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Objective: To study the clinical effect of laparoscopic vaginoplasty using pedicled ileal and sigmoid colon segment., Methods: From January 2004 to December 2009, 105 cases undergoing laparoscope-assisted vaginoplasty using a vascularized pedicled intestinal flap were studied retrospectively. Operation time, blood loss in operating, bowel movement after operation, postoperation hospital duration, side effect, and artificial vagina were compared between two surgical management., Results: The vaginoplasty were preformed successfully in all 105 cases. There were 48 patients treated by aparoscope-assisted ileal vaginoplasty and 57 patients treated by laparoscope-assisted sigmoid colon vaginoplasty. The values of the operation time [(141 ± 22) minutes versus (159 ± 18) minutes, P = 0.000], blood loss in operating [(42 ± 6) ml versus (83 ± 14) ml, P = 0.000], bowel movement after operation (36 ± 9) hours versus (68 ± 8) hours(P = 0.000), and postoperation hospital duration [(9.8 ± 2.0) days versus (11.1 ± 1.3) days, P = 0.004] in the sigmoid colon vaginoplasty group were longer or higher than those in ileal vaginoplasty group (P < 0.05).No intraoprative complication occurred. There were four postoperative complications: 2 cases with intestinal obstruction in sigmoid colon vaginoplasty group, 1 case with urethral orifice stenosis and 1 case with vaginal-rectal fistula in ileal vaginoplasty group. At follow-up of 6-62 months, all artificial vaginas had a capacity of over two fingers in wideness and 12-15 cm in length. Vaginal discharges resembled a milky white water or mucus without odour. Fifty-five patients with sexual intercourse reported satisfactory results.Six patients complained vaginal stenosis:5 patients in ileal vaginoplasty group and 1 patient in sigmoid colon vaginoplasty group., Conclusions: Laparoscope-assisted vaginoplasty using pedicled ileum or sigmoid colon segment are both the effective ways in forming vagina. The latter management takes more time and blood loss while operating, yet the incidence of vaginal opening contracture appeared to be decreasing trend.

Objective: To compare the postoperative recovery among patients undergoing orthotopic bladder substitution with sigmoid or ileal grafts., Methods: The clinical data and postoperative recovery (postoperative complications, continence recovery time and postoperative hospital stay) of 84 patients receiving orthotopic bladder substitution with sigmoid or ileal grafts after radical cystectomy for bladder cancer were analyzed., Results: Of the 84 cases, 70 had continent urinary reservoirs constructed, among whom 58 (aged 48-89 years) received an ileal neobladder (IN) and 12 (aged 28-80 years) received a sigmoid neobladder (SN). The postoperative complications rate, continence recovery time and postoperative hospital stay in IN group was 29.3% (17/58), 91.4%, and 23.5 days, as compared to 58.3%(7/12) (P=0.04), 66.7% (P=0.03), and 25 days (P=0.04) in patients in SN group, respectively., Conclusion: A neobladder constructed from ileal grafts achieves better postoperative recovery results compared to a neobladder constructed from sigmoid grafts.

