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Outcomes and Risk Factors in Urogenital Mobilization
ESPU Programme 2008
S61
From 16:40 to 16:45 # S12-2 (O) OUTCOMES AND RISK FACTORS IN UROGENITAL MOBILIZATION Richard RINK, Jeffrey LESLIE, Martin KAEFER, Kirstan MELDRUM, Rosalia MISSERI, Mark CAIN Riley Hospital for Children, Urology, Indianapolis, USA
PURPOSE Urogenital mobilization is a recent advance in reconstruction for urogenital sinus anomalies. Use of the mobilized sinus has improved cosmetics and function. Concern remains regarding outcomes, particularly continence with total or urogenital mobilization techniques. Other concerns include delayed stress incontinence, sensation loss and vaginal foreshortening.
MATERIAL AND METHODS We reviewed our last 50 vaginoplasties; 44 of whom had either a total or partial urogenital
mobilization. This group of 44 was analyzed for early continence, cosmetics and vaginal stenosis, as well as underlyling neurologic status.
has vaginal stenosis. Cosmetics are excellent.
RESULTS CONCLUSIONS Eighteen underwent TUM (7 neurologically normal, 11 have significant neurologic or anatomic abnormalities): 26 underwent PUM (25 neurologically normal, only 1 had a neurologic abnormality). Neurologically normal children > 3 years old are continent regardless of TUM versus PUM. Of those neurologically impaired, 2 are dry voiding, 7 are dry with CIC and 2 are wet. Only 1 of 44
PUM and TUM appear safe from an early continence standpoint. Early continence appears to be related more to underlying neurological status than the procedure. Cosmetics are excellent. Vaginal stenosis has been rare. Late stress continence, sensation, or need for secondary procedures following TUM or PUM remain unknown.
From 16:45 to 16:50 # S12-3 (V) SURGICAL TECHNIQUE FOR USE OF AUTOLOGOUS BUCCAL MUCOSA VAGINOPLASTY IN CHILDREN: VIDEO Juan PRIETO, Nicol BUSH, Linda BAKER Children’s Medical Center, Pediatric Urology, Dallas, USA
PURPOSE Vaginal replacement surgeries often require donor materials such as skin grafts, myocutaneous flaps, or bowel, each with significant disadvantages. We describe our technique using autologous buccal mucosa grafting for partial or complete neovagina creation.
MATERIAL AND METHODS Our indications for buccal mucosa vaginoplasty have included primary repair of congenital defects such as vaginal agenesis (Mayer-Rokitansky syndrome), cloacal abnormalities, and intersex disorders as well as secondary repair of postsurgical vaginal
defects like vaginal stenosis after vaginoplasty or pelvic extenteration. This video demonstrates our surgical technique in a Mayer-Rokitansky syndrome patient.
meshed graft is then stretched and tacked into position with interrupted 4-0 chromic sutures to achieve 360 degree coverage of the entire neovaginal area. A spongy vaginal mold is left in-situ for 5-7 days.
RESULTS A transverse incision is made over the mucosal prominence at the level of the expected location of the hymen. Blunt dissection and electrocautery are used to dissect between the urethra and anorectum to depth 8 cm and width 3 fingerbreadths. Bilateral buccal mucosa is harvested, prepared on the bench and sewn end to end. The graft mid-portion is secured with interrupted 4-0 chromic to the apex of the previously dissected vaginal vault. The
From 16:50 to 16:53 # S12-4 (PP) COLON REPLACEMENT OF THE VAGINA TO RESTORE MENSTRUAL FUNCTION Sudipta SEN, Lavanya KANNAIYAN Christian Medical College and Hospital, Vellore, Paediatric Surgery, Vellore, INDIA
CONCLUSIONS Buccal mucosa generates a moist, hairless, nonkeratinized neovaginal mucosa with excellent color and texture matching the genital/vaginal skin. It leaves no visible surgical scars, avoids abdominal bowel surgery and has no excess mucous production. It is an ideal replacement material for primary or secondary vaginoplasty with excellent early results.
