Wouter B van der Sluis1, Mark-Bram Bouman2, Wilhelmus J H J Meijerink3, Lian Elfering4, Margriet G Mullender2, Nanne K H de Boer5, Adriaan A van Bodegraven6. 1. Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Center, Amsterdam, the Netherlands; Emgo Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands. 2. Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Center, Amsterdam, the Netherlands; Emgo Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands; Center of Expertise on Gender Dysphoria, VU University Medical Center, Amsterdam, the Netherlands. 3. Center of Expertise on Gender Dysphoria, VU University Medical Center, Amsterdam, the Netherlands; Department of Gastro-Intestinal Surgery and Advanced Laparoscopy, VU University Medical Center, Amsterdam, the Netherlands. 4. Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Center, Amsterdam, the Netherlands; Center of Expertise on Gender Dysphoria, VU University Medical Center, Amsterdam, the Netherlands. 5. Department of Gastroenterology and Hepatology, Vrije Universiteit Medical Center, Amsterdam, the Netherlands. 6. Department of Gastroenterology and Hepatology, Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Department of Internal Medicine, Gastroenterology and Geriatrics, Zuyderland Medical Center, Heerlen-Sittard-Geleen, the Netherlands. Electronic address: v.bodegraven@vumc.nl.
Abstract
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.
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.
Authors: Wouter B van der Sluis; Kristin B de Haseth; Lian Elfering; Müjde Özer; Jan Maerten Smit; Andries E Budding; Adriaan A van Bodegraven; Marlon E Buncamper; Nanne K H de Boer; Margriet G Mullender; Mark-Bram Bouman Journal: Int J Transgend Health Date: 2020-02-13