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Objectives: The intestinal microbiota plays an important role in intestinal health. After colonic diversion from the fecal stream, luminal nutrients for bacteria are expected to be depleted, inducing changes in microbial composition. In this study, we describe microbial changes in the healthy colon following surgical fecal stream diversion, studied in the surgically constructed sigmoid-derived neovagina., Methods: At various postoperative times after sigmoid vaginoplasty, rectal, neovaginal, and skin microbial swabs were obtained for microbial analysis by interspacer profiling, a PCR-based bacterial profiling technique. Differences in bacterial profiles, in terms of bacterial abundance and phylum diversity, were assessed. Microbial dissimilarities between anatomical locations were analyzed with principal coordinate analysis and partial least squares discriminant analysis., Results: Bacterial samples were obtained from 28 patients who underwent sigmoid vaginoplasty. By principal coordinate analysis, microbial profiles of samples from the sigmoid-derived neovagina were distinctively different from rectal samples. Partial least squares discriminant analysis showed that the most discriminative species derived from the phylum Bacteroidetes. The abundance and diversity of Bacteroidetes species were reduced following fecal stream diversion compared with rectal samples (median Shannon diversity index of 2.76 vs. 2.18, P<0.01). Similar abundance of Phyla Firmicutes, Actinobacteria, Fusobacteria, Verrucomicrobia, and Proteobacteria was observed., Conclusion: By analyzing the microbiome of sigmoid-derived neovaginas, we studied the effects of fecal diversion on the microbial composition of the healthy intestine. Most changes were observed in the phylum Bacteroidetes, indicating that these bacteria are likely part of the diet-dependent (butyrate-producing) colonic microbiome. Bacteria of other phyla are likely to be part of the diet-independent microbiome.

Introduction: In children who remain incontinent after reconstruction of bladder exstrophy-epispadias complex (BEEC), continent anal urinary diversion (CAD) is one option to achieve continence. Known problems after CAD are an increased stool frequency and ureterointestinal stenosis. We devised a new surgical technique of CAD that we named the "Cologne pouch procedure" (CPP) that renders the possibility of separate evacuation of urine and feces. Furthermore, we connect the bladder plate to the rectosigmoid pouch instead of performing a ureterosigmoidostomy to reduce the rate of ureterointestinal stenosis. In this study, we want to introduce the CCP and critically evaluate our results., Study Design: In CPP a detubularized sigmoid-bladder pouch is created, which is naturally connected to the rectum. A retrospective study was performed including all patients with BEEC and CPP treated in our hospital between January 1, 2007, and December 31, 2016. Epidemiological and surgical key data, complications, and the need for alkaline supplementation were assessed. At follow-up examinations, we evaluated continence, ability of independent urine and feces evacuation, need for bicarbonate supplementation, status of the upper urinary tract, and complications such as urinary tract infections or urolithiasis., Results: In total, 29 patients with BEEC and CPP were included. The mean age at surgery was 4.2 ± 3.3 years (range 0.1-12.7 years). Overall, 14 short-term complications occurred in nine patients. Postoperatively, all patients were continent for urine and feces during daytime and only one child occasionally lost small portions of urine at night. An independent evacuation of urine and feces was accomplished in 22 patients (81.5%). Continued bicarbonate supplementation was necessary in 15 patients (55.6%). During the follow-up period six patients (22.2%) had a single urinary tract infection and four patients (14.8%) calculi of the urinary tract. No urinary tract abnormalities-especially no vesicoureteral reflux (VUR) or stenosis-were detected during follow-up ultrasound examination. In two children, a preoperatively known hydronephrosis decreased after CPP., Conclusion: CPP is a novel technique that yields excellent results concerning continence. In contrast to other forms of rectosigmoid urinary diversion, functional separation of defecation and urination can be achieved in most patients., (Copyright © 2018 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.)

Although vaginal reconstructions with intestinal segments require particularly complex surgical procedures, this technique has become popular with respect to fairly good functional and esthetic outcomes. This study describes cases of vaginal reconstruction performed using a modified rectosigmoid colon held in an ischemic state in order to reduce secretion and denervated in order to prevent defecation problems. Vaginal reconstructions with rectosigmoid colon were performed on 43 patients. In this retrospective study, 34 patients had Müllerian agenesis, while nine had undergone male to female sex reassignment surgery in which adequate vaginal depth had not been achieved. A rectosigmoid colon with its vascular pedicle was used and left in an ischemic state. All nerve structures within the pedicle were excised intraoperatively. Follow-up period was between 12 and 60 months. Partial necrosis occurred in one patient which was reconstructed with local flap. Hematoma developed beneath the skin incision in two cases, but resolved with conservative treatment. A good esthetic outcome was achieved in all cases. Sexual function was assessed using the Female Sexual Function Index (FSFI) in 15 patients. Fourteen out of 15 patients scored above 26.5 on this scale and were determined as having no sexual dysfunction (FSFI score ≥26.5). In conclusion, vaginal reconstruction with denervated rectosigmoid held in an ischemic state appears to be a reasonable option among several available reconstruction techniques.

Background: In view of the rarity of vaginal agenesis, malignancy arising in the neovagina is extremely rare., Case Presentation: Here, we report a 76-year-old female with an adenocarcinoma arising in the sigmoid colon neovagina which was constructed 53 years ago for congenital vaginal agenesis. Vaginal endoscopy to examine vaginal bleeding revealed a protruding lesion occupying three quarters of the lumen in the vicinity of anastomosis of the residual vagina and sigmoid colon. Transvaginal ultrasonography revealed the muscularis propria layer (hypoechoic fourth layer) to be interrupted. CT revealed no distant metastasis. Total pelvic exenteration was performed based on the diagnosis of neovaginal cancer at the anastomosis site. The 45-mm tumor showed well-differentiated adenocarcinoma with a mucinous adenocarcinoma component. Immunohistochemistry showed no p16-overexpressing tumor cells, suggesting the lack of human papilloma virus infection., Conclusions: Although rare, clinicians should be aware of cancer that arises in the ectopic intestine when anastomosed with other organs.

