The use of isolated sigmoid colon segment for vaginal replacement in young adults.

PURPOSE: Vaginoplasty for congenital atresia, a component of the Mayer-Rokitansky-Kuster syndrome, or for gender confirmation, may be achieved by several techniques. This report focuses on the efficacy of rectosigmoid neocolporrhaphy (RSNC) for primary vaginal replacement.

MATERIALS AND

METHODS

From 1990 to 2002 we evaluated six patients 16-33 years old (average age 23) who required vaginal replacement. The diagnoses included the Mayer-Rokitansky syndrome in two cases, classic bladder exstrophy in 1 and male pseudohermaphrodites in three cases. The vagina was reconstructed using a 15-cm isolated sigmoid segment placed between the bladder and rectum and anastomosed to the introitus in four patients. The Frank procedure was used in two patients.

RESULTS

A minimum of 1 year of followup is available in five of the six patients (mean of 32 month). Patients treated with sigmoid vaginoplasty had functional neovagina. with excellent cosmetic results and without excessive mucous production or the need for routine dilation. Stenosis at the mucocutaneous junction in one patient with a sigmoid vagina was treated with Y-V plasty. In the two patients managed by nonoperative perineal self-dilatation, there was little success noted and the two patients became surgical candidates.

CONCLUSIONS

Experience with this group of patients leads us to believe that isolated sigmoid segments provides a cosmetic, self-lubricating neovagina with low rates of failure and revision, and without the need for routine dilation.