University of Southern California Institute of Urology, Los Angeles, CA.
University of Southern California, Los Angeles, CA.
Urology. 2022 Sep;167:3-12. doi: 10.1016/j.urology.2022.02.021. Epub 2022 Mar 8.
We reviewed neovaginal colonization and inflammatory patterns, and factors that may impact this. A systematic review of the neovaginal microbiome was conducted in concordance with PRISMA guidelines through October 2021. Thirteen articles were included, totaling 458 patients. Neovaginal constructions were most commonly performed with penile and scrotal skin grafts, sigmoid segments, and peritoneal grafts. The neovaginal microflora identified were generally polymicrobial and shared similarities with the native tissue. Nine studies identified Lactobacillus: 5 of 6 for penile skin, 1 of 3 for sigmoid, 1 of 1 for peritoneum, and 2 of 3 for other graft types, suggesting that the neovagina may support Lactobacillus either innately, via rectal migration or oral probiotic supplementation. A polymicrobial, bacterial vaginosis-like environment was found in 9 studies. Inflammatory markers were also described: 2 of 6 for penile skin, 2 of 3 for sigmoid, 0 of 1 for peritoneum, and 1 of 3 for other graft types. Scant data were available on the impact of postsurgical duration, oral hormones, dilating, sexual practices, or douching on the neovaginal microbiome. Understanding and optimizing the polymicrobial neovaginal microenvironment may improve surgical outcomes, specifically inflammatory, pain, and infectious. Future research should focus on standardizing testing, classification systems, and treating neovaginal dysbiosis.
我们回顾了阴道新造的定植和炎症模式，以及可能影响这些模式的因素。我们按照 PRISMA 指南对阴道新造的微生物组进行了系统评价，检索时间截至 2021 年 10 月。共纳入 13 篇文章，总计 458 例患者。阴道新造术最常使用阴茎和阴囊皮瓣、乙状结肠段和腹膜移植物。鉴定的阴道新造微生物群通常为多种微生物共存，与天然组织有相似之处。9 项研究鉴定出乳酸杆菌：6 项阴茎皮瓣中有 5 项，3 项乙状结肠中有 1 项，1 项腹膜中有 1 项，3 项其他移植物中有 2 项，这表明阴道新造可能固有地支持乳酸杆菌，或者通过直肠迁移或口服益生菌补充。9 项研究发现了一种多微生物、细菌性阴道病样的环境。还描述了炎症标志物：6 项阴茎皮瓣中有 2 项，3 项乙状结肠中有 2 项，1 项腹膜中有 0 项，3 项其他移植物中有 1 项。关于手术后持续时间、口服激素、扩张、性行为或冲洗对阴道新造微生物群的影响，数据很少。了解和优化多微生物阴道新造微环境可能会改善手术结果，特别是炎症、疼痛和感染。未来的研究应集中在标准化检测、分类系统和治疗阴道新造微生态失调上。
