A number of different techniques have been described in the creation of a neovagina; however some methods suffer from technical difficulty or poor postoperative outcomes. Kapoor and colleagues from Uttar Pradesh, India describe their use of sigmoid vaginoplasty in those with vaginal agenesis secondary to Mayer-Rokitansky-Kuster-Hauser syndrome.

They reviewed the charts of 14 patients with Mayer-Rokitansky-Kuster-Hauser syndrome. The average age at the time of surgery was 16.8 years (range 13-22). 13 of the cases were diagnosed at menarche, while one occurred later. The procedure is performed in an extended lithotomy position to allow access to the perineum and abdomen. A simultaneous abdominoperineal approach is used. A 10-15 cm segment of sigmoid colon is isolated on its vascular pedicle to be used as the neovagina. An H shaped incision is made in the perineum and dissection is performed between the urethra and rectum. An abdominoperineal tunnel is created that is large enough to pass at least 2 fingers and the bowel segment is then pulled through the tunnel. The distal bowel segment is attached to the vulvar mucosa using absorbable sutures. The proximal portion of the neovagina is secured to the sacral promontory to prevent future prolapse. The neovagina is packed with petroleum gauze for 48 hours. Patients are taught self dilation and irrigation of the neovagina for mucus. This is performed daily for 8 weeks and then weekly.

The mean follow up of these 14 patients was 4.1 years (range 6 months- 7 years). Perioperative morbidity included one ileus and one superficial wound infection. . All the patients were compliant with dilation and there were no cases of stenosis. At the most recent follow-up, there were no complaints of irritation, dryness, excessive mucus production, or dyspareunia. The subjective satisfaction rates were 8.01 on scale of 0 (very disappointed) to 10 (satisfied).

The authors conclude that sigmoid vaginoplasty is an ideal treatment for vaginal atresia. It can be done safely with minimal morbidity. The sigmoid neovagina is functional, with low rates of dyspareunia, and patients have high satisfaction rates.

Urology 2006; 67: 1212-1215

Written by M. Louis Moy, MD, a Contributing Editor with UroToday.

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