What vaginoplasty technique is the best? Is vaginoplasty a safe surgery? How neovagina looks like? What presents clitoral reconstruction in vaginoplasty? Penile inversion technique. Sigmoid colon technique. Vaginoplasty re-do. A lot of photos and details. First-hand information.
This video is devoted to vaginoplasty, its methods, outcomes and postoperative care. Vaginoplasty is a reconstructive surgical procedure for creating a neovagina, inevitable in the case of vaginal agenesis, disorders of sexual development, transsexualism, defects resulting from genital cancer surgeries, and trauma.
In recent decades, due to progress in anesthesiology, antibiotics, and reduced risks associated with colorectal anastomosis, the sigmoid pedicled flap has become a first-line option in both children and adults. After penile inversion skin flap, sigmoid colon technique also presents the method of choice in transsexual surgery.
Use of a sigmoid colon loop seems a most favorable choice, due to anatomical proximity and easy mobilization of the vascular pedicle of this part of the bowel. This segment is thick-walled, large in diameter, and can tolerate trauma better than small bowel, bladder, or skin grafts. Postoperative management is simple and easy. Mucous production decreases dramatically after 3-6 months regardless of length of sigmoid segment. Although sufficient to provide adequate lubrication, it was neither excessive nor irritating to our patients. Dilation or calibration of the introital anastomosis is temporary and well tolerated.
Contrary to other techniques, rectosigmoid vaginoplasty results in a self-lubricating and goodsized neovagina, which does not require postoperative dilatation for extended periods of time. Use of rectosigmoid colon as a pedicled flap for the creation of a neovagina is effective since sufficient length may be obtained with excellent blood supply that could prevent complications such as contractions, shrinkage, or narrowing.
Sigmoid colon is particularly useful because it is anatomically similar to the perineum, with sufficient length and mobility of the segment that allows it to be easily brought into the perineum.
The neovagina is packed for 7 days, and an indwelling Foley catheter is left in place for 4 days. At discharge from hospital, patients irrigate the neovagina once a day for 2 months and weekly thereafter and dilate the introitus of the neovagina on a daily basis with a vaginal dilator.
Reconstructing the vagina using sigmoid colon creates an aesthetically pleasing vagina with an adequate length, natural lubrication, early intercourse and a low rate of shrinkage.
For transgender patients penile inverted skin flap presents the best option. Penile inversion technique includes creation of fully sensate neovagina from an inverted pedicled island penile skin flap and vascularized urethral flap. The important advance in this technique is complete penile disassembly, which ideally enables the use of all penile components (except the corpora cavernosa) in the construction of the new vulva, clitoris and vagina.
Ordinarily, procedure is started with bilateral orchidectomy. The penis is dissected into its anatomical components and corpora cavernosa are completely removed. Glans is reduced and fashioned to create a conically shaped clitoris, with fully preserved neurovascular bundle. The skin of the penis is inverted, as a pedicled flap preserving blood and nerve supplies to form a fully sensate vagina.
The urethra is then spatulated and used to create the mucosal part of the neovagina that provides additional sensitivity and wetting. Fixation of the vagina to the sacrospinous ligament is performed to achieve deep placement of the neovagina in the perineal cavity and to prevent prolapse.
Clitoral hood, labia minora, and labia majora is finally created by fashioning of the remaining penile and scrotal tissue.
Postoperative vaginal stenting and periodic dilatation is necessary. This way a fully sensate and sufficient vagina is created, enabling regular sexual intercourses with erogenous sensation.
Besides primary Vaginoplasty we often perform Vaginoplasty re-do for those patients, who had failed Vaginoplasty or need corrections after Vaginoplasty that they had in the past.
As successful sexual intercourse should be the primary end point when choosing the method for vaginal substitution, it should also be the starting point when evaluating surgical outcome.
The vaginoplasty procedure in the Belgrade Center for Genital Reconstructive Surgery provide a healthy aesthetically pleasing vagina that has an appropriate length.
If you have any questions, don’t hesitate to contact professor Djordjevic through our web site http://www.genitalsurgerybelgrade.com
