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Autologous Buccal Mucosa Vaginoplasty Outcomes from 16 years of Primary and Secondary Genitourinary Reconstruction
Shane Forest Batie, MD1, Caitlin Coco, MD1, Michelle Arevalo, MD1, Gwen Grimsby, MD2, Anjali Nambiar, MD1, Juan Carlos Prieto, MD1, Catherine Chen, MD3, Ellen Wilson, MD1, Yvonne Chan, MD1, Linda Baker, MD1.
1University of Texas Southwestern, Dallas, TX, USA, 2Phoenix Children's Hospital, Phoenix, AZ, USA, 3Loma Linda University, Loma Linda, CA, USA.

Background Pediatric urologists manage an array of anomalies and complications that require vaginal reconstruction at various ages. Finding expertise in this area can be challenging for patients and families. The end goal is to obtain functional vaginal caliber and length. Existing vaginoplasty methods have been associated with 1) stenosis rates from 30 to 50% necessitating reoperation and 2) transient new postoperative urinary incontinence as high as 30%, with 9% experiencing persistent new incontinence. Autologous buccal mucosa vaginoplasty (ABMV) was first reported in 2003 in Meyer Rokitansky Kuster Hauser Syndrome (MRKHS) patients undergoing neovagina creation. We report our 16-year intraoperative and postoperative outcomes with ABMV in a heterogenous population of reconstruction patients. Methods All patients undergoing ABMV from 2004-2020 by the senior author were retrospectively reviewed for demographics, diagnosis, and outcomes at > 3 months post-op. Vaginoplasty was classified as: 1) primary (no vaginoplasty) versus secondary (prior vaginoplasty), and 2) total (100% buccal neovagina) versus composite (native vagina augmented with buccal mucosa). Fisher's exact test was used for comparisons. Results 76 patients (41 primary, 35 secondary) had 9 different diagnoses leading to ABMV (Table). 8 were lost to follow up. One intraoperative complication occurred (distal urethral injury 1.3%). Vaginal stenosis occurred in 8/37 primary patients, with 7 undergoing reoperation (18.9%), while stenosis occurred in 5/31 secondary reconstructions, with 4 undergoing reoperation (12.9%) (p=0.51). Other re-operative complications were 1) vaginal foreshortening (n=3 secondary 4.4%), and 2) vaginal introitoplasty (n=1 primary 1.5%). Post-operative complications included 1) transient, new urinary incontinence (n=4 5.9%), 2) daytime spotty incontinence without pads (n=1 primary 1.5%) and 3) nocturnal enuresis (n=1 1.5% age 9 years at last follow up). Oral contracture was reported by 3 patients (4.4%). No patients experienced vaginal prolapse. At last follow-up of those over age 15 (59 patients), 17 (28.8 %) were sexually active with penetrative vaginal intercourse without dyspareunia, 10 (16.9%) were not sexually active, and 32 (54.2%) had an unknown status. Two patients are known to have carried a pregnancy to term delivering via cesarean-section. Conclusions At ~3.6 years follow-up, ABMV performed in a heterogenous population had few intraoperative and postoperative complications with excellent patient outcomes, demonstrating no difference in rates of stenosis between primary and secondary vaginoplasty even when considering 46% were secondary vaginoplasty.


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