the neovagina, a comprehensive treatment plan should be developed in consultation with gynecologists and surgeons. There is no standard treatment, although surgery plus chemotherapy or radiotherapy appears to be effective.

Digestive Health in Sexual and Gender Minority Populations

It has been over 50 years since the Stonewall Inn Riots in June 1969, a seminal event for the lesbian, gay, bisexual, transgender, queer, intersex, and other sexual and gender-diverse minorities (LGBTQI+, or lesbian, gay, bisexual, transgender, queer, intersex, and everyone else) rights movement. However, sexual and gender minority (SGM) individuals still face discrimination and harassment due to their sexual orientation or gender identity. As such, the National Institute on Minority Health and Health Disparities has identified SGM communities as a "health disparity population." Broadly, there are higher rates of sexually transmitted infections, substance use and abuse, mental health conditions, obesity and eating disorders, certain cancers (breast, cervical, and anorectal), and cardiovascular disease in SGM communities. Transgender patients, especially those of color, are more likely to be uninsured, experience discrimination, and be denied health care than cisgender patients. In addition, SGM individuals have twice the risk of lifetime exposure to emotional, physical, and sexual trauma compared with heterosexuals. It is expected all these factors would negatively affect digestive health as well. This review summarizes the effects of social determinants of health and discrimination on health care access, highlights important digestive diseases to consider in the SGM population, and offers solutions to improve and prioritize the health of these communities. We aim to draw attention to SGM-specific issues that affect gastrointestinal health and spur research that is desperately lacking.

A Review of Aesthetic Gynecologic Procedures for Women

Aesthetic gynecologic surgery is gaining popularity among women and physicians. Aesthetic genital surgery for women encompasses both minimally invasive and open surgical procedures. Cosmetic genital procedures for women described in this article include perineoplasty, vaginoplasty, vaginal rejuvenation, labiaplasty, G-spot enlargement, Bartholin gland surgery, clitoral hoodoplasty, clitroplasty, hymenoplasty, and mons pubis plastic surgery. Based on a review of the literature for each procedure, the article discusses procedural methods and techniques, indications for implementation, potential consequences and side effects of the procedure, nursing implications, patients' motives for undergoing the procedure, and positions of scientific institutions relative to the procedure.

Prevalence of urinary, prolapse, and bowel symptoms in Mayer-Rokitansky-Küster-Hauser syndrome

BACKGROUND

Müllerian agenesis, or Mayer-Rokitansky-Küster-Hauser syndrome, occurs in 1 in 4500 to 5000 individuals assigned female sex at birth. Pelvic floor symptoms among individuals with Mayer-Rokitansky-Küster-Hauser syndrome have not been well studied, and it is unknown how vaginal lengthening treatments affect these symptoms.

OBJECTIVE

This study aimed to assess urinary, prolapse, and bowel symptoms in individuals with Mayer-Rokitansky-Küster-Hauser syndrome and to determine whether symptoms vary by vaginal lengthening treatment.

STUDY DESIGN

We conducted a cross-sectional study in 2019 using an online survey distributed by the Beautiful You MRKH Foundation via social media to individuals with Mayer-Rokitansky-Küster-Hauser syndrome. Demographics, age at and timing of diagnosis, information about vaginal lengthening treatment, urinary symptoms (Michigan Incontinence Symptom Index), prolapse symptoms (Pelvic Organ Prolapse Distress Inventory short-form version), and bowel symptoms (Bristol Stool Form Scale) were obtained. The inclusion criteria included self-reported diagnosis of müllerian agenesis and female sex. Respondents with a history of renal transplant or dialysis, completion of <85% of the survey, and non-English survey responses were excluded. Descriptive analyses were used to describe the sample population. Logistic regression, Kruskal-Wallis, and Fisher exact tests were used to compare the prevalence of pelvic floor symptoms and vaginal lengthening treatments. Associations between age and genitourinary symptoms were investigated with Spearman correlations.

RESULTS

Of 808 respondents, 615 met the inclusion criteria, representing 40 countries. 81% of respondents identified as white. The median age of the participants was 29 years (interquartile range, 24-36), with a median age at diagnosis of 16 years (interquartile range, 15-17). Among the 614 respondents, 331 (54%) had vaginal lengthening treatment, 130 of whom (39%) had undergone surgical vaginal lengthening. Of individuals with Mayer-Rokitansky-Küster-Hauser syndrome, 428 of 614 (70%) reported having had one or more urinary symptoms, and 339 of 428 (79%) reported being bothered by these symptoms. Urinary symptoms included urinary incontinence (210 of 614 [34%]), urinary frequency (245 of 614 [40%]), urinary urgency (248 of 614 [40%]), pain with urination (97 of 614 [16%]), and recurrent urinary tract infections (177 of 614 [29%]). Prolapse symptoms included lower abdominal pressure (248 of 612 [41%]), pelvic heaviness or dullness (177 of 610 [29%]), and vaginal bulge (68 of 609 [11%]). In addition, constipation was reported by 153 of 611 respondents (25%), and anal incontinence was reported by 153 of 608 (25%) respondents. Beside recent urinary incontinence (P=.003) and anal incontinence (P<.001), the prevalence of pelvic floor symptoms (P>.05) did not differ significantly between those with and without vaginal lengthening. Among those with surgical vaginal lengthening, symptomatic vaginal bulge was highest in individuals who underwent a bowel vaginoplasty procedure.