Background/purpose: We report the current status of patients who underwent augmentation cystoplasty (AC) at least 20years previously., Methods: Surgical history, incidence of urinary tract infection (UTI) and bladder stones, vesicoureteral reflux (VUR), urine cytology, renal function, a colon cancer tumor marker (carcinoembryonic antigen: CEA), and patient outcomes were assessed., Results: Forty patients who underwent AC (mean age: 34.4years; mean follow-up time: 24.3years) were analyzed. Mean age at AC was 11years. Incidence of bladder stones was 30%. There were no incidences of carcinoma after AC, and CEA levels were not increased. Ureteral reimplantation (URI) was performed in 21 patients. URI performed at the same time as AC was successful in 14 cases (93%) and unsuccessful in 1 (7%) because of persistent VUR. UTI developed after AC in only 1 patient (2.5%) with persistent VUR. This patient required unilateral nephrectomy 18years after the AC because of repeated UTIs. Thirty-four patients (85%) were employed, and 4 (10%) were married. Two of the 19 female patients (11%) had experienced pregnancy and delivery. Five patients (13%) had mental disorders., Conclusion: Ultra long-term follow-up suggests that AC is a safe procedure with manageable sequelae, although some mental health issues remain., Type of Study: Case series with no comparison group., Level of Evidence: Level IV., (Copyright © 2017. Published by Elsevier Inc.)

Background: In young transgender women previously treated with puberty-suppressing hormones, penoscrotal hypoplasia can make penoscrotal inversion vaginoplasty unfeasible. The aim of this study was to prospectively assess surgical outcomes and follow-up of total laparoscopic sigmoid vaginoplasty as primary reconstruction in a cohort of transgender women with penoscrotal hypoplasia., Methods: Baseline demographics, surgical characteristics, and intraoperative and postoperative complications of all performed total laparoscopic sigmoid vaginoplasty procedures were prospectively recorded., Results: From November of 2007 to July of 2015, 42 transgender women underwent total laparoscopic sigmoid vaginoplasty as primary vaginal reconstruction. The mean age at the time of surgery was 21.1 ± 4.7 years. Mean follow-up time was 3.2 ± 2.1 years. The mean operative duration was 210 ± 44 minutes. There were no conversions to laparotomy. One rectal perforation was recognized during surgery and immediately oversewn without long-term consequences. The mean length of hospitalization was 5.7 ± 1.1 days. One patient died as a result of an extended-spectrum beta-lactamase-positive necrotizing fasciitis leading to septic shock, with multiorgan failure. Direct postoperative complications that needed laparoscopic reoperation occurred in three cases (7.1 percent). In seven cases (17.1 percent), long-term complications needed a secondary correction. After 1 year, all patients had a functional neovagina with a mean depth of 16.3 ± 1.5 cm., Conclusions: Total laparoscopic sigmoid vaginoplasty seems to have a similar complication rate as other types of elective laparoscopic colorectal surgery. Primary total laparoscopic sigmoid vaginoplasty is a feasible gender-confirming surgical technique with good functional outcomes for transgender women with penoscrotal hypoplasia., Clinical Questio/level of Evidence: Therapeutic, IV.

Background: Vaginal (re)construction can greatly improve the quality of life of indicated patients. If primary vaginoplasty fails, multiple surgical approaches exist for revision. The authors compared surgical results of laparoscopic intestinal versus full-thickness skin graft revision vaginoplasty., Methods: A retrospective chart review of patients who underwent revision vaginoplasty at the authors' institution was conducted. Patient demographics, surgical characteristics, complications, hospitalization, reoperations, and neovaginal depth for both surgical techniques were recorded and compared., Results: The authors studied a consecutive series of 50 transgender and three biological women who underwent revision vaginoplasty, of which 21 were laparoscopic intestinal and 32 were perineal full-thickness skin graft vaginoplasties, with a median clinical follow-up of 3.2 years (range, 0.5 to 19.7 years). Patient demographics did not differ significantly. There was no mortality. Two intraoperative rectal perforations (10 percent) occurred in the intestinal group versus six (19 percent) in the full-thickness skin graft group. Operative time was shorter for the full-thickness skin graft vaginoplasty group (131 ± 35 minutes versus 191 ± 45 minutes; p < 0.01). Hospitalization length did not differ significantly. Successful vaginal (re)construction was achieved in 19 intestinal (91 percent) and 26 full-thickness skin graft (81 percent) vaginoplasty procedures. A deeper neovagina was achieved with intestinal vaginoplasty (15.9 ± 1.4 cm versus 12.5 ± 2.8 cm; p < 0.01)., Conclusions: Both laparoscopic intestinal and full-thickness skin graft vaginoplasty can be used as secondary vaginal reconstruction. Intraoperative and postoperative complications do not differ significantly, but rectal perforation was more prevalent in the full-thickness skin graft vaginoplasty group. Although the operative time of laparoscopic intestinal vaginoplasty is longer, adequate neovaginal depth was more frequently achieved than in secondary perineal full-thickness skin graft vaginoplasty., Clincal Question/level of Evidence: Therapeutic, III.

