Chiaramonte Cinzia, Vestri Elettra, Tripi Flavia, Giannone Antonino Giulio, Cimador Marcello, Cataliotti Ferdinando
Department of Mother and Child Health, University of Palermo, Italy.
Department of Mother and Child Health, University of Palermo, Italy.
J Pediatr Adolesc Gynecol. 2018 Oct;31(5):528-532. doi: 10.1016/j.jpag.2018.06.003. Epub 2018 Jun 19.
Female vaginoplasty reconstruction, by choice, is usually performed with adjacent tissue. However in some clinical conditions such as high urogenital confluence sinus, cloacal malformation with extreme vaginal hypoplasia, local tissue may not be available. When vaginal replacement is performed in pediatric patients intestinal segments is preferred to non-operative procedures that require continuative dilations. However mucus production, malignant transformation risk and diversion colitis are important side effects.
We present a nouvel technique for vaginoplasty in a female child presenting with an isolated urogenital sinus malformation without virilization. The patient at 20 months underwent vaginoplasty using tubularized bladder mucosal graft.
Surgical procedure was devoid of complications. Pubertal development occurred at age of 15. She underwent regular follow up until 18 years of age. At this age we performed clinical evaluation: absence of vaginal introitus stenosis and good cosmetic results were observed. Then she underwent vaginoscopy with multiple biopsies. Pathology examination of the bladder mucosal graft evidenced a normal structure of the mucosa, with a stratified squamous epithelium.
Different techniques are taken into account for vaginal reconstruction according to the severity and to the type of malformation. We describe the use of bladder mucosal graft with favorable results after long term follow-up.
女性阴道成形术重建通常选择使用邻近组织。然而，在某些临床情况下，如高位泌尿生殖窦道、泄殖腔畸形伴严重阴道发育不全，可能无法获得局部组织。在儿科患者中进行阴道替代时，肠段优于需要持续扩张的非手术方法。然而，黏液分泌、恶变风险和分流性结肠炎是重要的副作用。
我们介绍一种针对一名患有孤立性泌尿生殖窦畸形且无男性化表现的女童的阴道成形术新技术。该患者20个月时接受了使用管状膀胱黏膜移植物的阴道成形术。
手术过程无并发症。15岁时出现青春期发育。她接受定期随访直至18岁。在这个年龄我们进行了临床评估：未观察到阴道入口狭窄，且美容效果良好。然后她接受了阴道镜检查并多次活检。膀胱黏膜移植物的病理检查证明黏膜结构正常，有复层鳞状上皮。
根据畸形的严重程度和类型，考虑采用不同的技术进行阴道重建。我们描述了使用膀胱黏膜移植物并在长期随访后取得良好效果。