CONCLUSION

Urinary, prolapse, and bowel symptoms are common among individuals with Mayer-Rokitansky-Küster-Hauser syndrome and should be evaluated in this population. Overall, compared with no vaginal lengthening treatment, having vaginal lengthening treatment is not associated with substantial differences in the prevalence of pelvic floor symptoms, with the exception of recent urinary incontinence and anal incontinence. Our data suggested that bowel vaginoplasty may be associated with greater symptoms of vaginal bulge. More robust studies are needed to determine the impact of various vaginal lengthening treatments on pelvic floor symptoms.

Caring for Transgender Patients: Complications of Gender-Affirming Genital Surgeries

Patients who undergo gender-affirming genital surgeries may present to the emergency department for their postsurgical complications. In this paper, we briefly describe the transfeminine and transmasculine genital procedures, review the diagnosis and management of both common and potentially life-threatening complications, and discuss the criteria for hospitalization and time frame for surgical consultation and referral.

Excising the neovagina due to introital atresia and closed neovaginal loop after sigmoid vaginoplasty: A case report

INTRODUCTION

Vaginal agenesis is a congenital disorder, which can be managed by nonsurgical dilation or surgical reconstruction of the vagina. The sigmoid vaginoplasty procedure is a popular approach, which pulls down part of the sigmoid colon to form a neovagina. One complication of this procedure is introital stenosis.

PATIENT CONCERNS

A 55-year-old woman presented to the outpatient general surgery department with severe, persistent abdominal pain. The patient was diagnosed with congenital absence of uterus and vagina, and a sigmoid vaginoplasty was performed 34 years ago.

DIAGNOSIS

A pelvic MRI and an abdominal enhanced CT scan were performed, finding that the uterus was absent, and the os of the vagina was closed, forming a closed loop full of fluid. Introital atresia and closed loop of neovaginal colon conduit were diagnosed.

INTERVENTIONS

Based on our conclusions and the patient's consent we surgically removed the neovagina.

OUTCOMES

After surgery, the abdominal pain was relieved, and the patient reported full recovery during a 6-month follow-up appointment.

CONCLUSION

Introital stenosis is one of the long-term complications of sigmoid vaginoplasty procedure. Introital stenosis, leading to introital atresia, is rare but may occur. Surgical removal of neovagina can relieve the pain in patients who do not have the demand of sexual intercourse.

Long-term urologic and gynecologic follow-up and the importance of collaboration for patients with anorectal malformations

Anorectal malformations (ARM) are well recognized to be associated with anomalies in other organ systems. The introduction of screening protocols has increased the diagnosis of these anomalies and greater collaboration with other specialties has influenced the treatment and follow-up of patients with ARMs. Much of the medical literature regarding the treatment of anorectal malformations has focused on technical details of operations and early post-surgical outcomes. Recently, an increase in published data regarding the long-term sequelae of an ARM diagnosis has resulted in an emphasis extended follow up in this population. Patient support groups have highlighted complex issues in ARM patients persist into adulthood have advocated for improved transitional care. This article describes the benefits of long-term follow-up and identifies key issues in ARM patients with respect to urologic and gynecologic health. A collaborative model of care is outlined and suggested timings of screening for potential problems is described.

Neovagina creation in congenital vaginal agenesis: New mini-laparoscopic approach applying intraoperative indocyanine green fluorescence

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.

Prolapse of Colonic Neovagina After Vaginoplasty for Childhood Rhabdomyosarcoma Treated With Modified Altemeier Procedure

We present the case of a patient with recurrent sigmoid neovaginal prolapse treated with a modified Altemeier procedure for rectal prolapse, which has not been previously described in the literature.Our case highlights the difficulty in treating patients with intestinal neovaginal prolapse due to their complex abdominal surgical history, altered anatomy, and goals of care.

