title: A posterior sagittal approach for revision vaginoplasty.
abstract: OBJECTIVE
  To review our experience with revision vaginoplasty without using bowel, by the posterior sagittal approach.
  
  
  METHODS
  The notes of eight patients (median age 12.3 years, range 9.0-15.6) were retrospectively reviewed; all had had revision vaginoplasty using a posterior sagittal approach. Their original diagnosis was cloacal anomaly in three, urogenital sinus in two, cloacal exstrophy in two, and congenital adrenal hyperplasia in one patient.
  
  
  RESULTS
  Indications for re-operation included: haematocolpos in four patients, absent vaginal opening in two, hydrocolpos in one, and vesico-vaginal fistula in one. The vagina was reconstructed by total urogenital mobilization in seven patients and in one by anastomosing anterior and posterior aspects of a duplicated vagina. The vagina was mobilized by up to 6 cm in this manner. Bowel was not required for any of the vaginoplasties. The median (range) inpatient stay was 6 (4-17) days after surgery and the median follow-up was 35.3 (4.5-50) months. One patient developed a vesico-vaginal fistula and vaginal stenosis, and had further surgery. Two patients required subsequent use of vaginal dilators. The remainder have had a satisfactory outcome.
  
  
  CONCLUSIONS
  For revisional vaginal surgery the posterior approach provides excellent exposure, and can be useful in dealing with a variety of pathologies. Combined with total urogenital mobilization, vaginoplasty can be successful despite long common channels. However, there were still several complications.
authors.affiliation: Department of Urology, Great Ormond Street Hospital, London WC1N 3JH, UK. a.taghizadeh@ukonline.co.uk
authors.forename: Arash K
authors.initials: AK
authors.lastname: Taghizadeh
authors.forename: Duncan T
authors.initials: DT
authors.lastname: Wilcox
mesh_terms: D000293:Adolescent; D000312:Adrenal Hyperplasia, Congenital / Q000601:surgery*; D002648:Child; D002988:Cloaca / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006399:Hematocolpos; D006801:Humans; D010502:Perineum / Q000601:surgery; D012086:Reoperation; D012189:Retrospective Studies; D016896:Treatment Outcome; D014621:Vagina / Q000002:abnormalities* / Q000601:surgery*; D014719:Vesicovaginal Fistula / Q000601:surgery*