title: Re-innervation pattern of the 'neovagina' created from the bladder flap in patients with Mayer-Rokitanski-Kistner-Hauser syndrome: an immunochemical study.
abstract: BACKGROUND
  Cystovaginoplasty (CVP) is a method of vaginal reconstruction in women with Mayer-Rokitansky-Kistner-Hauser Syndrome (MRKHS). The neo-vagina allows normal sexual intercourses, but after CVP, the sexual life of patients with MRKHS does not differ significantly from normal females. Therefore, we decided to elucidate the pattern of sensory re-innervation of the bladder flap used for the surgery.
  
  
  METHODS
  Biopsies were taken from vaginal vestibule and urinary bladder during the CVP and 1 year later in four patients with MRKHS. The following neurotransmitters were studied calcitonin gene-related peptide (CGRP), galanin (GAL), vasoactive intestinal polypeptide (VIP) and pituitary adenylate cyclase-activating peptide (PACAP).
  
  
  RESULTS
  CGRP and PACAP nerve fibres were sparse under the urothelium and in submucosal layer of the neovagina, they were more numerous around blood vessels and in the vicinity of smooth muscles. This was similar to the pattern observed in the urinary bladder. VIP- and GAL-positive nerve fibres were most numerous in the submucosa around blood vessels and in smooth muscle bundles of neovagina. They were distinctly less numerous beneath the epithelium. This innervation pattern mimicked that seen in normal vagina and in vaginal vestibule of patients with MRKHS.
  
  
  CONCLUSIONS
  Our findings demonstrate considerable nervous system plasticity in the bladder flap. Distribution of presumably sensory CGRP and PACAP immunoreactive nerve fibers was similar to the pattern observed within the intact bladder wall, and VIP or GAL immunoreactive nerve fibers (vasomotor functions) were distributed in a manner similar to that observed in the intact vaginal wall.
authors.affiliation: Department of Urology, Medical University of Warsaw, Warsaw, Poland. pradziszewski@neostrada.p
authors.forename: Piotr
authors.initials: P
authors.lastname: Radziszewski
authors.forename: Mariusz
authors.initials: M
authors.lastname: Majewski
authors.forename: Włodzimierz
authors.initials: W
authors.lastname: Baranowski
authors.forename: Maciej
authors.initials: M
authors.lastname: Czaplicki
authors.forename: Agnieszka
authors.initials: A
authors.lastname: Bossowska
authors.forename: Piotr
authors.initials: P
authors.lastname: Dobroński
authors.forename: Andrzej
authors.initials: A
authors.lastname: Borkowski
mesh_terms: D001706:Biopsy; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D009412:Nerve Fibers / Q000378:metabolism; D009479:Neuropeptides / Q000378:metabolism; D019738:Surgically-Created Structures / Q000294:innervation*; D013577:Syndrome; D001743:Urinary Bladder / Q000294:innervation / Q000601:surgery*; D014621:Vagina / Q000002:abnormalities / Q000294:innervation* / Q000601:surgery*; D055815:Young Adult
chemical_list: D009479:Neuropeptides