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Should Vaginal atresia - MRKH syndrome Treatment by Sigmoid vaginoplasty be taken up by Urologists ?
Vaginal Atresia and MRKH syndrome dont get to Urological reconstruction forum and training schedules !
Venugopal P14 Mar 2021 11:42:57 AM
Sanjay Pandey has taken us to another realm where Urologists could play a major role which hitherto we had not given due consideration. It could be that with Sanjayâ€™s interest in Transgender surgeries have brought his interest towards this area. Most of Urologists at present have very little knowledge concerning such Abnormalities leave alone the treatment.
The term Vaginal Atresia is used for a condition in which the vagina is abnormally closed or absent. The main causes can either be complete vaginal hypoplasia (underdevelopment or incomplete development of the vagina), or a vaginal obstruction, often caused by an imperforate hymen or, less commonly, a transverse vaginal septum. It is often seen associated with Mayer-Rokitansky-Kuster-Hauser Syndrome
Grigoris F. Grimbizis* et al (2013) provided the â€˜ESHRE/ESGE Classification Female Genital Tract Anomaliesâ€™ and this is a consensus Classification (PDF provided).
Sanjay has eloquently narrated the need and use of Intestinal segments for Vaginoplasty. There are several articles now available addressing the use of Intestinal segment and one of the worth reading is from Jiledar Rawat* et al (2010) published an article on â€˜Sigmoid Colon Neovaginoplastyâ€™ which is worth looking into.
https://www.jiaps.com/temp/JIndianAssocPediatrSurg15119-1327126_034111.pdf (at times may not open)
https://www.jiaps.com/article.asp?issn=0971-9261;year=2010;volume=15;issue=1;spage=19;epage=22;aulast=Rawat (PDF available)
Rakesh Kapoor, Deepak Dubey, Anil Mandhani et al (2006 Urology) published their long term outcomes with Sigmoid Vaginoplasty stating that there were very few negligible problems encountered with this procedure. Incidentally use of Intestine for Vaginoplasty is not a new procedure as it has been reported by Baldwin in 1904.
Initially in the development of Vaginal Reconstruction, many procedures were in vogue and many of them were not using Intestinal segment. I am providing a video on using the Wharton-Sheares-George method to create a neovaginaâ€™ which is a non intestinal technique.
A good update of the various techniques has been provided by Nina Callens, Martine Cools* et al (2014). Those interested will find it a useful read.
https://academic.oup.com/humupd/article/20/5/775/2952651 (PDF available)
Vaginal Atresia is a poorly understood subject for us Urologists but as mentioned by Sanjay, we Urologists have considerable experience of using intestines for various Urological reconstructions with Sanjay Kulkarni using it for even Posterior Urethral Strictures, it is possible that surgeries performed by Urologists could have less complications.
Lalit Shah08 Mar 2021 01:15:08 PM