Objective: To study the clinical effect of gasless-laparoscopic vaginoplasty using sigmoid colon segment., Methods: Clinical data of 119 cases undergoing laparoscopic or gasless-laparoscopic vaginoplasty using a vascularized pedicled sigmoid colon segment in Beijing Anzhen Hospital from January 2007 to December 2010 were reviewed retrospectively. Those patients were classified into 57 cases with laparoscopic sigmoid colon vaginoplasty and 62 cases with gasless-laparoscopic sigmoid colon vaginoplasty. The operation time, blood loss in operating, bowel movement after operation, postoperation hospital duration, side effect, and artificial vagina were compared between laparoscopic and gasless-laparoscopic group., Results: The vaginoplasty were preformed successfully in 119 cases. The mean operation time of were (159 ± 18) min in laparoscopic group and (146 ± 17) min in gasless-laparoscopic group, respectively, which reached statistical difference (P < 0.01). The blood loss in operating were (83 ± 14) ml and (86 ± 13) ml, bowel movement after operation were (68 ± 8) hours and (68 ± 11) hours, and postoperation hospital duration were (11.1 ± 1.3) days and (11.4 ± 1.9) days respectively in laparoscopic group and gasless-laparoscopic group. No significant difference were found in the blood loss in operating, bowel movement after operation, and postoperation hospital duration between two groups (P > 0.05) .No intraoperative complication occurred. There were two cases with incomplete adhesive intestinal obstruction at 15-20 days postoperatively, which one was in laparoscopic group and one was in gas-less laparoscopic group. At 6-50 months of following up (median time 12 months), all artificial vaginas had a capacity of over two fingers in wideness and 12-15 cm in length. Vaginal discharges resembled a milky white water or mucus without odour. Eighty-five patients with sexual intercourse reported satisfactory feeling. One patients complained vaginal stenosis in laparoscopic group., Conclusion: Gasless-laparoscopic vaginoplasty using sigmoid colon segment is an alternative feasible and practical treatment.

Objective: To investigate re-innervation in the neovaginal mucosa of patients underwent sigmoid colon vaginoplasty in treatment of Mayer-Rokitansky-Kistner-Hauser Syndrome (MRKHS)., Methods: Biopsies in the upper third of the posterior neovagina were taken in 20 patients treated by sigmoid colon vaginoplasty at 1, 2 and 3 years after surgery, respectively. Protein gene product 9.5 (PGP 9.5), vasoactive intestinal peptide (VIP) and neuropeptide Y (NPY) were detected by immunohistochemical method and compared with those in intact sigmoid colon mucosa., Results: (1) Density of nerve fiber: abundant distribution of PGP 9.5 nerve fibers were observed in the mucosal muscle layer, submucosa, and smooth muscle layer of the neovagina. The nerve fibers of VIP and NPY immunoreactivity were mainly distributed around blood vessels and in the smooth muscles. In the neovagina, the density of nerve fibers of PGP 9.5 of 17 ± 6 were much more than VIP of 2.9 ± 1.0 and NPY of 2.5 ± 0.8 significantly (P < 0.05). (2) Expression of PGP 9.5 in neovagina: at 1 year after surgery, PGP 9.5 positive expression of 14 ± 4 was significantly lower in the neovagina than 28 ± 7 in the intact sigmoid colon (P < 0.05). However, after 2 to 3 years, its expression displayed an upgrade tendency in the neovagina and was significantly higher at the 3 year postoperatively than that at the 1 years postoperatively (22 ± 7 vs. 14 ± 4, P < 0.05). The changes were much more obvious in submucosa. (3) The expression of VIP and NPY in neovagina: at 1 year after surgery, VIP and NPY positive nerve fibers were also decreased in the neovagina when compared with those in the intact sigmoid colon (2.3 ± 0.7 vs. 5.3 ± 1.4, P < 0.05; 2.5 ± 1.1 vs. 5.5 ± 1.1, P < 0.05). At 2 to 3 years after surgery, the positive VIP fiber showed initially decreased and subsequently increased tendency. The density of VIP of 3.7 ± 0.7 in the neovagina at 3 years postoperatively was higher than 2.3 ± 0.7 at 1 years postoperatively (P < 0.05). No significant up-regulation was observed in NPY-positive expression in the neovagina within 3 years after operation., Conclusions: Distribution of sensory PGP 9.5, VIP and NPY immunoreactive nerve fibers was similar to the pattern observed within the intact sigmoid colon wall. The number of nerve fibers in the neovagina decreased after surgery and then increased subsequently within 3 years after surgery.

