(123) OUTCOMES OF VAGINOPLASTY IN PATIENTS WITH DISORDERS OF SEX DEVELOPMENT

Abstract Introduction The use of autologous skin grafts through the McIndoe technique for neovagina construction is the most common approach for patients with vaginal malformation, atresia, or agenesis. However, this technique leaves a scar at the donor site with potential for infection and dehiscence. A novel technique developed in Ceará, using Nile tilapia skin, has been performed since 2016 with great results. Objective To describe the main etiologies, epidemiological data, and gynecological examination findings of a group of patients with differences in sex development (DSD) who underwent neovaginoplasty at a tertiary university hospital. Methods This is a retrospective, cross-sectional, and quantitative study through the review of medical records of patients who underwent neovaginoplasty from April 2004 to April 2024. The collected data were organized in a spreadsheet and presented as mean, number, and percentages. Results Records of 62 patients were obtained during this time period, of which 74% were diagnosed with Mayer-Rokitansky-Küster-Hauser syndrome; 17% with 46,XY DSD; 3% with other Müllerian anomalies; 1% with Fraser syndrome; 1% with the classical form of congenital adrenal hyperplasia; and 1% with ovotesticular DSD with 46,XX karyotype. The average age at diagnosis was 17.9 years and the average age at surgery was 20.8 years. Regarding the technique used, 68% underwent neovaginoplasty with Nile tilapia skin, 29% with autologous skin, and 1% with the sigmoid colon, the latter performed at another hospital. During the first consultation, 82% had a vaginal canal length of less than two cm, with an average of 0.6 cm (two patients had attempted vaginal dilation with silicone molds prior to surgery, reaching a maximum of two cm). Out of all cases, 51 had information on vaginal length in postoperative follow-ups. Vaginal length was measured at the first, third, sixth month, and one year postoperatively, with an average of 8.2 cm. Four patients, who were not sexually active and did not use the silicone mold as instructed postoperatively, experienced a regression to less than four cm in vaginal length one year after surgery. Half of the patients reported satisfactory sexual activity with penetration; six complained of a short vagina and dyspareunia, while this information was not found in the records for the remaining patients. Conclusions Neovaginoplasty using Nile tilapia skin has proven to be an important tool for promoting the quality of life and sexual health of patients with DSD associated with vaginal atresia or agenesis. Disclosure No.