Objective To evaluate the use value of the perineal H-shaped incision in laparoscopic peritoneum vaginoplasty. Methods Between January 2005 and July 2011, 29 cases of congenital absence of vagina underwent laparoscopic peritoneum vaginoplasty. There were 2 married cases and 27 unmarried cases, with a mean age of 22.7 years (range, 20-30 years). The patients had no vagina mouth or had a shallow depression. B ultrasound showed normal bilateral ovarian and no uterine or primordial uterus in the pelvic cavity. H-shaped incision was made between urethra and rectum for peritoneum vaginoplasty. Results All operations were successfully completed. The mean operation time was 130.5 minutes, and the mean blood loss was 73.5 mL. Primary healing of incision was achieved in all patients and no complication occurred. All the patients were followed up 1-2 years (mean, 1.5 years). At 3 months after operation, the mean length of neovagina was 9.5 cm (range, 8.2-10.5 cm); the neovagina could hold 2 fingers and the mucosa appeared so soft and smooth with normal lubrication; vaginal exfoliate cell maturation index was 50.5% ± 9.3% ; and the mean urethra-vaginal orifices spacing was 1.0 cm (range, 0.8-1.2 cm). At 1 year after operation, the mean length of the neovagina was 9.3 cm (range, 7.2-10.0 cm); the neovagina could hold 2 fingers; the vaginal exfoliate cell maturation index was 58.6% ± 8.1%; the mean urethra-vaginal orifices spacing was 1.1 cm (range, 0.9-1.3 cm). The rate of sexual satisfaction was 95%. Conclusion Use of the H-shaped incision in laparoscopic peritoneum vaginoplasty is a preferred way to reconstruct vagina for simple operation and good effectiveness.
ObjectiveTo explore the indication and effectiveness of urogenital sinus surgery in feminizing genitoplasty of disorder of sex development (DSD).MethodsA retrospective analysis was made on clinical data from 22 patients with DSD who underwent one stage feminizing genitoplasty between October 2010 and December 2015. The patients’ age ranged from 1 year and 2 months to 21 years, with the median age of 2 years and 1 month. According to the Prader classification criteria, the appearance of vulvas were rated as grade Ⅰ in 7 cases, grade Ⅱ in 6 cases, grade Ⅲ in 8 cases, and grade Ⅳ in 1 case. Cystoscopy was applied before feminizing genitoplasty in all patients. Low confluence of vagina and urethra was found in 19 patients, while high confluence was found in 3 patients. The mean length of urogenital sinus was 1.6 cm (range, 0.5-3.0 cm). The mean length of water-filled vagina was 4.4 cm (range, 3.5-5.5 cm). Cervix was detected at the end of vagina in 16 patients, meanwhile absence of cervix was detected in 6 patients. The same procedures of clitoroplasty and labioplasty were used in all patients. Three procedures of urogenital sinus surgery were applied, as the " cut-back” vaginoplasty in 6 patients, the " flap” vaginoplasty in 11 patients, and the partial urogenital sinus mobilization (PUM) in 5 patients.ResultsAll procedures were completed successfully and the incisions healed by stage Ⅰ. All patients were followed up 12-74 months, with the average of 30.5 months. The outcome of appearance evaluation was excellent in 13 patients (59.1%), good in 6 patients (27.3%), and poor in 3 patients (13.6%). Urinary incontinence, post-void residual, urinary infection, and urethrovaginal fistula were not found in 17 toilet trained patients.ConclusionUrogenital sinus surgery is the most critical step in feminizing genitoplasty of DSD. It can be finished in one stage procedure with clitoroplasty and labioplasty before puberty. If thoroughly evaluation before surgery is completed and the principle of different procedures is handled, the outcome will be satisfactory.