title: Vaginal reconstruction in female cloacal exstrophy patients.
abstract: OBJECTIVE
  To present our experience of vaginal reconstruction in female cloacal exstrophy patients.
  
  
  METHODS
  The records of 7 postpubertal female cloacal exstrophy patients (median age, 17 years; range, 11-26 years) were retrospectively reviewed. Complete duplication of the uterus and vagina was noted in all patients. All of them underwent various types of vaginoplasty at the time of urinary tract reconstruction. When a pull-through vaginoplasty was difficult, the native vagina was anastomosed to the neovagina using the large or small bowel. Alternatively, the native bladder remaining connected to the vagina was used as a neovagina with simultaneous construction of the gastroileal composite reservoir.
  
  
  RESULTS
  The median age at vaginoplasty was 6 years (range, 5-8 years). The techniques were pull-through vaginoplasty in 1 patient, intestinal vaginoplasty in 2 patients, and vaginoplasty using the native bladder in 4 patients. Five patients required revision surgery for hematometrocolpos after the onset of puberty (median age, 14 years; range, 11-16 years). Three patients underwent an end-to-side reanastomosis of the uterus to the neovagina using the bowel or the native bladder, whereas 2 patients received a side-to-side anastomosis of the uterus to the neovagina using the native bladder. No patient developed recurrence of hematometrocolpos after the revision surgery, with a mean follow-up of 71 months.
  
  
  CONCLUSIONS
  Our recent approach to vaginoplasty can be an alternative for female cloacal exstrophy patients. A side-to-side anastomosis of the uterus to the neovagina is a technically easy procedure in surgical management of hematometrocolpos.
authors.affiliation: Department of Urology, Kobe Children's Hospital, Kobe, Japan. Electronic address: hisamatsu_kch@hp.pref.hyogo.jp.
authors.forename: Eiji
authors.initials: E
authors.lastname: Hisamatsu
authors.affiliation: Department of Urology, Kobe Children's Hospital, Kobe, Japan.
authors.forename: Yoshikiyo
authors.initials: Y
authors.lastname: Nakagawa
authors.affiliation: Department of Urology, Kobe Children's Hospital, Kobe, Japan.
authors.forename: Yoshifumi
authors.initials: Y
authors.lastname: Sugita
mesh_terms: D000293:Adolescent; D000328:Adult; D000714:Anastomosis, Surgical; D002648:Child; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000379:methods; D006801:Humans; D019651:Plastic Surgery Procedures / Q000379:methods; D012189:Retrospective Studies; D016896:Treatment Outcome; D014564:Urogenital Abnormalities / Q000601:surgery*; D014599:Uterus / Q000002:abnormalities* / Q000601:surgery; D014621:Vagina / Q000002:abnormalities* / Q000601:surgery; D055815:Young Adult