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Sigmoid reconfigured vaginal construction in children
L G Freitas Filho1, J Carnevale, C E Melo
1Department of Urology, Hospital Infantil Darcy Vargas, São Paulo, Brazil.
Insights
This study introduces a novel sigmoid neovaginal construction technique for children, improving surgical outcomes and neovaginal caliber. The method ensures adequate vaginal conduit length and caliber, with long-term functional assessment pending sexual activity.
Area of Science:
- Pediatric Surgery
- Urology
- Genitourinary Reconstruction
Background:
- Neovaginal construction is essential for gender affirmation and reconstructive surgery in children.
- Traditional techniques can face challenges with pedicle viability and achieving adequate caliber.
Purpose of the Study:
- To present a modified sigmoid neovaginal construction technique in pediatric patients.
- To protect the sigmoid pedicle, allow caliber adjustment, and reorient the mucosal fold longitudinally.
Main Methods:
- A modified Yang-Monti concept was used for intestinal reconfiguration in 10 genetically male children (ages 1-13).
- Indications included androgen insensitivity, congenital adrenal hyperplasia, and bladder exstrophy with sex reassignment.
- The technique involved sigmoid segment utilization for neovagina creation.
Main Results:
- Eight children achieved an adequate neovaginal caliber after initial dilation.
- One case of stricture required successful reoperation.
- Another child developed a mid-segment stricture, managed with ongoing dilation.
Conclusions:
- The modified sigmoid reconfiguration technique facilitates the creation of a long vaginal conduit with adequate caliber.
- This approach allows for the use of smaller intestinal segments.
- Future assessment is needed to evaluate the long-term adequacy for penetration after sexual activity begins.
Purpose:
We present a modified technique of sigmoid neovaginal construction in children that protects the sigmoid pedicle from traction, allows easy adjustment of caliber and reorients the mucosal fold in a longitudinal direction.
Materials And Methods:
From 1997 to 2000, 10 genetically male (46 XY) children 1 to 13 years old underwent construction of a neovagina with sigmoid, incorporating the Yang-Monti concept of intestinal reconfiguration. The diagnosis was androgen insensitivity in 7 patients, congenital adrenal hyperplasia in 2 due to 17 alpha-hydroxylase deficiency and 3 beta-hydroxysteroid dehydrogenase deficiency, respectively, and bladder exstrophy in 1 who required sex reassignment.
Results:
Eight children had an adequate caliber neovagina after an initial period of systematic dilation. In 1 case a relevant stricture required reoperation using the same technique and the outcome was good. In another child a stricture developed in the middle of the reconfigured sigmoid segment and a regular dilation schedule is still being followed after 23 months of followup.
Conclusions:
The new sigmoid reconfiguration technique enables the use of smaller dimension intestinal segments and construction of a long vaginal conduit of adequate caliber. Its optimal adequacy for penetration must be assessed in the future after these patients begin sexual activity.
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