A new era for treating vaginal aplasia using transretropubic balloon vaginoplasty approach

Transumbilical Vaginoplasty Through Fractionated Miniports: A Sutureless Procedure

BACKGROUND

Vaginal agenesis is a müllerian anomaly characterized by congenital absence of the vagina. In this case series, the authors describe a novel, minimally invasive technique using microport entry for treatment of complete vaginal agenesis.

TECHNIQUE

A balloon catheter is passed through a fenestrated perfluoroalkoxy polymer resin-supporting platform, then tied by a silk suture over the caudal end of the inserter. Two 4-mm microports are created intraumbilically; one to insert the scope and the other to introduce the catheter inserter that is advanced under direct vision. The inserter loaded with a catheter is passed across the pelvic floor to position the balloon at the vaginal dimple. The balloon is inflated and tightly positioned against the dimple. The perfluoroalkoxy polymer resin piece is clamped at the umbilicus. Traction is applied to the catheter stem and increased progressively to achieve desired vaginal depth.

EXPERIENCE

Twenty-two women aged 17-28 years with vaginal agenesis underwent microport vaginoplasty. Twenty-one women were diagnosed with müllerian agenesis and one patient with androgen insensitivity syndrome. Preoperative vaginal depth ranged between 0.5 and 3 cm. The procedure was well tolerated with no intraoperative or postoperative complications. Patients achieved neovaginal depth between 9 and 11 cm and penetrations scores increased to 80-90%.

CONCLUSION

Microport vaginoplasty is a feasible and effective procedure for management of vaginal agenesis.

The Greek Surgeon-Gynecologist Savvas Georgiadis (1857-1942) and the First Vaginal Reconstruction in Smyrna

The Greek surgeon-gynecologist Savvas Georgiadis from Phocaea in Asia Minor had performed in 1897 an innovative surgical operation in a young female patient, reconstructing her vagina. Having been educated both in Greece and France, specialized in gynecology, he became a famous surgeon in the Hellenic Hospital of Smyrna "Agios Charalampos," where the operation was masterfully executed. Although among the pioneers in neovagina techniques, Georgiadis still is searching his place among the important figures in the history of plastic surgery.

A rescue management plan for ruptured balloons during balloon vaginoplasty

OBJECTIVES

To present the first repeat procedure and a simple way for management of balloon rupture during balloon vaginoplasty (BV) procedures.

STUDY DESIGN

Repeat BV (reBV) procedure was done for one case, and a ruptured catheter's end to new catheter's end (ENE) procedure was done for two cases. The anatomic and functional outcomes of reBV and ENE are presented.

RESULTS

Balloon rupture and deflation were encountered in a total of 3/45 cases who had undergone BV procedures. Replacement time was 22 min for reBV, and 9 and 10 min for ENE. General anesthesia was needed in the reBV case. Post-operative course and final outcomes were generally good but objectively less favorable in the ENE than in the reBV case (neovaginal depths were 8.5 and 9.4 cm versus 11 cm, respectively). Penetration and satisfaction scores were increased up 85 points for both couples.

CONCLUSIONS

Balloon ruptures were reported in 3/45 cases undergoing balloon vaginoplasty. End to new catheter end replacement was a very fast and simple rescue procedure but its preliminary anatomical outcomes were less favorable than the outcomes obtained with the original or repeat procedure.