Appropriateness for revision?

Hola Dra , seria bueno evaluarle y ahi confirmamos si realmente necesita la revision, pero si usted no se siente conforme podemos coregir esa laxitud, muchas veces se resuelve con un tenzado vaginal laser en consulta de manera ambulatoria. muchas gracias, estamos a la orden .

Thank you for your question.YES, REVISION CAN BE PRODUCED IN PREVIOUSLY UNHAPPY WOMEN. BUT YOU NEED TO BE WELL INFORMED.Vaginoplasty literally means plastic surgery of the vagina. It is not a specific procedure (though originally it meant the creation of a new vagina) and every surgeon has a different idea of what technique(s) comprises a vaginoplasty. There is no consensus on which surgical procedure(s) is performed. Therefore , which procedure(s) your surgeon performed will determine the effectiveness of your results. The vagina is like a six sided tube: entrance, apex, upper inside(bladder), lower inside(rectum) and two sides. Each of these needs to be evaluated and has different treatments. My best analogy for understanding what is going on the inside is the steel belted tire which which has a strong support structure (fascia steel belt) and a flexible stretchable surface which has grooves(mucosatread). When the steel belt tears, the tread balloons out increasing the surface area and smoothes out the grooves. This is what is called prolapsing or "an acquired sensation of smooth/wide vagina." There typically are several defects that can occur from childbirth and these can all be corrected best by a procedure called " site specific defect repair".. You need a surgeon who knows how to identify and correct each of the possible defects within the length of the vagina. Also, there can be defects on the entrance(orifice) and apex. These also must be evaluated and repaired. These procedures can be done safely by well trained surgeons but unfortunately most surgeons have learned "anterior and posterior" repair surgery which does not give optimum results for the "acquired sensation of smooth/wide vagina" which is your issue. Find a surgeon trained in "site specific defect repair" and who will evaluate and treat the six sides. There is no reason why you shouldn't be able to get the results you are looking for. but requires you to do your homework, examine their reviews and before and after photos and evaluate the quality of the consult.

Thank you for sharing your experience. Vaginoplasty procedures are typically performed in accordance with standard anatomical guidelines. However, there is an option for an 'extra tight' procedure for those seeking more pronounced results. Since it has been over a year since your initial surgery, there is no issue with considering a revision.
if you feel looseness, a revision procedure can help further tighten your pelvic floor muscles, providing enhanced support and addressing your concerns about tightness. If you’re also experiencing urinary symptoms such as incontinence, a cystocele repair (bladder lift procedure) may be combined with the revision surgery, if deemed necessary during your pre-operative evaluation.
Best regards,Dr. SEN"

Hello, yes, revision is an option you can consider. I understand from your explanation that the surgery was inadequate. We perform revision procedures on patients who have similar results to yours and they return home happy.

Lack of tightness and urinary issues after a vaginoplasty require a pelvic examination to assess the anatomy and the quality of the repair. If the exam reveals that the repair was properly conducted, a revision is unlikely to provide benefit and might provoke stenosis. If the exam reveals that the repair was not properly conducted and that there is room for additional tightening, then revision is likely to provide a benefit. Beyond proper technique, factors that affect the quality of the healing are neuromuscular deficits, muscle atrophy and damage, hormonal deficiencies, and impaired bloodflow; some of these can be improved, others not. A virtual consultation would make sense as the first step.

ThanksI guess the outcome of surgery was either not fully discussed with possible urinary symptoms especially if anterior vaginal wall surgery was included (ie double-walled vaginoplasty). A revision can the done; however expectations must be realistic and agreed and consent to information regarding possible post-vaginoplasty changes in bowel and urinary symptoms as risk or side-effects

Hello Doctor!

Q: Am I a candidate for consideration for examination and revision of vaginal reconstruction (marketing vaginoplasty) and iatrogenic stress urinary incontinence?

A: Yes, both conditions are curable; however, iatrogenic stress urinary incontinence depends on the prior surgical-related injuries. The surgery failure for a sensation of the wide/smooth vagina requires a very meticulous clinical pelvic evaluation that includes the paravaginal, lateral, anterior-posterior vaginal walls, and posterior perineum. Also, dynamic MRI is beneficial in establishing site-specific defects. The sensation of a wide vagina is a complex surgical treatment in multiple anatomical regions. You will find my research on this topic by consulting the PubMed database and using the password Ostrzenski a. I will give you a few of my scientific-clinical articles that will help you familiarize yourself with your condition:
1. Ostrzenski A. An acquired sensation of wide/smooth vagina: a new classification. Eur J Obstet Gynecol Reprod Biol. 2011 Sep;158(1):97-100. doi: 10.1016/j.ejogrb.2011.04.019. Epub 2011 May 26. PMID: 21620554.
2. Ostrzenski A. Anterior vaginal introitoplasty for an acquired sensation of wide vagina: a case report and new surgical intervention. J Reprod Med. 2014 May-Jun;59(5-6):327-9. PMID: 24937977.
3. Ostrzenski A. Modified posterior perineoplasty in women. J Reprod Med. 2015 Mar-Apr;60(3-4):109-16. PMID: 25898473.
4. Ostrzenski A. Vaginal rugation rejuvenation (restoration): a new surgical technique for an acquired sensation of wide/smooth vagina. Gynecol Obstet Invest. 2012;73(1):48-52. doi: 10.1159/000329338.


Surgical iatrogenic stress urinary incontinence can be caused by:
1. Surgically released the “kinked urethra” due to bulging urinary bladder. This condition requires reconstructive surgery with native tissues.

2. Inadvertently resection of the perineal body. This structure is located under the posterior-distal-middle vaginal wall. If the perineal body has a site-specific defect(s), this condition is surgically treatable. Ostrzenski A. Anatomy of the bulbus vestibuli: A cadaveric study. Ann Anat. 2021 Jan; 233:151588. Doi: 10.1016/j.aanat.2020.151588.
If, during your prior surgery, inadvertently, the perineal body was partially resected, then therapy is possible but difficult. A diagnosis and corrective surgery must be done by a very experienced with a well-documented track record of reconstructive surgery with native tissue.
I do not use the RealSelf company for my practice marketing, so I cannot offer you a telehealth consultation through these sources.
Kind regards,
Prof. Dr. Adam Ostrzenski
USA

Vajinoplasti sonrasında memnuniyet ve cerrahi sonuçlar kişiden kişiye değişebilir. Eğer işlemin etkisinin beklediğinizden daha az olduğunu ve yeni ortaya çıkan idrar semptomlarınız olduğunu düşünüyorsanız, bu durum revizyon için bir değerlendirme yapılmasını gerektirebilir. Revizyon işlemleri genellikle ameliyattan memnun olmayan kadınlarda başarılı sonuçlar verebilir, ancak bu durum öncelikle ayrıntılı bir muayene ve uzman bir cerrah ile görüşme ile belirlenmelidir. Uzman, mevcut sıkışma hissini, yapısal değişiklikleri ve yeni semptomları değerlendirebilir ve size en iyi tedavi seçeneklerini sunabilir.