Our Summary

This research paper discusses a case of an 11-year-old girl with a rare condition called cloaca, where the rectum, vagina and urethra are connected into a single channel. This is a very rare condition, occurring in approximately 1 out of every 50,000 live births. The girl had a surgery to correct it when she was 11 months old. However, when she started to menstruate, she experienced uterine pain, so the doctors decided to perform another surgery.

In this surgery, the doctors used a graft of buccal mucosa, which is the lining inside the mouth. They harvested the graft from the girl’s lower lip and cheek, making sure to keep as much fat as possible to avoid damaging the muscles. The graft was cut into small pieces to create a mesh, which was then used to create a new vagina. The doctors made an incision and placed the mesh graft in the newly created vaginal cavity. They confirmed that the new vagina was the right size and that there was no bleeding before inserting a soft mold to help it keep its shape. The girl had a urinary catheter for 14 days after the surgery.

After the surgery, the girl was instructed to perform vaginal dilation exercises every three hours during the day. Ten months after the surgery, the doctors report that she is doing well. They note that using a buccal mucosa graft has several advantages over other methods, including its color, texture, lack of hair, and mild mucous production. They conclude that this method is a viable alternative for treating females with cloaca.

FAQs

  1. What is the condition called cloaca and how often does it occur?
  2. How did doctors use buccal mucosa graft to create a new vagina in this case?
  3. What were the aftercare measures taken post-surgery and how is the patient doing now?

Doctor’s Tip

A doctor may advise a patient undergoing vaginoplasty to follow post-operative care instructions carefully, including performing vaginal dilation exercises as recommended. This can help maintain the shape and function of the newly created vagina and promote healing. It is important for patients to follow up with their healthcare provider regularly to monitor progress and address any concerns.

Suitable For

Vaginoplasty is typically recommended for patients who are transgender women looking to align their physical appearance with their gender identity. It may also be recommended for individuals with congenital conditions that affect the development of the vagina, such as Mayer-Rokitansky-Küster-Hauser syndrome (MRKH) or cloaca. Additionally, vaginoplasty may be recommended for individuals who have experienced trauma or injury to the vaginal area.

In the case discussed in the research paper, the patient had a rare congenital condition called cloaca, which required surgical intervention to create a functional vagina. The doctors used a buccal mucosa graft to create a new vagina for the patient, and she underwent post-operative care to ensure the success of the procedure. This case highlights the importance of individualized treatment plans for patients with complex medical conditions that may require vaginoplasty.

Timeline

Before vaginoplasty:

  • Patient is diagnosed with a rare condition called cloaca, where the rectum, vagina, and urethra are connected into a single channel.
  • Patient undergoes surgery to correct the condition at 11 months old.
  • Patient experiences uterine pain when menstruating, prompting the need for another surgery.

After vaginoplasty:

  • Doctors use a buccal mucosa graft harvested from the girl’s lower lip and cheek to create a new vagina.
  • Graft is cut into small pieces and used to create a mesh in the vaginal cavity.
  • Soft mold is inserted to help the new vagina keep its shape.
  • Urinary catheter is used for 14 days post-surgery.
  • Patient is instructed to perform vaginal dilation exercises every three hours during the day.
  • Ten months after the surgery, the patient is reported to be doing well, with the new vagina functioning properly and showing advantages over other methods for treating cloaca.

What to Ask Your Doctor

Some questions a patient should ask their doctor about vaginoplasty include:

  1. What are the potential risks and complications associated with vaginoplasty surgery?
  2. What is the expected recovery time and post-operative care for vaginoplasty?
  3. How long will it take to see the final results of the surgery?
  4. Will I need to undergo any additional procedures or treatments after vaginoplasty?
  5. How will vaginoplasty impact my sexual function and sensation?
  6. What are the limitations or potential challenges I may face after vaginoplasty?
  7. Are there any specific lifestyle changes or precautions I should take following vaginoplasty?
  8. How often will I need to follow up with my doctor after the surgery?
  9. Can you provide me with before and after photos of previous patients who have undergone vaginoplasty?
  10. What are the success rates of vaginoplasty in patients with similar conditions to mine?

Reference

Authors: Macedo A, Ottoni SL, Jordan Balladares R, Correa R, Garrone G, Leal da Cruz M. Journal: J Pediatr Urol. 2023 Aug;19(4):485-486. doi: 10.1016/j.jpurol.2023.03.036. Epub 2023 Mar 31. PMID: 37120365