Clinical and histological studies on vaginal reconstruction after radical hysterectomy

: The extensive resection of vagina has a prime importance to obtain the remission in patients with invasive carcinoma of cervix. Maintenance of optimal length, configuration and physiologic function of vagina has been neglected because of malignant nature of lesions. Thus, sexual frigidity coupled with dyspareunia was usually a serious problem faced by postoperative patients. In order to resolve this problem we devised a new attempt to obtain sufficient regeneration of vagina in postoperative patients. The protection procedure for a shortened vagina consists of enlargement of the vaginal vault and promotion of epithelial regeneration. Vaginal length in 145 patients who had received the protection procedure as well as the radical hysterectomy was 7.0 +/- 0.1 cm, being not different from the one in 187 patients with simple hysterectomy. However, significantly shortened length was observed in 21 patients hysterectomized radically who had not the protection. The influence of preserved ovarian functions into the regeneration process of vagina was investigated. The mean length was 7.3 cm in 75 patients with ovarian conservation and 6.3 cm in 7 patients with bilateral oophorectomy. The latter was significantly shorter than the former. However, administration of synthetic estrogens alone was incomplete for the full reconstruction of remnant vagina. Adjuvant radiotherapy was not an obstacle in obtaining the optimal vaginal length. The mean length of irradiated group was 7.4 cm, being not different from the one of the nonirradiated group. Regeneration process of vagina was investigated histologically. New vaginal lumen consisted originally of the remnant vagina and granulation tissues obliterating dead spaces in the pelvic floor. Then, epithelia stained with iodine followed to cover the granulation. Enlargement of such areas directed into the deep part of vault was evident with the passage of time following the operation. As a result, epithelial covering of the whole reconstructed vagina was completed within 2 months after the operation. Those results indicated the clinical availability of the protection procedure in radically hysterectomized patients. Then, ovaries conserved either by orthotopic manner or transposition plays some role for the reconstruction of remnant vagina.