S61
From 16:40 to 16:45 # S12-2 (O) OUTCOMES AND RISK FACTORS IN UROGENITAL MOBILIZATION Richard RINK, Jeffrey LESLIE, Martin KAEFER, Kirstan MELDRUM, Rosalia MISSERI, Mark CAIN Riley Hospital for Children, Urology, Indianapolis, USA
PURPOSE Urogenital mobilization is a recent advance in reconstruction for urogenital sinus anomalies. Use of the mobilized sinus has improved cosmetics and function. Concern remains regarding outcomes, particularly continence with total or urogenital mobilization techniques. Other concerns include delayed stress incontinence, sensation loss and vaginal foreshortening.
MATERIAL AND METHODS We reviewed our last 50 vaginoplasties; 44 of whom had either a total or partial urogenital
mobilization. This group of 44 was analyzed for early continence, cosmetics and vaginal stenosis, as well as underlyling neurologic status.
has vaginal stenosis. Cosmetics are excellent.
RESULTS CONCLUSIONS Eighteen underwent TUM (7 neurologically normal, 11 have significant neurologic or anatomic abnormalities): 26 underwent PUM (25 neurologically normal, only 1 had a neurologic abnormality). Neurologically normal children > 3 years old are continent regardless of TUM versus PUM. Of those neurologically impaired, 2 are dry voiding, 7 are dry with CIC and 2 are wet. Only 1 of 44
PUM and TUM appear safe from an early continence standpoint. Early continence appears to be related more to underlying neurological status than the procedure. Cosmetics are excellent. Vaginal stenosis has been rare. Late stress continence, sensation, or need for secondary procedures following TUM or PUM remain unknown.
From 16:45 to 16:50 # S12-3 (V) SURGICAL TECHNIQUE FOR USE OF AUTOLOGOUS BUCCAL MUCOSA VAGINOPLASTY IN CHILDREN: VIDEO Juan PRIETO, Nicol BUSH, Linda BAKER Children’s Medical Center, Pediatric Urology, Dallas, USA
PURPOSE Vaginal replacement surgeries often require donor materials such as skin grafts, myocutaneous flaps, or bowel, each with significant disadvantages. We describe our technique using autologous buccal mucosa grafting for partial or complete neovagina creation.
MATERIAL AND METHODS Our indications for buccal mucosa vaginoplasty have included primary repair of congenital defects such as vaginal agenesis (Mayer-Rokitansky syndrome), cloacal abnormalities, and intersex disorders as well as secondary repair of postsurgical vaginal
defects like vaginal stenosis after vaginoplasty or pelvic extenteration. This video demonstrates our surgical technique in a Mayer-Rokitansky syndrome patient.
meshed graft is then stretched and tacked into position with interrupted 4-0 chromic sutures to achieve 360 degree coverage of the entire neovaginal area. A spongy vaginal mold is left in-situ for 5-7 days.
RESULTS A transverse incision is made over the mucosal prominence at the level of the expected location of the hymen. Blunt dissection and electrocautery are used to dissect between the urethra and anorectum to depth 8 cm and width 3 fingerbreadths. Bilateral buccal mucosa is harvested, prepared on the bench and sewn end to end. The graft mid-portion is secured with interrupted 4-0 chromic to the apex of the previously dissected vaginal vault. The
From 16:50 to 16:53 # S12-4 (PP) COLON REPLACEMENT OF THE VAGINA TO RESTORE MENSTRUAL FUNCTION Sudipta SEN, Lavanya KANNAIYAN Christian Medical College and Hospital, Vellore, Paediatric Surgery, Vellore, INDIA
CONCLUSIONS Buccal mucosa generates a moist, hairless, nonkeratinized neovaginal mucosa with excellent color and texture matching the genital/vaginal skin. It leaves no visible surgical scars, avoids abdominal bowel surgery and has no excess mucous production. It is an ideal replacement material for primary or secondary vaginoplasty with excellent early results.