Sigmoid vaginoplasty with a modified single Monti tube: A pediatric case series

Michael Garcia-Roig, Miguel Castellan, Javier Gonzalez, Michael Gorin, Omar Cruz-Diaz, Andrew Labbie, Rafael Gosalbez

Research output: Contribution to journalArticle

Abstract

Purpose No consensus exists regarding the most effective procedure for neovagina formation. We describe our experience with modified single Monti tube colovaginoplasty in pediatric patients with disorders of sexual differentiation. Materials and Methods Six patients were retrospectively identified who underwent primary sigmoid vaginoplasty with a modified single Monti tube between 2009 and 2012. Data were collected from patient charts. The procedure is performed by isolating an 8 to 10 cm segment of distal sigmoid colon or proximal rectum, which is detubularized along the anterior mesentery, folded and retubularized longitudinally, leaving the mesentery in a cephalad position. A channel is dissected in the pelvis to accommodate the neovagina. Results Mean patient age was 12.7 years (range 6 to 17). The primary diagnosis was androgen insensitivity in 3 cases (50%), and Mayer-Rokitansky syndrome, partial androgen insensitivity and persistent cloaca in 1 each (16.7%). Chromosomal analysis revealed 46XY in 4 patients (66.7%). Median followup was 7.9 months (range 3 to 41). One patient who engages in vaginal intercourse reported satisfactory vaginal length without discomfort. In 1 patient an anastomotic stricture developed, which was managed by buccal mucosal grafting. Conclusions Modified single Monti tube sigmoid vaginoplasty is a safe, effective technique for neovagina formation in pediatric patients with disorders of sexual differentiation. Compared to other existing methods, our technique allows for the use of shorter bowel segments with decreased tension of the vascular pedicle.

Original languageEnglish (US)
Pages (from-to)1537-1542
Number of pages6
JournalJournal of Urology
Volume191
Issue number5 SUPPL
DOIs
StatePublished - Jan 1 2014

Fingerprint

Sigmoid Colon
Pediatrics
Disorders of Sex Development
Mesentery
Cloaca
Androgen-Insensitivity Syndrome
Cheek
Pelvis
Rectum
Androgens
Blood Vessels
Pathologic Constriction

Keywords

  • androgen-insensitivity syndrome
  • colon
  • reconstructive surgical procedures
  • sex differentiation
  • sigmoid
  • vagina

ASJC Scopus subject areas

  • Urology

Cite this

Garcia-Roig, M., Castellan, M., Gonzalez, J., Gorin, M., Cruz-Diaz, O., Labbie, A., & Gosalbez, R. (2014). Sigmoid vaginoplasty with a modified single Monti tube: A pediatric case series. Journal of Urology, 191(5 SUPPL), 1537-1542. https://doi.org/10.1016/j.juro.2013.08.073

Sigmoid vaginoplasty with a modified single Monti tube : A pediatric case series. / Garcia-Roig, Michael; Castellan, Miguel; Gonzalez, Javier; Gorin, Michael; Cruz-Diaz, Omar; Labbie, Andrew; Gosalbez, Rafael.

In: Journal of Urology, Vol. 191, No. 5 SUPPL, 01.01.2014, p. 1537-1542.

Research output: Contribution to journalArticle

Garcia-Roig, M, Castellan, M, Gonzalez, J, Gorin, M, Cruz-Diaz, O, Labbie, A & Gosalbez, R 2014, 'Sigmoid vaginoplasty with a modified single Monti tube: A pediatric case series', Journal of Urology, vol. 191, no. 5 SUPPL, pp. 1537-1542. https://doi.org/10.1016/j.juro.2013.08.073
Garcia-Roig M, Castellan M, Gonzalez J, Gorin M, Cruz-Diaz O, Labbie A et al. Sigmoid vaginoplasty with a modified single Monti tube: A pediatric case series. Journal of Urology. 2014 Jan 1;191(5 SUPPL):1537-1542. https://doi.org/10.1016/j.juro.2013.08.073
Garcia-Roig, Michael ; Castellan, Miguel ; Gonzalez, Javier ; Gorin, Michael ; Cruz-Diaz, Omar ; Labbie, Andrew ; Gosalbez, Rafael. / Sigmoid vaginoplasty with a modified single Monti tube : A pediatric case series. In: Journal of Urology. 2014 ; Vol. 191, No. 5 SUPPL. pp. 1537-1542.
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abstract = "Purpose No consensus exists regarding the most effective procedure for neovagina formation. We describe our experience with modified single Monti tube colovaginoplasty in pediatric patients with disorders of sexual differentiation. Materials and Methods Six patients were retrospectively identified who underwent primary sigmoid vaginoplasty with a modified single Monti tube between 2009 and 2012. Data were collected from patient charts. The procedure is performed by isolating an 8 to 10 cm segment of distal sigmoid colon or proximal rectum, which is detubularized along the anterior mesentery, folded and retubularized longitudinally, leaving the mesentery in a cephalad position. A channel is dissected in the pelvis to accommodate the neovagina. Results Mean patient age was 12.7 years (range 6 to 17). The primary diagnosis was androgen insensitivity in 3 cases (50{\%}), and Mayer-Rokitansky syndrome, partial androgen insensitivity and persistent cloaca in 1 each (16.7{\%}). Chromosomal analysis revealed 46XY in 4 patients (66.7{\%}). Median followup was 7.9 months (range 3 to 41). One patient who engages in vaginal intercourse reported satisfactory vaginal length without discomfort. In 1 patient an anastomotic stricture developed, which was managed by buccal mucosal grafting. Conclusions Modified single Monti tube sigmoid vaginoplasty is a safe, effective technique for neovagina formation in pediatric patients with disorders of sexual differentiation. Compared to other existing methods, our technique allows for the use of shorter bowel segments with decreased tension of the vascular pedicle.",
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