Surgical and functional outcomes of sigmoid vaginoplasty among patients with variants of disorders of sex development.

PURPOSE: To assess the use of sigmoid colon in vaginal reconstruction of some patients with disorders of sex development. MATERIALS AND METHODS: The study included 31 patients with disorders of sex development of various causes. All were reared as females. Female gender was decided for all cases after complete medical assessment. All patients underwent sigmoid vaginoplasty. Assessment of surgical and functional outcomes was carried out in a follow-up period of up to 6 years. RESULTS: The preoperative diagnoses included mullerian aplasia (16 cases), androgen insensitivity syndrome (12 cases) and previous failed vaginoplasty (3 cases). Associated surgical procedures were gonadectomy in 5 cases and gonadectomy combined with clitoroplasty and vulvoplasty in 7 cases. No intra-operative or early postoperative complications occurred. A cosmetic neovagina with adequate size was achieved in all cases. Long term follow-up showed introital stenosis in 4 cases (12.9 %). Two of them responded to vaginal dilatation. The third one needed y-v plasty while the fourth one presented by acute abdomen secondary to ruptured vagina and was submitted to urgent laparotomy. Mucosal prolapse occurred in 1 case (3.2 %). Reoperation rate was 9.6 %. Sexual satisfaction was achieved among 9 sexually active cases. The subjective satisfaction score of the surgical outcome was 8.03. CONCLUSIONS: For patients with disorders of sex development of various etiologies, sigmoid vaginoplasty is the preferred technique for vaginal replacement. It is a safe technique that provides the patient with a cosmetic neovagina of adequate caliber and a satisfactory functional outcome.

Surgical and functional outcomes of sigmoid vaginoplasty among patients with variants of disorders of sex development

PURPOSE:To assess the use of sigmoid colon in vaginal reconstruction of some patients with disorders of sex development. MATERIALS AND METHODS: The study included 31 patients with disorders of sex development of various causes. All were reared as females. Female gender was decided for all cases after complete medical assessment. All patients underwent sigmoid vaginoplasty. Assessment of surgical and functional outcomes was carried out in a follow up period of up to 6 years. RESULTS: The preoperative diagnoses included mullerian aplasia (16 cases), androgen insensitivity syndrome (12 cases) and previous failed vaginoplasty (3 cases). Associated surgical procedures were gonadectomy in 5 cases and gonadectomy combined with clitoroplasty and vulvoplasty in 7 cases. No intra-operative or early postoperative complications occurred. A cosmetic neovagina with adequate size was achieved in all cases. Long term follow up showed introital stenosis in 4 cases (12.9 %). Two of them responded to vaginal dilatation. The third one needed y-v plasty while the fourth one presented by acute abdomen secondary to ruptured vagina and was submitted to urgent laparotomy. Mucosal prolapse occurred in 1 case (3.2%). Reoperation rate was 9.6%. Sexual satisfaction was achieved among 9 sexually active cases. The subjective satisfaction score of the surgical outcome was 8.03. CONCLUSIONS: For patients with disorders of sex development of various etiologies, sigmoid vaginoplasty is the preferred technique for vaginal replacement. It is a safe technique that provides the patient with a cosmetic neovagina of adequate caliber and a satisfactory functional outcome.

Modification of flip-flap technique for correction of distal penile hypospadias.

Flip-flap is a popular technique used for correction of distal penile hypospadias. When the flap length is more than 2 cm, meatal stenosis may develop postoperatively. This stenosis is probably due to the ischemia at the tip of the flap. We have used flaps with wide base to ensure good blood supply to avoid this complication. The results were excellent in all of the cases in which this modification was used.

Urethroplasty using transverse penile island flap for hypospadias.

We describe a new procedure in which dorsal penile skin is used to correct hypospadias in circumcised patients and those in whom surgical correction usually is difficult. Of 48 hypospadiac patients treated by this technique 26 (54 per cent) had been circumcised previously, while 22 (46 per cent) had undergone a prior hypospadias repair that resulted in marked tissue scarring and fistulas. The procedure is accomplished in 2 stages. In stage 1 the urethra is reconstructed and the penis is buried in the scrotum. Separation is done after an average of 6 weeks (stage 2). The results were satisfactory in 45 patients and in all cases a viable new urethra of adequate caliber and length was created with the end at the tip of the glans. The procedure is simple and safe, and complications were minimal.