Objective: To validate the technical feasibility and anatomical and functional outcomes of transumbilical single-incision laparoscopic (SIL) sigmoid vaginoplasty hybrid transperineal approach in women with Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome., Methods: Twenty-five patients who underwent transumbilical SIL sigmoid vaginoplasty hybrid transperineal approach were retrospectively evaluated. Operation time and postoperative complications were analyzed. The length and breadth of the neovagina, lubrication and the Female Sexual Function Index were evaluated to assess the anatomical and functional outcomes of the surgery., Results: All the cases were successfully performed without any intraoperative morbidity. The mean operative time and postoperative hospital stay were 162 ± 38 min and 11 ± 3 days, respectively. The postoperative complications included one case of a stress ulcer, one case of a neovaginal ulcer and two cases of umbilical incision infection. Sixteen women had regular intercourse and were satisfied with both the surgical outcome and subsequent sexual activity., Conclusion: Transumbilical SIL sigmoid vaginoplasty hybrid transperineal approach offers a feasible scarless method with cosmetic advantage for women with MRKH syndrome to establish new functional vagina.

A 46-year-old, HIV-positive transgender woman of South American ethnicity consulted our outpatient clinic to discuss the possibilities of a surgical, secondary neovaginal reconstruction because of complete stenosis of her inverted penile skin-lined neovagina. She was taking abacavir/lamivudine and nevirapine as antiretroviral therapy. We successfully performed a total laparoscopic sigmoid vaginoplasty without any complications. There was no short-term morbidity and no complications were reported after 15 months of follow-up. To our knowledge, this is the first report of laparoscopic sigmoid vaginoplasty as vaginal reconstruction in a HIV-positive transgender woman. Worldwide, transgender women have a high burden of HIV infection. This report shows that intestinal vaginoplasty is a feasible surgical option for HIV-positive transgender women in need of vaginal reconstruction. Because patients are again able to engage in penetrative sexual intercourse, we emphasise the importance of practicing safe sex and early initiation of adequate antiretroviral therapy in this patient population., (© The Author(s) 2015.)

Aims: Autologous intestinal grafts are used to (re)create a vagina in selected patients. The risk of diversion colitis is mentioned as a disadvantage, although its prevalence remains unclear. This study aimed to assess the histopathological characteristics of the sigmoid-derived neovaginal epithelial lining after diverting surgery and correlate these with clinical findings., Methods and Results: Biopsy specimens were obtained from the epithelial lining of the sigmoid-derived neovagina and remaining rectosigmoid as regular follow-up from 26 patients with a median age of 22 years (range 19-52) and median postoperative follow-up of 13 months (range 6-52). Medical history, neovaginal symptoms and sexual activity were documented. An experienced gastrointestinal histopathologist assessed the specimens using a descriptive item-score, comprising signs of chronic and active inflammation. Inflammatory changes were observed in 21 (80.7%) neovaginal and one (3.8%) rectosigmoid specimens. The neovaginal appearance was characterized by an increase of lymphoid aggregates and lymphoplasmacellular infiltrate. Other common features were the presence of polymorphonuclear neutrophils and Paneth cell metaplasia. Neovaginal discharge was correlated with the presence of inflammatory changes (P = 0.008, Spearman's rho = 0.506)., Discussion: Acute and chronic inflammation of the sigmoid-derived neovagina was commonly observed and consistent with a proposed diagnosis of diversion neovaginitis. Neovaginal discharge correlates with this histopathological entity., (© 2015 John Wiley & Sons Ltd.)

Objective: To assess the endoscopic characteristics of the sigmoid-derived neovagina, which have been scarcely described., Design: Prospective observational study., Setting: University tertiary medical center., Patient(s): Patients that underwent sigmoid vaginoplasty., Intervention(s): Patients were invited yearly to undergo neovaginoscopy and sigmoidoscopy, preceded by taking a medical history and physical examination, as routine follow-up., Main Outcome Measure(s): Endoscopic signs of neovaginal inflammation., Result(s): Thirty-four patients with a sigmoid neovagina underwent a total of 43 combined neovaginoscopies and sigmoidoscopies. After a mean postoperative time of 23 months, the most notable endoscopic features of the sigmoid-derived neovagina comprised a diminished vascular pattern, edema, granularity, friability, decreased resilience, and erythema. In the control rectosigmoidoscopy images, no concurrent abnormalities were observed. When applying the MAYO score to the neovaginal images, 12 (35%) patients scored MAYO 0, 19 (56%) MAYO I, 3 (9%) MAYO II, and none MAYO III. The presence of neovaginal discharge and malodor correlated with inflammatory endoscopic alterations., Conclusion(s): The endoscopic appearance of a sigmoid segment after use in neovaginoplasty differs significantly from that of the remaining rectosigmoid. Inflammatory changes of the sigmoid-derived neovagina were observed in most patients. Clinically, the inflammatory changes appear similar to those encountered in diversion colitis., (Copyright © 2016 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.)

Surgical creation of a neovagina using the sigmoid was one of the main techniques used in patients with Mayer-Rokinatsky-Küster-Hauser syndrome. Nowadays, this surgery is not common as a result of the high frequency of complications and adverse outcomes, one of which is sigmoid neovagina prolapse. There are no standards of treatment because of the rarity of these clinical events; therefore, any medical case is important. We present a case report of a 72-year-old patient with prolapse of the sigmoid stump. Perscrutation of this example allows us to conclude that laparoscopic sacrocolpopexy is the optimal operation for patients with apical prolapse and a history of sigmoidal colpopoiesis owing to its high level of safety and excellent outcomes.

