Vaginal switch--a useful technical alternative to vaginal replacement for select cases of cloaca and urogenital sinus

The aim of this study was to describe the indications, technical details, and complications of a surgical maneuver designed to repair the vagina in select cases of cloaca and urogenital sinus.

A vaginal switch maneuver (VSM) is applicable when patients have two high large hemivaginas, and the distance between both hemiuteri is longer than the longitudinal length of the vaginas. It consists of resecting one hemiuterus and the vaginal septum, tubularizing both hemivaginas to create a single one, and switching down the vaginal dome of the side of the resected hemiuterus. Sixty patients who underwent this procedure were reviewed.

Mean common channel length was 5.2 cm. Complications occurred in twenty-six (43%) and included: acquired vaginal atresia that later required a vaginal replacement (n=11), introital stricture (n=6), incidental oophorectomy owing to damaged blood supply (n=4), vaginal-urethral fistula (n=3), partial vaginal dehiscence (n=1), and partial vaginal mucosal prolapse (n=1). In four cases VSM was unsuccessfully attempted owing to ischemia, and a partial vaginal replacement was performed. Forty-five patients (75%) were able to keep their native vaginal tissue as a vagina. Thirty patients are older than 12 years of age, and eight are menstruating.

The vaginal switch maneuver is a useful alternative to vaginal replacement. In spite of the morbidity, it is valuable because of the inherent advantages of preserving native vaginal tissue.