Presentation Authors: Moneer Hanna*, West Orange, NJ, Ashraf Fahmy, Cairo, Egypt
Introduction: The abnormalities of the external genitalia in females born with bladder exstrophy occur in a spectrum and their extent is related to the degree of the symphyseal diastasis. In some cases the vaginal introitus is narrow, in other cases the introitus is positioned anteriorly and is located on the lower abdomen. These anatomic abnormalities may interfere with sexual function, can be obtrusive, and cause poor self-image during adolescence
Methods: We reviewed the records of 17 patients (13-22 years old) who underwent vaginoplasty between 1996 and 2017. 3/17 underwent posterior episiotomy for vaginal stenosis and subsequently two of them were revised by inverted Y-V plasty, which was also performed in three different patients. In 9 patients (16-19year old) who had had urinary diversion with a catheterizable abdominal stoma and/or Mainz II pouch, the vagina, which was displaced anteriorly in the pubic area was dissected circumfirencialy. An inverted V shape perineal skin flap was raised posteriorly, and the deep perineal tissues were incised in the midline to accommodate the realigned vagina, which was then incised posteriorly and anastomosed to the perineal V skin flap. Two patients 12 and 17 years old who underwent unsuccessful bladder exstrophy closure during early childhood complicated by complete dehiscence managed to maintain a relatively healthy bladder plate over the years. Both underwent one stage total mobilization of the urethral plate attached to the vagina as a single unit without separating them from each other to preserve the urethral blood supply, which was subsequently tubularized as a part of complete primary bladder closure, bladder neck reconstruction and urethroplasty in addition to the vaginal realignement. All patients underwent simultaneous reconstruction of the mons pubis
Results: The 6 patients who underwent Y-V episiotomy for vaginal stenosis maintained vaginal patency up to 18 months follow up. 3/6 including the patient who had had posterior episiotomy are sexually active without complaints. In 1/11 patients who underwent vaginal mobilization the repair partially broke down and was successfully revised 6 months post operatively. Minor complications were noted in 2/11 pts including suture granulomas and a hypertrophic scar both of whom responded to local treatment. 5/11 are sexually active and reported no dyspareunia. The follow up varied between 9 months and 4 years (mean 2years)
Conclusions: As children born with bladder exstrophy transition to adolescence, the genital tract acquires significant importance. Y-V vaginoplasty is preferable to posterior cut back episiotomy for correction of severe entroital stenosis. Restoration of the anteriorly displaced vagina by total mobilization and caudal realignment closer to the anus, in addition to contouring of the mons pubis camouflages the anatomic deformities of the external genitalia of females born with bladder exstrophy. However, in some cases complex and extensive reconstruction of the pubic area is required.