Background: The absence of a normal functioning vagina can have a profound impact on women's quality of life and psychological well being. Frasier syndrome is a rare autosomal recessive disorder which presents with male pseudohermaphroditism with gonadal dysgenesis, renal failure in early adulthood and increased risk of developing gonadoblastoma. Kidney transplant recipients are reported to have a high complication rate after colorectal surgery, most probably resulting from immunosuppressive therapy., Case: A 25-year-old female kidney transplant recipient with Frasier syndrome consulted our department to discuss the possibilities of surgically constructing a functional vagina. She successfully underwent a total laparoscopic colocolpopoiesis without any complications. A sigmoid segment of 16 cm long was isolated laparoscopically and transferred caudally in a dissected pouch between bladder and rectum on its vascular pedicle. There was no short-term morbidity and no complications up to 3 years postoperatively. She experienced no neovaginal symptoms and was able to engage in neovaginal penetration by means of vibrator or neovaginal dilatator., Conclusions: The positive results in this patient lead us to recommend laparoscopic colocolpopoiesis in kidney transplant patients who are seeking vaginoplasty. We advocate considering a total laparoscopic approach whenever rectosigmoid colocolpopoiesis is indicated, even after a kidney transplantation.

Background: Bladder augmentation technique has changed over the years and the current practice has significant adverse health effects and long-term sequelae. Previously, we reported a novel cell transfer technology for covering demucosalized colonic segments with bladder urothelium and smooth muscle cells through an aerosol spraying of these cells and a fibrin glue mixture., Objective: To determine the long-term durability and functional characteristics of demucosalized segments of colon repopulated with urothelial cells in the bladder of swine for use in augmentation cystoplasty., Study Design: Nine swine were divided into three groups. The first group (control) underwent standard colocystoplasty; the second group underwent colocystoplasty with colonic demucosalization and aerosol application of fibrin glue and urothelial cell mixture; in the third group detrusor cells were added to the mixture described in group two. The animals were kept for 6 months. Absorptive and secretory function was assessed. Bladders were harvested for histological and immunohistochemical evaluation., Results: All animals but one in the experimental groups showed confluent urothelial coverage of the colonic segment in the bladder without any evidence of fibrosis, inflammation, or regrowth of colonic epithelial cells. Ten percent of the instilled water in the bladder was absorbed within an hour in the control group, but none in experimental groups(p = 0.02). The total urine sediment and protein contents were higher in the control group compared with experimental groups (p < 0.05)., Discussion: Both study groups developed a uniform urothelial lining. Histologically, the group with smooth muscle had an added layer of submucosal smooth muscle. Six months after bladder augmentation the new lining was durable. We were also able to demonstrate that the reconstituted augmented segments secrete and absorb significantly less than the control colocystoplasty group. We used a non-validated simple method to evaluate permeability of the new urothelial lining to water. To determine if the aerosol transfer of bladder cells would have behaved differently in the neurogenic bladder population, this experiment should have been performed in animals with neuropathic bladders., Conclusion: Aerosol spraying of single cell suspension of urothelial and muscular cells with fibrin glue resulted in coverage of the demucosalized intestinal segment with a uniform urothelial layer. This new lining segment was durable without regrowth of colonic mucosa after 6 months. The new reconstituted segment absorbs and secretes significantly less than control colocystoplasty., (Copyright © 2015 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.)

Background: We reported our experience of adenocarcinoma of sigmoid colon neovagina., Case Presentation: A 67-year-old female with a history of neovagina construction for Rokitansky syndrome complained of vaginal bleeding. She had a mucinous adenocarcinoma at the anterior aspect of the neovagina. Her original surgery, using sigmoid colon to construct the artificial vagina, was 40 years ago, Conclusions: This patient's case may contribute to our understanding of carcinogenesis in the colon.

Purpose: To assess the necessity of performing simultaneous collateral reimplantation during sigmoid bladder augmentation (SBA) to reduce vesicoureteral reflux (VUR) in low-compliance neuropathic bladder with associated VUR., Methods: We retrospectively identified 31 patients who underwent SBA alone or with simultaneous ureteral reimplantation at our hospital. The video urodynamics data, VUR status, renal function, and clinical symptoms were studied during follow-up., Results: The mean follow-up time was 57 months (range 12-117). All patients displayed significantly increased safe cystometric capacity (P < 0.001) and bladder compliance (P < 0.001) and decreased creatinine (P < 0.01) and urea nitrogen (P < 0.05) compared with preoperative levels. High-grade VUR was resolved in only 7 of 15 patients (47%) in Group A (simultaneous ureteral reimplantation), whereas low-grade VUR was resolved in 13 of 16 patients (81%) in Group B (SBA alone). The other 11 patients still displaying VUR after SBA had larger safe bladder volumes due to augmentation. The patients' improving renal function benefited most from the enlarged bladder and partly from increased antireflux resistance of vesico-ureter anastomosis. Twelve (38.7%) had recurrent febrile urinary tract infection after SBA, and one (3.2%) suffered from vesico-ureter anastomosis contracture after ureteral reimplantation., Conclusions: A preoperative intravesical VUR pressure of 20 cmH2O is not an effective cutoff point for whether ureteral reimplantation should be simultaneously performed during SBA. Augmentation appears to be more important than reimplantation for protecting kidney from damage due to febrile urinary tract infection after SBA. Simultaneous reimplantation may be not necessary during SBA in neurogenic bladder.

