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UPJ INSIGHT Long-Term Bowel Vaginoplasty With a Single Yang-Monti Tube

By: Cinthia Galvez, MD, Nicklaus Children’s Hospital, Miami, Florida, Desai-Sethi Urology Institute, University of Miami, Miller School of Medicine, Florida; Adele Raymo, BSc, Nicklaus Children’s Hospital, Miami, Florida, Desai-Sethi Urology Institute, University of Miami, Miller School of Medicine, Florida; Andrew Ransford, MD, Nicklaus Children’s Hospital, Miami, Florida, Desai-Sethi Urology Institute, University of Miami, Miller School of Medicine, Florida; Hugo G. Quezada-Pinedo, MD, The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, The Netherlands; Daniel E. Nassau, MD, Nicklaus Children’s Hospital, Miami, Florida, Desai-Sethi Urology Institute, University of Miami, Miller School of Medicine, Florida; Miguel Castellan, MD, Nicklaus Children’s Hospital, Miami, Florida, Desai-Sethi Urology Institute, University of Miami, Miller School of Medicine, Florida; Andrew S. Labbie, MD, Nicklaus Children’s Hospital, Miami, Florida, Desai-Sethi Urology Institute, University of Miami, Miller School of Medicine, Florida; Alireza Alam, MD, Nicklaus Children’s Hospital, Miami, Florida, Desai-Sethi Urology Institute, University of Miami, Miller School of Medicine, Florida; Rafael Gosalbez, MD, Nicklaus Children’s Hospital, Miami, Florida, Desai-Sethi Urology Institute, University of Miami, Miller School of Medicine, Florida | Posted on: 18 Mar 2024

Galvez C, Raymo A, Ransford A, et al. Long-term bowel vaginoplasty with a single Yang-Monti tube. Urol Pract. 2024;11(2):439-446.

Study Need and Importance

This study addresses the crucial need for effective surgical techniques for neo-vaginoplasty in patients with congenital vaginal agenesis, a condition that can significantly impact quality of life. Focusing on the single Yang-Monti tube (SYMT) technique, this study is important for its potential to offer improved surgical outcomes in cases where traditional methods have limitations or have failed.

What We Found

The study reviewed 17 patients undergoing SYMT for neo-vaginoplasty at Nicklaus Children’s Hospital between 2009 and 2021. The SYMT technique, involving the use of colon segments, showed promising results (Figure). The primary diagnoses included Mayer-Rokitansky-Küster-Hauser syndrome, androgen insensitivity syndrome, and persistent cloaca. The technique was noted for its safety, with no intraoperative complications and successful creation of a functional neo-vagina. Complications included vaginal introital stenosis and a few other postoperative issues, but overall patient satisfaction with the functional and cosmetic outcomes was high.

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Figure. A, An 8- to 10-cm segment of cecum-ascending colon is harvested based on the vascular supply (solid lines). If a patient has an intact colon, the sigmoid is still a good option for neo-vagina (dashed lines). The harvested flap was detubularized near the mesenteric border (B), folded (C), and retubularized transversally (D), leaving the mesentery in a cephalad position. E, The neo-vagina is delivered to introitus and secured in place with interrupted sutures.

Limitations

Key limitations of the study include its retrospective nature, small sample size, absence of a control group, and the subjective nature of patient satisfaction measures. The study’s findings might not be generalizable due to potential biases inherent in retrospective studies and the specific patient selection criteria.

Interpretation for Patient Care

For patient care, the study underscores the SYMT technique as a safe and effective option for neo-vaginoplasty in patients with vaginal agenesis. It highlights the importance of personalized surgical planning, considering patient-specific anatomical and clinical factors. The study also emphasizes the need for comprehensive postoperative care, including managing potential complications and long-term follow-up. For health care providers, these findings offer valuable insights for surgical decision-making, patient counseling, and setting realistic expectations regarding the outcomes of neo-vaginoplasty.

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