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    Vaginoplasty and the role of autologous buccal mucosa

    Buccal mucosa is an ‘excellent graft alternative’ for simple and complex repairs

     

    Neovaginoplasty options and concerns

    In situations where there is total absence of the vagina (figure 1), a variety of techniques have been described for the creation of a total neovagina, all with inherent advantages and disadvantages. The following is a short, selected list provided for illustrative purposes. For a more exhaustive review, see Human Reproduction Update (2014; 20:775-801) and others.

    Figure 3. Cloacal anomalies, the most severe neonatal genitourinary fusion anomalies, are marked by internal fusion of the vagina, urethra, and anorectum. This infant female has only one perineal orifice, the cloaca. (Photo courtesy of Linda A. Baker, MD)

    Figure 3. Cloacal anomalies, the most severe neonatal genitourinary fusion anomalies, are marked by internal fusion of the vagina, urethra, and anorectum. This infant female has only one perineal orifice, the cloaca. (Photo courtesy of Linda A. Baker, MD)

    The Frank method. A nonoperative procedure first described in 1938 (Am J Obstet Gynecol 1938; 35:1053–5), the patient utilizes increasing sized sequential dilators to intermittently manually apply pressure on the perineal vaginal dimple where the vagina should have formed. Although clearly the least invasive and most cost-effective procedure, it requires substantial patient motivation, patient effort, and a significant time investment. Unfortunately, younger patients often show limited success, especially in cases with only a minimal skin dimple with which to start.

    Also see: How to manage recurrent UTIs in postmenopausal women

    The Vecchietti procedure or traction vaginoplasty. Originally described in 1965 (Attual Ostet Ginecol 1965; 11:131–47) and later improved with a minimally invasive laparoscopic approach, the Vecchietti procedure establishes traction on a perineally positioned bead with sutures passing through the prevesical space to the traction tension device on the ventral abdominal wall. Continuous upward pressure is applied by the traction bead to the vaginal agenesis dimple, which in turn stretches, dissects, and elongates a mucosal cavity. There are some disadvantages, including pain with continued tightening of the traction device, potential abdominal or pelvic complications with traction thread placement, and discomfort and inconvenience of wearing an indwelling vaginal form at night for months after the vaginoplasty to prevent vaginal contraction and stenosis.

    Next: Intestinal vaginoplasty

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