Background: A previous study showed that foot stimulation can delay the bladder filling sensation and increase bladder volume in healthy humans without OAB. The aim of this study was to determine whether or not electrical stimulation of somatic afferent nerves in the foot can increase bladder capacity in neurogenic bladder patients after sigmoid cystoplasty., Methods: Eleven subjects underwent 30-min foot stimulation using skin surface electrodes connected to a bladder-pelvic stimulator. The electrodes were attached to the bottom of the foot. The subjects completed a 5-day voiding diary, during which time foot stimulation was applied on day 3. The stimulation parameter was a continuous, bi-polar square wave form with a pulse duration of 200 μs and a stimulation frequency of 5 Hz. The stimulation intensity was set by each subject at a maximal level without causing discomfort., Results: The volume per clean intermittent catheterization (CIC) was 279.4 ± 11.7 ml and 285.4 ± 11.8 ml on the 1st and 2nd days, respectively. On the 3rd day, the average volume per CIC increased to 361.1 ± 18.1 ml after stimulation (p <0.05). The average volume per CIC returned to 295.4 ± 13.4 ml and 275.1 ± 11.5 ml on the 4th and 5th days, respectively., Conclusions: Foot stimulation can delay the bladder filling sensation and significantly increase bladder capacity in neurogenic bladder patients after sigmoid cystoplasty.

Background: Ninety per cent of cases of congenital vaginal agenesis are represented by the Mayer-Rokitansky-Küster-Hauser syndrome, the remaining 10% being represented by the testicular feminization syndrome and vaginal aplasia. Numerous surgical methods for the treatment of vaginal agenesis have been described. Neovagina construction by sigmoid colpoplasty seems to be the best surgical option as regards the anatomical and functional outcome., Method: We report the case of three patients operated of neovagina construction with a sigmoid graft by a laparoscopic-perineal approach., Results: The surgical intervention lasted for 330 minutes, 210 minutes and 150 minutes respectively for the three patients. There were no perioperative complications. The duration of hospitalization was respectively 7, 4 and 6 days. The length of the neovagina was 15, 14 and 18 cm without retraction on the follow-up at 2 and 6 months. The vaginal wall maintained its patency allowing normal intercourse. The patients had normal sexual life after the surgery., Conclusion: Our results demonstrate the feasibility of laparoscopic-perineal neovagina construction by sigmoid colpoplasty when it is performed by experienced surgeons in gynecology and digestive laparoscopic surgery.

Objective: To assess the clinical and urodynamic outcomes of patients with low-compliance neurogenic bladder who were treated with sigmoid bladder augmentation (SBA) over a long-term follow-up., Materials and Methods: We retrospectively reviewed 52 patients with low-compliance neurogenic bladder who underwent SBA alone or with antireflux techniques in our hospital from 2006 to 2014. Clinical outcomes regarding bladder function, incontinence, medications, catheterization schedules, subsequent interventions, bowel function, and patient satisfaction were addressed., Results: The mean follow-up was 49 months. All patients experienced significant increases in safe cystometric capacity from 113.8 ± 65.9 mL to 373.1 ± 66.7 mL (P <.001), bladder compliance from 2.96 ± 1.55 mL/cm H2O to 14.07 ± 5.45 mL/cm H2O (P <.001), and decreases in creatinine from 88.1 ± 38.6 μmol/L to 77.1 ± 30.4 μmol/L (P <.001) compared with those before surgery. Six patients (11.5%) required anticholinergic medicine to control neurogenic detrusor overactivity, and 11 (21.1%) had recurrent febrile urinary tract infections after SBA. Among 47 prehydronephrosis patients (grade I-II in 10 and III-V in 37), 16 still had minor hydronephrosis after SBA, but the hydronephrosis had been improved significantly (all posthydronephroses were grade I-II instead). All patients reported significant improvements in constipation, and no patient had obvious metabolic acidosis or bladder perforation after SBA. All patients expressed extreme satisfaction with the operation., Conclusion: SBA provided durable clinical and urodynamic improvement for patients with low-compliance neurogenic bladder and constipation. SBA alone, without ureteral reimplantation, seemed sufficient for neurogenic bladder. Furthermore, there was a high level of patient satisfaction with SBA., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Objective: The aim of this study is to estimate the overall rates of significant incontinent conduit-related complications and compare rates between conduit types., Methods: This was a retrospective review of 166 patients who underwent incontinent urinary diversion from April 1993 through April 2013. Patients were categorized by conduit type-ileal, sigmoid colon, and transverse colon. Significant conduit-related complications were assessed at 30 and 90days after surgery. Significant conduit-related complication was defined as any of the following: ureteral stricture, conduit leak, conduit obstruction, conduit ischemia, ureteral anastomotic leak, stent obstruction requiring intervention via interventional radiology procedure or reoperation, and renal failure., Results: A total of 166 patients underwent formation of an incontinent urinary conduit, most commonly during exenteration for gynecologic malignancy. There were 129 ileal, 11 transverse colon, and 26 sigmoid conduits. The overall significant conduit-related complication rate within 30days was 15.1%. Complication rates for ileal, transverse and sigmoid conduits were 14.7%, 0%, and 23.1%, respectively (Fisher's exact test, p=0.24). By 90days, the Kaplan-Meier estimated rates of significant complications were 21.8% overall, and 22.3%, 0%, and 28.9%, respectively, by conduit type (log-rank test, p=0.19). The most common significant conduit-related complications were conduit or ureteral anastomotic leaks and conduit obstructions. By 1 and 2years following surgery, the Kaplan-Meier estimated overall rate of significant conduit-related complication increased to 26.5% and 30.1%, respectively., Conclusions: Our study suggests that there are multiple appropriate tissue sites for use in incontinent conduit formation, and surgical approach should be individualized. Most significant conduit-related complications occur within 90days after surgery., (Copyright © 2014 Elsevier Inc. All rights reserved.)

