Departments of Urology, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
Int Braz J Urol. 2012 May-Jun;38(3):380-6; discussions 387-8. doi: 10.1590/s1677-55382012000300011.
To assess the use of sigmoid colon in vaginal reconstruction of some patients with disorders of sex development.
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.
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.
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.
评估乙状结肠在某些性别发育障碍患者阴道重建中的应用。
本研究纳入了 31 名不同病因的性别发育障碍患者。所有患者均被养育为女性。在完成全面医学评估后，所有病例均决定为女性。所有患者均行乙状结肠阴道成形术。在随访期间（最长 6 年）对手术和功能结果进行评估。
术前诊断包括苗勒氏管发育不全（16 例）、雄激素不敏感综合征（12 例）和既往阴道成形术失败（3 例）。5 例患者同时行性腺切除术，7 例患者同时行性腺切除术、阴蒂成形术和阴唇成形术。术中及术后早期均无并发症发生。所有患者均获得美容性阴道再造，且阴道大小合适。长期随访发现 4 例（12.9%）患者存在阴道入口狭窄。其中 2 例经阴道扩张后得到缓解，3 例行 Y-V 成形术，1 例因阴道破裂导致急性腹痛而行紧急剖腹探查术。1 例（3.2%）患者发生阴道黏膜脱垂，需再次手术。有性生活的 9 例患者中，有 8 例（88.9%）获得性满足。患者对手术结果的主观满意度评分为 8.03。
对于各种病因的性别发育障碍患者，乙状结肠阴道成形术是阴道重建的首选方法。该技术安全可靠，可为患者提供具有足够大小和满意功能的美容性阴道。
