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Bowel vaginoplasty in children: a retrospective review
Jeffrey L O'Connor1, Romano T DeMarco, John C Pope
1Department of Pediatric Urology, Vanderbilt University Children's Hospital, Nashville, TN, USA.
Insights
Intestinal segments are a successful option for creating a neovagina in children with congenital conditions, offering good cosmetic results and manageable complications. This method can improve outcomes for vaginal agenesis and atresia.
Area of Science:
- Pediatric Surgery
- Genitourinary Reconstruction
- Congenital Anomalies
Background:
- Congenital genitourinary conditions frequently lead to vaginal agenesis or atresia.
- Surgical reconstruction aims for long-term functional and cosmetic outcomes with minimal morbidity.
- Traditional methods like skin grafts have yielded suboptimal results.
Purpose of the Study:
- To review the authors' experience using intestinal segments for neovaginal creation.
- To evaluate the efficacy and safety of this reconstructive technique.
Main Methods:
- A retrospective review of 10 pediatric patients undergoing vaginal construction with intestinal segments (1996-present).
- Data collected included etiology, surgical procedure, complications, and follow-up.
- Intestinal segments used were sigmoid colon, ileum, or mucous fistula.
Main Results:
- The average age at surgery was 10.9 years.
- Indications included cloacal extrophy (3 cases) and vaginal atresia (7 cases).
- Complications included one ureteral injury and one case of cyclic pelvic pain requiring reanastomosis.
Conclusions:
- Intestinal segments provide a successful method for neovaginal creation with excellent cosmetic results.
- The technique offers an acceptable complication rate in carefully selected patients.
- Utilizing the mucous fistula can avoid the need for bowel anastomosis.
Background/Purpose:
There are numerous congenital genitourinary conditions that result in vaginal agenesis or atresia. Reconstruction presents a challenge to the surgeon who wishes long-term functional and cosmetic results with low morbidity. Historically, reconstruction has involved the use of skin grafts and nonoperative methods with less than ideal results. The preference of the authors is to use intestinal segments for creating the neovagina and herein review their experience with this procedure.
Methods:
The authors identified 10 children who underwent vaginal construction with intestinal segments from 1996 to the present. Patient charts were reviewed for etiology, procedure performed, operative and postoperative complications, and follow-up.
Results:
Average age at surgery was 10.9 years (1 to 29 years). Of the 10 children, 3 required vaginal construction for cloacal extrophy, and 7 had vaginal atresia of various etiology. Sigmoid colon was utilized in 6 cases, ileum in 2, and, in 2 patients with high imperforate anus, their mucous fistula segment was used to create the vagina. Mean follow-up was 24 months. Complications included a right ureteral injury necessitating placement of an indwelling ureteral stent and a girl presenting with cyclic pelvic pain who required reanastomosis of the neovagina to the uterus for an obstructed cervical os.
Conclusions:
Intestinal segments can be used successfully for creation of a neovagina with exceptional cosmetic results and an acceptable complication rate. In appropriate patients, the mucous fistula can be used to create the vagina obviating the need for a bowel anastomosis.