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., (Copyright © 2014 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.)

Background: For better cosmetic appearance, attempts to reduce the number of laparoscopic wounds have been sought. Investigators have thus begun to carry out procedures through a single incision or natural orifice endoscopic surgery instead of using conventional laparoscopic surgery. The authors here describe transumbilical single-incision hybrid transperineal laparoscopic surgery as a novel approach for vaginoplasty using a sigmoid graft., Patients and Methods: From August 2010 to October 2012, 15 young females with Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome underwent laparoscopic sigmoid vaginosplasty using a combined transumbilical single-incision and transperineal approach. A multichannel single port was placed through the umbilical incision for the main laparoscopic procedures. A 12-mm trocar as an assisting working port was inserted into the pelvic cavity through the transvaginal dimple between the rectum and urethra., Results: A functioning vagina 12-15 cm in length and approximately 4 cm in width was created in all the patients. The average operative time and hospital stay were 151.5±34.2 minutes and 7.4±3.2 days, respectively. The only perioperative complications were 1 case of stress ulcer and 1 case with umbilical infection. All patients were satisfied with the surgery, and 12 of them had subsequent sexual activity., Conclusions: Transumbilical single-incision hybrid transperineal laparoscopic sigmoid vaginoplasty offers a feasible scarless approach for females with MRKH syndrome. The favorable cosmetic results would favor use of this type of vaginoplasty as an alternative to the conventional laparoscopic approach.

Objective: Absorbable staples facilitate detubularization and reconfiguration of the bowel when performing augmentation colocystoplasty. We compared the outcomes of stapled sigmoid augmentation with standard sutured colocystoplasty., Materials and Methods: Between 2003 and 2011, 108 children underwent bladder augmentation at our institution. Colocystoplasty was used in 30 patients (27.8%). Medical charts of children who underwent stapled (n = 8) or sutured (n = 22) sigmoid augmentation were compared with regard to patient demographics and surgical complications, including anastomotic leak and urolithiasis., Results: Eight children with underwent stapled sigmoid colocystoplasty. Average age at surgery was 8 years (range 4-17 years). Time to detubularize and refashion the bowel segment prior to augmentation was consistently under 5 min. Average length of follow-up was 44 months (range 12-80 months). One patient experienced anastomotic leak. Two of eight children (25%) in the stapled anastomosis cohort developed bladder stones. Twenty-two patients underwent standard sigmoid augmentation during the same time period (average age 8.2 years; range 4-16 years). One of 22 (4.5%) experienced anastomotic leak. Seven of 22 (31.8%) developed cystolithiasis., Conclusions: Complications from stapled sigmoid anastomosis are similar to those from standard colocystoplasty. Use of absorbable staples decreases operating time by avoiding bowel spatulation and suturing, and should be considered in pediatric patients undergoing colocystoplasty., (Copyright © 2013 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.)

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.

Vaginal reconstructive options commonly include the use of split-thickness skin grafts or intestinal conduits. When a colonic segment is chosen, the sigmoid colon is favored because of its location, size, and durability. When circumstances preclude the use of sigmoid colon and a colonic conduit is preferred, creative means of mobilization are required. This article describes a case and technique utilizing the descending colon in a tension-free vaginoplasty.

Vaginoplasty using sigmoid colon is a common technique for creation of a neovagina. However, special consideration must be given to potential long term consequences of using a colonic conduit for vaginal replacement. We report on the youngest described case in which a patient developed ulcerative colitis refractory to medical therapy with simultaneous involvement of a sigmoid neovagina requiring total proctocolectomy and neovaginectomy. A 17 year old XY female with a history of gonadal dysgenesis and sigmoid graft vaginoplasty presented with a history of bloody, mucoid vaginal discharge, abdominal pain, bloody diarrhea and weight loss. Colonic and neovaginal biopsies demonstrated active colitis with diffuse ulcerations, consistent with ulcerative colitis. Despite aggressive immunosuppressive treatment she had persistent neovaginal and colonic bleeding requiring multiple transfusions, subtotal colectomy and ultimately completion proctectomy and neovaginectomy. It is imperative to recognize that colectomy alone may be an inadequate surgical intervention in patients with ulcerative colitis and a colonic neovaginal graft and that a concomitant neovaginectomy may be integral in providing appropriate treatment., (Copyright © 2013 Elsevier Inc. All rights reserved.)

Unlabelled: We report a case of a 30-year-old woman with congenital anal cloaca who presented with vaginal bleeding and urinary retention from sigmoid neovagina. She was found to have metastatic mucinous producing adenocarcinoma in the neovagina., Background: Malignancy of neovagina is rare., Summary: We report a case of metastatic colorectal cancer after creation of a neovagina and urethra using sigmoid colon.

