Vaginal replacement in the pediatric age group: a 34-year experience of intestinal vaginoplasty in children and young girls
| Autor: | Mario Lima, Giulio Gregori, Marcello Domini, Giovanni Ruggeri, Enrico La Pergola, Tommaso Gargano, B Randi |
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| Přispěvatelé: | Mario Lima, Giovanni Ruggeri, Beatrice Randi, Marcello Domini, Tommaso Gargano, Enrico La Pergola, Giulio Gregori |
| Jazyk: | angličtina |
| Rok vydání: | 2010 |
| Předmět: |
Adult
Male medicine.medical_specialty Vaginal agenesis 46 XX Disorders of Sex Development Adolescent Intestinal vaginoplasty Kidney Surgically-Created Structures Introitus Congenital Abnormalities Age Distribution Gynecologic Surgical Procedures Complete androgen insensitivity syndrome Colon Sigmoid Ileum Humans Medicine Abnormalities Multiple Child Mullerian Ducts business.industry Uterus Sigmoid colon General Medicine Aplasia Androgen-Insensitivity Syndrome Plastic Surgery Procedures medicine.disease Adrenogenital Syndrome Spine Surgery Penile Agenesis Treatment Outcome medicine.anatomical_structure Somites Child Preschool Vagina Pediatrics Perinatology and Child Health Adrenogenital syndrome Vaginoplasty Female Genital Diseases Male business Penis |
| Popis: | Background/Purpose The absence of vagina is rare in the pediatric population. It can occur as a result of congenital malformations such as an aplasia of mullerian ducts (46,XX Mayer-Rokitansky-Kuster-Hauser syndrome) or a complete androgen insensitivity syndrome (46,XY testicular feminizing syndrome). Intersex patients, who underwent reassessment of a female sex, need a genital reconstruction toward a feminine phenotype. Patients with congenital adrenogenital syndrome with high urogenital sinus could have a severe hypoplastic vagina. In all these cases, a vaginal replacement is required. We reviewed our experience of vaginal replacement using a sigmoid conduit. Methods In 34 years, we evaluated 47 patients. The observation period was from 1 to 34 years (mean: 12 years). The preoperative diagnosis was Mayer-Rokitansky-Kuster-Hauser syndrome in 17 cases, androgen insensitivity syndrome in 24 cases, adrenogenital syndrome with high urogenital sinus in 5 and 1 patient was affected by penile agenesis. Forty-six patients were treated with vaginal reconstruction by interposition of sigmoid colon. Only in 1 case we performed a vaginal construction with an ileal loop: in this case, the sigmoid colon was extremely dilated by a chronic constipation secondary to a high anorectal malformation corrected at birth. Results The outcome for 47 patients is excellent: 18 are sexually active and 4 are married. Only 1 patient with adrenogenital syndrome died of endocrine problems. Complications occurred in 17 cases: in 1 patient a necrosis of the replaced vagina occurred, thus requiring vaginal exeresis; now she is waiting for a second operation. Another patient had an abdominal abscess, which was surgically treated. In 12 cases a second procedure was required: 6 had stenotic new-vaginal introitus, 4 had new-vaginal prolapse, and 2 had intestinal obstruction. Conclusions We believe that the preferable technique for vaginal replacement is the use of intestinal conduit. The sigmoid colon is the best intestinal tract to be used owing to its size, location and preserved blood supply. Our experience leads us to believe that the sigmoid segment is the segment of choice, although we consider ileal loop as a good alternative when the sigmoid colon is not available. |
| Databáze: | OpenAIRE |
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