Laparoscopic vaginal bead pull-through vaginoplasty technique using dental prosthesis material

OBJECTIVE

Many reconstructive surgical procedures have been described for vaginal agenesis. Almost all are surgically challenging, multistage, time-consuming or leave permanent scars on the abdomen or skin removal areas. The aim of this study was to introduce a simple and cheaper approach for laparoscopic vaginal bead-pull through.

MATERIALS AND METHODS

In this retrospective study, we report a total of six patients with congenital absence of vagina [Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome] who were treated with a laparoscopic vaginal bead pull-through technique between 2018 till 2019 with a dental prosthesis material.

RESULTS

Six patients with MRKH syndrome were treated with a laparoscopic vaginal bead pull-through technique. None of the women had any previous treatment. The mean age at the time of surgery was 18.7±3.1 years and mean body mass index was 25 (range, 19-38) kg/m2. None of the patients had any additional malformations. In all patients, normal external genitalia and complete vaginal agenesis were observed during examination. The mean duration of surgery was 72 (range, 55-95) minutes. All patients were discharged on the 3rd postoperative day. No intraoperative complications were encountered. All patients had their urinary catheters removed within 12 hours after surgery. The mean vaginal length at discharge was 10 (range, 8-13) cm and all patients had adequate vaginal diameter, allowing introduction of three fingers easily. At the 12th postoperative month, the mean vaginal length was 9.2±1.6 cm. All patients had complete epithelization. All the women were sexually active one year after surgery.

CONCLUSION

The laparoscopic vaginal bead pull-through technique using dental prosthesis material can provide satisfactory results with shorter surgical time and lower cost.

Vaginal reconstruction for distal vaginal atresia without anorectal malformation: is the approach different?

INTRODUCTION

Distal vaginal atresia is a rare condition and treatment approaches are varied, usually driven by symptoms.

METHODS

A retrospective review was performed to identify patients with distal vaginal atresia without anorectal malformation. Data collected included age and symptoms at presentation, type and number of operations, and associated anomalies.

RESULTS

Eight patients were identified. Four presented at birth with a hydrocolpos and four presented with hematometrocolpos after 12 years of age. Number of operations per patient ranged from one to seven with an average of three. The vaginal reconstruction was achieved by perineal vaginal mobilization in four patients and abdomino-perineal approach in four patients. One patient, with a proximal vagina approximately 7 cm from the perineum, required partial vaginal replacement with colon. In addition, she had hematometrocolpos with an acute inflammation at the time of reconstruction despite menstrual suppression and drainage which may have contributed to the difficulty in mobilizing the vagina. In five patients, distal vaginal atresia was an isolated anomaly. In the other three cases, associated anomalies included: mild hydronephrosis that improved after hydrocolpos decompression (2), cardiac anomaly (2), and vertebral anomaly (1).

CONCLUSION

In this series, a distended upper vagina/uterus was a common presentation and the time of reconstruction was driven by the presence of symptoms. Drainage of the hydrocolpos/hydrometrocolpos with menstrual suppression in post-pubertal patients, followed by further work-up, and planned reconstruction is a good surgical strategy.

Anatomy of genital reaffirmation surgery (male-to-female): Vaginoplasty using penile skin graft with scrotal flaps

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.

Anatomic and Functional Outcomes of Paramesonephric Remnant-Supported Laparoscopic Double-Layer Peritoneal Pull-Down Vaginoplasty Technique in Patients with Mayer-Rokitansky-Küster-Hauser Syndrome: Uncu Modification

OBJECTIVE

To describe modifications to the double-layer peritoneal pull-down laparoscopic vaginoplasty technique (Davydov operation) and evaluate anatomic and functional outcomes of the new technique, known as the Uncu modification.

DESIGN

Case series (Canadian Task Force classification III).

SETTING

Tertiary care university hospital.

PATIENTS

Women with Mayer-Rokitansky-Küster-Hauser syndrome (MRKHS) who underwent surgery between 2010 and 2016.

INTERVENTIONS

Laparoscopic double-layer peritoneal pull-down vaginoplasty with paramesonephric remnant support to the neovagina.

MEASUREMENTS AND MAIN RESULTS

Long-term anatomic and functional satisfaction results. Twenty-seven women with MRKHS underwent surgery with the Uncu-modified Davydov procedure. At 1 year after surgery, the mean vaginal length in these patients was 7.91 ± 1.4 cm. Among the 23 patients who had regular vaginal intercourse, the mean functional satisfaction score was 8.65 ± 1.2. One patient had a perioperative bladder injury, and another patient had a rectovaginal fistula at 3 months after the operation. One woman who did not comply with the prescribed postoperative mold exercises had complete closure of the introitus.

CONCLUSION

The Uncu modified laparoscopic double-layer peritoneal pull-down technique appears to be an effective and safe surgical management option that is easy to learn and perform by gynecologic surgeons.