Objective: To study clinical effect of vaginoplasty with sigmoid colon by laparoscopic surgery., Method: Clinical data of 45 cases with laparoscopic vaginoplasty using a vascularized pedicled sigmoid colon flap were reviewed, including 41 cases with congenital absence of vagina and 4 cases with male pseudohermaphroditism. Operation time, blood loss, the anatomical and functional newly forming vagina were evaluated., Results: The sigmoid colon colpopoiesis was preformed successfully in all 45 cases. The range of operation time was 135 - 245 minutes and the mean time was 157 minutes. The mean blood loss was 82 ml during operation. The artificial vaginas had excellent cosmetic outcome, including adequate vaginal length, good lubrication, and appearance and physical functions similar to natural vagina. A vaginal mould was employed for more than 3 months in 34 cases, achieving a good dilatation of the artificial vagina. Twenty-five patients with satisfied sexual intercourse were reported., Conclusion: Laparoscopic vaginoplasty using a vascularized pedicled sigmoid colon flap is a feasible and ideal management.

Objective: In order to evaluate the changes of neovaginal defense function in the sight of physical barrier by investigating the changes in the histological morphology and expression of occludin, zona occluden-1 (ZO-1) in mucosal cells of the neovagina in patients undergoing vaginal construction by sigmoid colon., Methods: Fifteen cases with neovagina constructed by sigmoid colon matched with 15 cases' vaginal mocusa as control specimens were observed with light microscopic and electron microscopic methods. At the same time, the expression of occludin and ZO-1 were semiquantitatively measured by streptavidin-perosidase (SP) immunohistochemical method., Results: (1) Squamous metaplasia was observed in colonic mucosa from lower one-third of the artificial vagina in 10 cases (67%, 10/15). (2) The intercellular tight junctions of neovaginal mucosa became shorter and wider, the number of them were decreased or disappeared by electron microscopic study. (3) In upper neovagina, the positive rates of occludin and ZO-1 expression in mucosal cells were 80% (12/15) and 73% (11/15), respectively. In lower neovaginal mucosa where squamous metaplasia occurred, the positive rates of two protein expression in cells were both 100% (10/10) and also was 100% (15/15) in control group, which showed significant difference (P < 0.05, P < 0.01). In lower neovaginal mucosa where squamous metaplasia hadn't occurred, the positive expression of two protein in cells (4/5, 2/5) were significantly lower than those in lower neovaginal mucosa where squamous metaplasia had happened 100% (10/10), 100% (10/10) and in control group [100% (15/15), 100% (15/15)] (P < 0.05), while there were no significantly difference in positive expression of two protein in cells between this group and upper neovagina (P > 0.05)., Conclusions: The squamous metaplasia had occurred in lower neovaginal mucosa. The decreased expression of occludin and ZO-1 in upper and lower neovaginal mucosa where squamous metaplasia didn't occurred. However, In lower neovaginal mucosa where squamous metaplasia occurred, the expression of occludin and ZO-1 in cells were similar to those in control group, which might play a role in the defense function of neovaginal mucosa.

Objective: To study the changes of the histology and expression of neuronal nitric oxide synthase (nNOS) in the neovaginal mucosa of the patients undergoing vaginal construction with sigmoid colon., Methods: Biopsy samples of upper one-third and lower one-third of the artificial vagina were obtained from 14 patients who underwent vaginal construction with sigmoid colon 9 - 48 months before and samples of normal sigmoid colon were collected from another 14 patients during vaginal construction with sigmoid colon as control group. The pathological and ultrastructural changes were comparatively observed by light microscopy and electron microscopy. At the same time, the expression of nNOS was semiquantitatively evaluated with immunohistochemical method., Results: The upper one-third of the artificial vagina muscular layer of mucosa was hyperplastic and hypertrophic and the density of the submucosal nerve plexus was 3.6 +/- 1.5, significantly higher than that of the control group (1.7 +/- 0.8, P < 0.05). Squamous metaplasia was seen in the colonic mucosa from some 3 samples of lower one-third of the artificial vagina. Partial fusion of the intercellular tight junction, disappearance and fusion of mitochondrial cristae, and degranulation of rough endoplasmic reticulum could be seen in the vaginal colonic mucosa. Compared with the normal control, the expression of nNOS in the vaginal colonic mucosa was significantly decreased., Conclusion: Morphologic changes occur nNOS expression decreases in the colonic mucosa of the artificial vagina.