Abstract
Background
Female vaginoplasty reconstruction, by choice, is usually performed with adjacent
tissue. However in some clinical conditions such as high urogenital confluence sinus,
cloacal malformation with extreme vaginal hypoplasia, local tissue may not be available.
When vaginal replacement is performed in pediatric patients intestinal segments is
preferred to non-operative procedures that require continuative dilations. However
mucus production, malignant transformation risk and diversion colitis are important
side effects.
Technique
We present a nouvel technique for vaginoplasty in a female child presenting with an
isolated urogenital sinus malformation without virilization. The patient at 20 months
underwent vaginoplasty using tubularized bladder mucosal graft.
Results
Surgical procedure was devoid of complications. Pubertal development occurred at age
of 15. She underwent regular follow up until 18 years of age. At this age we performed
clinical evaluation: absence of vaginal introitus stenosis and good cosmetic results
were observed. Then she underwent vaginoscopy with multiple biopsies. Pathology examination
of the bladder mucosal graft evidenced a normal structure of the mucosa, with a stratified
squamous epithelium.
Discussion
Different techniques are taken into account for vaginal reconstruction according to
the severity and to the type of malformation. We describe the use of bladder mucosal
graft with favorable results after long term follow-up.
Key Words
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References
- Vaginal malformations: a proposed classification based on embryological, anatomical and clinical criteria and their surgical management (an analysis of 167 cases).Pediatr. Surg. Int. 2012; 28: 797-803
- Vaginoplasty for disorders of sex development.Front. Endocrinol. 2013; 4: 29
- Partial uro genital mobilization: a limited proximal dissection.J. Pediatr. Urol. 2006; 2: 351-356
- Autologous buccal mucosa vulvovaginoplasty for high urogenital sinus.J. Pediatr. Urol. 2006; 2: 486-488
- Evaluation of amnion in creation of neovagina in women with Mayer-Rokitansky-Kuster-Hauser syndrome.Fertil. Steril. 2017; 108: 341-345
- Consensus statement on management of intersex disorders.Arch. Dis. Child. 2006; 91: 554-563
- Timing of elective surgery on the genitalia of male children with particular reference to the risks, benefits, and psychological effects of surgery and anaesthesia.Pediatrics. 1996; 97: 590e4
- Bladder mucosa in urethral reconstructions.J. Urol. 1990; 144: 827-834
- Free bladder mucosal graft biology: unique engraftment characteristics in rabbits.J. Urol. 1992; 148: 663-666
- Total mucosal denudation of the canine bladder: experimental observations and clinical implications. Final report.J. Urol. 1958; 79: 63-77
- Neovagina con injerto libre de mucosa vesical (técnica original de Claret); Libro de Actas del XXVIII.Congreso de la Sociedad Española de Cirugía Pediátrica, Lloret de Mar, Spain1988: 40
- Neovagina in vaginal agenesis: surgical methods and long term results.J. Ped. Surg. 1992; 27: 10-14
- Evidence of estrogen receptors in the trigone area of human urinary bladder.J. Steroid Biochem. 1981; 15: 317-320
- Estrogen receptors in the human female lower urinary tract.Am. J. Obstet. Gynecol. 1981; 141: 817-820
- Progesterone receptors in the human female lower urinary tract.J. Urol. 1987; 138: 1301-1304
- Management of Lower Vaginal Agenesis in a Patient with Unicornuate Uterus.J. Pediatr. Adolesc. Gynecol. 2013; 26: 21-23
- Vaginoplasty technique for female pseudohermaphrodites.Surg. Gynecol. Obstet. 1964; 18: 545-548
- Feminizing genitoplasty.J.Urol. 1999; 161: 1592-1593
- Total urogenital mobilization–an easier way to repair cloacas.J. Pediatr. Surg. 1997; 32 (discussion 267–268): 263-267
- Engeneering of vaginal tissue in vivo.Tissue Eng. 2003; 9: 301-306
Article info
Publication history
Published online: June 18, 2018
Accepted:
June 11,
2018
Received in revised form:
June 8,
2018
Received:
February 21,
2018
Footnotes
The funding for the study was provided by University of Palermo.
All authors declare no conflict of interest.
The work has not yet be presented at any meeting.
Identification
Copyright
© 2018 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc.
