Congenital Anomalies: A Colour Atlas of Wharton’s, McIndoe’s and Nagrath’s Vaginoplasty (Volume 32) Narendra Malhotra, Arun Nagrath, Manju Nagrath
×
Chapter Notes

Save Clear


1Wharton's Vaginoplasty
  • Introduction
  • The Operations
  • Postoperative Care2

IntroductionChapter 1

The basic principal of a simple vaginoplasty was first reported by Wharton and it is this name after whom this initial operation is named. This operation involves the dissection of a space between the bladder and rectum and lining of this space with flaps of skin from the labia or inner thighs also were tried. Marked scarring resulted, and hair usually grew in the vagina. Extensive plastic procedures to construct a vagina are no longer necessary or desirable and have been discarded in favour of safer procedures unless there is the problem of maintaining a vaginal canal after an extensive exenterative operation for pelvic malignancy.
The operation is most popular today for creating a new vagina began with simple surgical attempts to create a space between the bladder and the rectum. These early attempts were often made in patients with cryptomenorrhoea. However, such a space usually would constrict because the surgeon would fail to recognise the importance of prolonged continuous dilatation until the constrictive phase of healing was complete.
 
Wharton's Operation
At the Johns Hopkins Hospital in 1938, Wharton combined an adequate dissection of the vaginal space with continuous dilatation by a balsa form that was covered with a thin rubber sheath and was left in the space. He did not use a split-thickness skin graft. Instead, he based his operation on the principle that the vaginal epithelium has remarkable powers of proliferation and in a relatively short time will cover the raw surface. Recalling that a similar process occurs in the foetus when the epithelium of the sinovaginal bulbs and the urogenital sinus form the vaginal canal, Wharton merely applied this same principle in the adult.
This simple procedure is entirely satisfactory as long as the space is kept dilated long enough to allow the epithelium to grow in. Occasionally, however, even after several years, the vault of the vagina remains without epithelial covering. Coital bleeding and leucorrhoea result from the persistent granulation tissue, and there is a tendency for vaginas constructed by this method to be constricted by scarring in the upper portion.
Surgeons who have thereafter pursued and practiced this operation appear to be satisfied with its results and state that the disadvantages of persistent granulation tissue with bleeding and leucorrhoea were of no consequence.
Before envisaging on the more complicated methods of performing a vaginoplasty the new surgeon needs to master himself in the art of dissecting the space between the bladder anteriorly and the rectum posteriorly.
A case of Wharton's vaginoplasty commonly known as simple vaginoplasty is presented.