Vaginal Reconstruction During Posterior Sagittal Anorectovagino-Urethroplasty / PSARVUP
Vaginal Reconstruction
Vaginal Rotation
Reconstruction of
Perineal Body
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Colorectal surgeons at Cincinnati Children's Hospital Medical Center provide information about vaginal reconstruction in Posterior Sagittal Anorectovagino-Urethroplasty / PSARVUP.
Once the urethra has been reconstructed, the vagina is brought down and sutured to the perineal skin with interrupted long-term absorbable 5-0 sutures.
The electrical stimulator will allow identification of the anterior and posterior limits of the external sphincter which represent the limits of the new anus; we mark those limits with temporary 5-0 silk stitches.
The limits can be easily identified in patients with good muscles because they are represented by the crossing of the vertical fibers (muscle complex) with the parasagittal fibers.
The vertical fibers are always medial to the parasagittal ones. Once we have identified these limits, we then reconstruct the perineal body, bringing together both anterior edges of the muscle complex with long-term absorbable fine sutures.
In cases where the anterior vaginal wall has been seriously damaged during the dissection, the surgeon must resist the temptation to leave a damaged anterior vaginal wall in contact with the urethral suture line, because that may be a predisposing factor to the formation of a urethrovaginal fistula.
The specific recommendation under those circumstances is to create a 90 degree rotation in the vagina, thus leaving a lateral intact full-thickness, well-vascularized, vaginal wall posterior to the urethral suture line.
This maneuver is shown in the second image to the right. We then have to reapproximate the anterior edge of the muscle complex as seen in the third image to the right below.
For more information or to request an appointment, please contact the Colorectal Center at Cincinnati Children's.
