Prolapse of the sigmoid neovagina: report of three cases.

Department of Obstetrics and Gynecology, Academic Hospital Rotterdam, Dijkzigt, Rotterdam, The Netherlands.
Obstetrics and Gynecology (Impact Factor: 4.8). 06/1994; 83(5 Pt 2):876-9. DOI:10.1097/00006534-199801000-00070
Source: PubMed

ABSTRACT Prolapse of a sigmoid neovagina, created in patients with congenital vaginal aplasia or male transsexualism, is rare. In correcting this condition, preservation of coital function and restoration of the vaginal axis should be of primary interest.
One patient with Mayer-Rokitansky-Küster syndrome developed a protrusion of the sigmoid neovagina almost 4 years after the initial operation. The prolapse was treated successfully using an abdominal approach to suspend the neovagina to a Cooper ligament. The second patient is a male-to-female transsexual who developed a prolapse 3 years after the creation of a sigmoid neovagina. After suspension of the neovagina to a Cooper ligament, the prolapse recurred; in a repeat approach, the neovagina was successfully suspended to the sacral promontory. The third patient, with Mayer-Rokitansky-Küster syndrome, complained of a protrusion immediately after creation of the neovagina. Initially, the redundant sigmoid was resected vaginally. However, the prolapse recurred, and an abdominal suspension to a Cooper ligament was performed. Finally, after 1 year, another recurrence was treated successfully with a vaginal approach.
Prolapse of an artificially created vagina is a rare occurrence, without a standard treatment. Both abdominal and vaginal approaches may be needed to restore the neovagina without compromising its function.

0 0
1 Bookmark
  • [show abstract] [hide abstract]
    ABSTRACT: To provide a comprehensive review of the pathophysiology, evaluation, and treatment of gynatresia and urinary incontinence, 2 conditions that can arise following the repair of obstetric fistulas. The article discusses relevant issues with respect to urinary diversion in the treatment of obstetrical fistula and associated urinary incontinence. A review was conducted of the existing literature and of the expert recommendations issued at the Gates Institute fistula meeting held in July 2005 at the Johns Hopkins Bloomberg School of Public Health. Gynatresia and urinary incontinence develop in approximately 10% and 16% of patients, respectively, after the first repair. Urinary diversion may be necessary when fistulas cannot be closed vaginally or in cases of severe urinary incontinence following successful closure. Gynatresia, urinary incontinence, and urinary diversion are all associated with morbidity, and they require surgical and nonsurgical expertise for proper management. Closing the anatomical fistula is not always sufficient, and treatment paradigms must shift toward the prevention and repair of gynatresia and urinary incontinence at the time of the primary operation.
    International Journal of Gynecology & Obstetrics 12/2007; 99 Suppl 1:S57-64. · 1.84 Impact Factor
  • [show abstract] [hide abstract]
    ABSTRACT: Hematometrocolpos is the result of vaginal obstruction and can become an emergency in the pubertal period. The treatment of imperforate hymen is well defined, but the treatment of vaginal atresia is more complex. We report a case of hematometrocolpos secondary to distal vaginal atresia that was operated on in the pubertal period. The patient had isolated distal atresia without persistence of the urogenital sinus. A combined abdominal laparoscopic and perineal approach and a posterior vaginoplasty were carried out. Finally, an abdominoperineal pull-through was successfully performed. Neovagina was successfully developed with this method. The embryology and literature are reviewed. The classification, indications, and surgical technique are discussed. We suggest that this procedure is suitable for patients with vaginal agenesis and a normal uterus.
    Journal of Pediatric Surgery 04/2012; 47(4):e13-5. · 1.38 Impact Factor
  • [show abstract] [hide abstract]
    ABSTRACT: Various operative methods have been devised to create a neovagina for patients with Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome. Sigmoid vaginoplasty, a common modality for vaginal reconstruction, is believed to have satisfactory long-term anatomical and functional results. We herein report a patient with MRKH syndrome and vault prolapse of a sigmoid neovagina 26 years after vaginoplasty. Biopsies from the neovagina revealed colonic mucosa. Bilateral iliococcygeus fascia fixation of the neovaginal vault was performed vaginally. The patient had a low Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire-12 (PISQ-12) score preoperatively, which further decreased postoperatively. Therefore, the surgery failed to achieve a good functional result. No recurrence of the prolapse was observed 2 years postoperatively.
    International Urogynecology Journal 04/2012; · 2.17 Impact Factor

I Freundt