School of Medicine--University of Belgrade, Belgrade, Serbia.
J Sex Med. 2011 Dec;8(12):3487-94. doi: 10.1111/j.1743-6109.2011.02494.x. Epub 2011 Oct 13.
There are several techniques for creation of a neovagina. However, rectosigmoid segment presents the most natural substitute for vaginal tissue.
To evaluate the anatomical and functional results of sigmoid vaginoplasty and long-term sexual and psychological outcomes in 86 patients with vaginal absence.
Between April 2000 and February 2009, 86 patients, aged 18 to 57 years (mean 22) underwent rectosigmoid vaginoplasty. Indications were vaginal agenesis (54), female transgenderism (27), and genital trauma (5). Rectosigmoid segments ranging from 8 cm to 11 cm were isolated, to avoid excessive mucus production. Preferably, it should be dissected distally first in order to check its mobility and determine the correct site for its proximal dissection. Stapling device was used for the colorectal anastomosis as the safest procedure. Creation of perineal cavity for vaginal replacement was performed using a simultaneous approach through the abdomen and perineum. Perineal skin flaps were designed for anastomosis with rectosigmoid vagina for the prevention of postoperative introital stenosis. Main Outcome Measures. Sexual and psychosocial outcomes assessment was based on the Female Sexual Function Index, Beck Depression Inventory, and standardized questionnaires.
Follow-up ranged from 8 to 114 months (mean 47 months). Good aesthetic result was achieved in 77 cases. Neovaginal prolapse (7) and deformity of the introitus (9) were repaired by minor surgery. There was no excessive mucus production, vaginal pain, or diversion colitis. Satisfactory sexual and psychosocial outcome was achieved in 69 patients (80.23%).
Rectosigmoid colon presents a good choice for vaginoplasty. According to our results, sexual function and psychosocial status of patients who underwent rectosigmoid vaginoplasty were not affected in general, and patients attained complete recovery.
有几种方法可以创建新的阴道。然而，直肠乙状结肠段是阴道组织的最佳替代品。
评估 86 例阴道缺失患者的乙状结肠阴道成形术的解剖和功能结果以及长期的性和心理结果。
2000 年 4 月至 2009 年 2 月，86 例年龄 18 至 57 岁（平均 22 岁）的患者接受了乙状结肠阴道成形术。适应证为阴道发育不全（54 例）、女性易性症（27 例）和生殖器创伤（5 例）。分离 8-11cm 的直肠乙状结肠段，以避免产生过多的黏液。最好先从远端开始解剖，以检查其活动度，并确定近端解剖的正确部位。使用吻合器进行结直肠吻合是最安全的方法。通过腹部和会阴部同时进行会阴腔的创建，用于阴道置换。会阴皮瓣设计用于与直肠乙状结肠阴道吻合，以预防术后阴道入口狭窄。
主要结果测量。基于女性性功能指数、贝克抑郁量表和标准化问卷评估性和心理社会结果。
随访时间为 8 至 114 个月（平均 47 个月）。77 例获得良好的美学效果。7 例出现阴道脱垂，9 例出现阴道入口畸形，通过小手术修复。无过度黏液分泌、阴道疼痛或分流性结肠炎。69 例（80.23%）获得满意的性和心理社会结果。
直肠乙状结肠是阴道成形术的良好选择。根据我们的结果，接受直肠乙状结肠阴道成形术的患者的性功能和心理社会状况总体上不受影响，并且患者完全康复。