Background: Immediate reconstruction after pelvic exenteration is challenging. Several flap techniques, such as the vertical rectus abdominis musculocutaneous flap and the gracilis flap, have been reported. However, flap-specific complications have been documented. Instead of harvesting the myocutaneous flap from the abdomen or legs, our group has proposed a colonic flap for neovaginal reconstruction especially for rectal cancer with vaginal invasion. Nevertheless, the application of a colonic flap for individuals needing only vascularized tissue to fill up the pelvic dead space is problematic. The aim of this study was to demonstrate this novel technique., Methods: There were eight patients: three rectal cancers, one vulvar cancer with synchronous rectal cancer, one malignant nerve sheath tumor, one cervical cancer, one prostate cancer, and one rectal gastrointestinal stromal tumor. The operations included four total pelvic exenterations, three total pelvic exenterations with S3-sacrectomy, and one total pelvic exenteration with S3-sacrectomy and left nephrectomy. A colonic flap from which the mucosa was removed was used for immediate pelvic reconstruction in all patients. The flap detail involved harvesting the segment of sigmoid colon with low ligation of the inferior mesenteric artery, spatulation of the antimesenteric side of the flap, and mucosectomy. The flap was sutured to the pelvic sidewall with the mucosa-removed surface facing toward the pelvic defect., Results: There were no intraoperative complications, and free surgical margins were achieved. Two patients developed a fluid collection, which was successfully treated with percutaneous drainage. Perineal wound complications were not found. None of the patients developed incisional hernias or perineal hernias at the follow-up., Conclusions: Immediate pelvic reconstruction with mucosa-removed colonic flap is technically feasible and straightforward. This technique provides good outcomes.

Purpose: To assess the use of sigmoid colon in vaginal reconstruction of some patients with disorders of sex development., Materials and Methods: The study included 31 patients with disorders of sex development of various causes. All were reared as females. Female gender was decided for all cases after complete medical assessment. All patients underwent sigmoid vaginoplasty. Assessment of surgical and functional outcomes was carried out in a follow-up period of up to 6 years., Results: The preoperative diagnoses included mullerian aplasia (16 cases), androgen insensitivity syndrome (12 cases) and previous failed vaginoplasty (3 cases). Associated surgical procedures were gonadectomy in 5 cases and gonadectomy combined with clitoroplasty and vulvoplasty in 7 cases. No intra-operative or early postoperative complications occurred. A cosmetic neovagina with adequate size was achieved in all cases. Long term follow-up showed introital stenosis in 4 cases (12.9 %). Two of them responded to vaginal dilatation. The third one needed y-v plasty while the fourth one presented by acute abdomen secondary to ruptured vagina and was submitted to urgent laparotomy. Mucosal prolapse occurred in 1 case (3.2 %). Reoperation rate was 9.6 %. Sexual satisfaction was achieved among 9 sexually active cases. The subjective satisfaction score of the surgical outcome was 8.03., Conclusions: For patients with disorders of sex development of various etiologies, sigmoid vaginoplasty is the preferred technique for vaginal replacement. It is a safe technique that provides the patient with a cosmetic neovagina of adequate caliber and a satisfactory functional outcome.

Objective: To retrospectively assess early postoperative complications in augmentation cystoplasty without preoperative mechanical bowel preparation (MBP)., Material and Methods: Between May 1987 and May 2006, 162 cystoplasties were performed in 158 children. The segments used were: sigmoid colon (81.5%), ileum (13%), and ileocecum (5.5%). The mean age was 8.65 years (range 2.1-22.7 years). No preoperative MBP of any kind was used in any of the patients and all of them received antibiotics preoperatively and postoperatively., Results: No intraoperative complications related to the procedure were reported. The mean hospital stay was 9.48 days (range 4-30 days). The mean time to intake of oral fluids was 94.77 h (range 48-288 h). Postoperative complications occurred in 9.87%: urinary fistula was the most common (2.4%); only 3 patients presented wound infection (1.85%); 5 patients required reoperative surgery (hemoperitoneum, patch necrosis and 3 cases of urinary peritonitis); 1 patient presented an intra-abdominal abscess that resolved with antibiotic treatment., Conclusions: Preoperative MBP can be omitted in children that require augmentation cystoplasty without an increased risk of infectious or anastomotic complications. Further prospective, randomized clinical trials should be carried out in order to validate our findings in the pediatric population., (Copyright © 2011 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.)

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.

Aim: To evaluate our experience in sigmoid augmentation to manage renal upper tract dilatation and urinary incontinence., Material and Methods: Retrospective descriptive study of the augmentation cystoplasties with sigmoid patch. We analyze clinical, urodinamic and surgical parameters., Results: We have make 30 cistoplasties with a mean age of 10.24 years (3-15 years) with a mean follow up of 8 years (9 months-15 years). The main diagnosis was neurogenic bladder (63,3%) being the main indication for the augmentation the progressive dilatation of the renal upper tract (43,3%). We associate to the procedure the collocation of an artificial sphinter (30%), Mitrofanoff or ureteral reimplantation. There was no major complication. In the urodinamics, the bladders had low capacity, high pression and low compliance. After surgery, urodinamic parameters improve. During follow up, continence improve with more intermittent clean catheterism (median 4/day). Vesical lithiasis was more common late complication with nor acute abdominal surgical illness nor malignancy; 2 patients finished in renal transplantation. Evolution was positive in 66%, and negative in 18,5%., Conclusions: Sigmoid augmentation cystoplasty is a good technique, that allows urodinamic and continence improvement. The conscience in the importance of intermittent catheterisms reduces the incidence of complications.

Background/purpose: The absence of vagina is rare in the pediatric population. It can occur as a result of congenital malformations such as an aplasia of mullerian ducts (46,XX Mayer-Rokitansky-Küster-Hauser syndrome) or a complete androgen insensitivity syndrome (46,XY testicular feminizing syndrome). Intersex patients, who underwent reassessment of a female sex, need a genital reconstruction toward a feminine phenotype. Patients with congenital adrenogenital syndrome with high urogenital sinus could have a severe hypoplastic vagina. In all these cases, a vaginal replacement is required. We reviewed our experience of vaginal replacement using a sigmoid conduit., Methods: In 34 years, we evaluated 47 patients. The observation period was from 1 to 34 years (mean: 12 years). The preoperative diagnosis was Mayer-Rokitansky-Küster-Hauser syndrome in 17 cases, androgen insensitivity syndrome in 24 cases, adrenogenital syndrome with high urogenital sinus in 5 and 1 patient was affected by penile agenesis. Forty-six patients were treated with vaginal reconstruction by interposition of sigmoid colon. Only in 1 case we performed a vaginal construction with an ileal loop: in this case, the sigmoid colon was extremely dilated by a chronic constipation secondary to a high anorectal malformation corrected at birth., Results: The outcome for 47 patients is excellent: 18 are sexually active and 4 are married. Only 1 patient with adrenogenital syndrome died of endocrine problems. Complications occurred in 17 cases: in 1 patient a necrosis of the replaced vagina occurred, thus requiring vaginal exeresis; now she is waiting for a second operation. Another patient had an abdominal abscess, which was surgically treated. In 12 cases a second procedure was required: 6 had stenotic new-vaginal introitus, 4 had new-vaginal prolapse, and 2 had intestinal obstruction., Conclusions: We believe that the preferable technique for vaginal replacement is the use of intestinal conduit. The sigmoid colon is the best intestinal tract to be used owing to its size, location and preserved blood supply. Our experience leads us to believe that the sigmoid segment is the segment of choice, although we consider ileal loop as a good alternative when the sigmoid colon is not available., (Copyright © 2010 Elsevier Inc. All rights reserved.)

Purpose: We examined sexuality and psychosocial functioning in patients with Mayer-Rokitansky-Kuster-Hauser syndrome who underwent colovaginoplasty., Materials and Methods: Patients who underwent colovaginoplasty for Mayer-Rokitansky-Kuster-Hauser syndrome in Italy and Bangladesh were required to meet certain criteria, including age greater than 18 years, college degree/high socioeconomic status, procedure done by the same surgical team and a minimum 6-year followup. Outcomes were evaluated by a retrospective chart review and an English version of the female sexual function index. Psychosocial functioning was measured by an English version of a 36-item survey, including the Rosenberg Self-Esteem Scale, Beck Depression Index and Cohen Test for Life Management ability with results compared to those in 30 healthy control subjects., Results: Of 40 patients who answered the female sexual function index 37% were married and 12% had adopted children while 40% were sexually active, 100% were attracted to males and 7% were on self-dilation. None required pads and 80% used a home douche. Of the patients 92% reported sexual desire and 87% reported sexual arousal. Sexual confidence and satisfaction were reported by approximately 90% of the patients and partner satisfaction was considered adequate by 93%. Most patients reported satisfactory orgasm. Of the women 89% reported adequate lubrication and none reported dyspareunia. Psychosocial functioning was not statistically different between patients and controls., Conclusions: Based on the scoring system outcome colovaginoplasty seems to be an excellent choice to manage vaginal agenesis and ensure good quality of general and sexual life., (Copyright © 2010 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.)

Contractile activity of the iliac and sigmoid intestines versus detrusor activity, reabsorption and secretory activity of the iliac and sigmoid intestinal mucosa in contact with urine were studied in 30 rats. It was found that isolated segments of the iliac and sigmoid intestines have spontaneous contractile activity (stronger in the iliac intestine) while bladder segment contracted only in response to electric stimulation. A contraction-stimulating effect of acetylcholine and a relaxing effect of noradrenaline in experiments with the iliac intestine were close to their effects on the detrusor. The sigmoid intestine responded weaker to the above mediators. The iliac mucosa actively reabsorbed urinary urea, creatinin, glucose causing elevation of their concentrations in blood as well as K, Na, Ca, CI, P and secreted protein in urine leading to hypoproteinemia. The sigmoid mucosa showed weaker metabolic activity. The results of the study demonstrate importance of consideration of biological properties of different intestinal regions for choice of a cystoplasty method after cystectomy.

Purpose: Seromuscular colocystoplasty lined with urothelium is a method of bladder augmentation that avoids incorporating intestinal mucosa into the urinary tract. Others have reported a repeat augmentation rate of 23%. We analyzed the results in 20 patients who underwent the procedure, as performed by one of us (RG), at 3 institutions., Materials and Methods: After receiving institutional review board approval we retrospectively reviewed the charts of all patients operated on since 1998. Preoperative and postoperative bladder capacity at 30 cm H(2)O, expressed as the percent of expected capacity for age using the equation, bladder capacity in ml = (age +1) x 30, as well as prior, concomitant and subsequent bladder or bladder neck procedures, continence and the need for repeat augmentation were recorded., Results: There were 20 patients, including 7 females, with a mean age at surgery of 9 years and a mean followup of 53 months. All patients had neurogenic bladder dysfunction. An artificial urinary sphincter was implanted at the time of seromuscular colocystoplasty in 10 patients, preoperatively in 6 and postoperatively in 1. A sling was used in 3 females. Patients were divided into 2 groups. The 15 group 1 patients underwent no concomitant procedure in the bladder and the 5 in group 2 underwent creation of a continent channel at seromuscular colocystoplasty. There were no failures of augmentation in group 1, in which bladder capacity increased from 60% of that expected for age to 100%. All patients were continent. Three of the 5 patients in group 2 required repeat augmentation., Conclusions: Seromuscular colocystoplasty lined with urothelium has proved to be an effective method to augment the bladder in patients who have an artificial urinary sphincter or who undergo simultaneous artificial urinary sphincter implantation. We do not recommend constructing a continent catheterizable channel at the time of seromuscular colocystoplasty lined with urothelium.

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.