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Johnston AW, Soyster ME, Koch MO, Roth JD. Gender-Affirming Robotic Tubularized Peritoneal Vaginoplasty: Feasibility and Outcomes. Urology 2024:S0090-4295(24)00789-1. [PMID: 39271026 DOI: 10.1016/j.urology.2024.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Revised: 07/18/2024] [Accepted: 09/03/2024] [Indexed: 09/15/2024]
Abstract
OBJECTIVES To evaluate the outcomes of robot-assisted tubularized peritoneal vaginoplasty (RATPV) for trans-feminine patients desiring genital gender-affirming surgery (gGAS). METHODS We retrospectively reviewed all patients (adults ≥ 18 years old) who underwent RATPV for gGAS at our institution (July 2020-July 2022). Initial technique involved anastomosing the peritoneal flap to the introitus. The updated technique anastomosed the flap intraperitoneally to inverted penile shaft skin. Patient demographics, intraoperative details, and postoperative outcomes are described. RESULTS In 33 patients, the median age was 26 years old (IQR:24-37) and BMI 26 (IQR:23-32). Median operative time was 406 minutes (IQR: 370-434) and robotic console time 177 minutes (IQR:154-220). Intraoperatively, the median vaginal depth was 17cm and diameter 3+cm. Median length of stay was 7 days. One-third (n=11) of patients had a complication within 30 days postoperatively (40% Clavien Dindo I and 60% Clavien II). No patient had a Clavien III+ complication. At a median follow up of 499 days (range: 137-835), some degree of vaginal stenosis occurred in 48% (11/23) of patients with the original approach versus 10% (1/10) of those with the newer approach (p=0.05). Median vaginal depth was 11.3cm. Three patients (9%) required revision vaginoplasty, all of whom had the original approach and had difficulty dilating postoperatively. All had clitoral sensation. CONCLUSIONS RATPV is a safe and effective option for individuals seeking gender affirming vaginoplasty that obviates the need for laser hair removal prior to surgery. More research is needed into long term outcomes of this technique.
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Affiliation(s)
- Ashley W Johnston
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN
| | - Mary E Soyster
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN
| | - Michael O Koch
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN
| | - Joshua D Roth
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN.
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Lei XH, Wang X, Shao SY, Hua KQ, Zhang Y. Self-esteem, depression, anxiety and sexual function in Mayer-Rokitansky-Küster-Hauser syndrome with neovagina: A case series. Eur J Obstet Gynecol Reprod Biol 2024; 298:85-90. [PMID: 38733778 DOI: 10.1016/j.ejogrb.2024.04.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 04/17/2024] [Accepted: 04/21/2024] [Indexed: 05/13/2024]
Abstract
BACKGROUND The Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome is a rare condition with significant psychological implications. However, our understanding of its impact on postoperative sexual function and mental health is still limited. AIM Evaluate the mental health status and sexual functioning of women with MRKH syndrome after vaginoplasty surgery. METHODS We enrolled 53 cases with MRKH syndrome who underwent artificial vaginoplasty. The participants were asked to participate in a two-round survey conducted between February 2021 during the covid-19 period and March 2023. The survey included questionnaires to measure depression, anxiety, self-esteem, and sexual functioning. Differences between scores over time were analysed using a paired sample t-test, and we assessed the correlation between mental health and sexual functioning. RESULTS In the first round, patients' mean ± SD age at surgery was 23.6 ± 4.5 years old, and the mean ± SD time that had elapsed since surgery at the time of the survey was 34.2 ± 20.8 months. None of the patients reported low self-esteem, 45.3 % reported mild-to-moderate depression, and 34.0 % reported mild anxiety. Thirty patients have had vaginal intercourse during the last six months. The mean ± SD Female Sexual Functioning Index score was 24.6 ± 4.4, and 60.0 % had a score of 23.5 or higher, indicating high sexual functioning. The sexual functioning scores were positively correlated with self-esteem scores and negatively correlated with depression or anxiety scores (p < 0.05). There was no significant improvement in patient's mental health status and sexual function between the second round survey (71.3 ± 17.8 months after surgery) and the first round survey (p > 0.05). In contrast, the sexual arousal of FSFI were significantly higher in the second survey round (p < 0.05). CONCLUSION Most patients undergoing vaginoplasty reported persisting mental health challenges. However, the majority reported good sexual functioning.
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Affiliation(s)
- Xiao-Hong Lei
- Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, 128 Shenyang Road, Shanghai 200082, China.
| | - Xiao Wang
- Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, 128 Shenyang Road, Shanghai 200082, China.
| | - Shu-Yi Shao
- Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, 128 Shenyang Road, Shanghai 200082, China.
| | - Ke-Qin Hua
- Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, 128 Shenyang Road, Shanghai 200082, China.
| | - Ying Zhang
- Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, 128 Shenyang Road, Shanghai 200082, China.
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O'Dwyer C, Kumar S, Wassersug R, Khorrami A, Mukherjee S, Mankowski P, Genoway K, Kavanagh AG. Vaginal self-lubrication following peritoneal, penile inversion, and colonic gender-affirming vaginoplasty: a physiologic, anatomic, and histologic review. Sex Med Rev 2023:7146050. [PMID: 37105933 DOI: 10.1093/sxmrev/qead015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 03/20/2023] [Accepted: 03/23/2023] [Indexed: 04/29/2023]
Abstract
INTRODUCTION Vaginal self-lubrication is central to the sexual satisfaction and healthy genitourinary function of patients who have undergone gender-affirming vaginoplasty (GAV). Secretory capacities of different neovaginal lining tissues have been variably described in the literature, with little evidence-based consensus on their success in providing a functionally self-lubricating neovagina. We review the existing neovaginal lubrication data and the anatomy, histology, and physiology of penile and scrotal skin, colon, and peritoneum to better characterize their capacity to be functionally self-lubricating when used as neovaginal lining. OBJECTIVES The study sought to review and compare the merits of penile and scrotal skin grafts, spatulated urethra, colon, and peritoneal flaps to produce functional lubrication analogous to that of the natal vagina in the setting of GAV. METHODS We conducted a systematic review following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Medline, EMBASE, ClinicalTrials.gov, and the Cochrane Library databases were searched for peer-reviewed studies published prior to December 12, 2022, that (1) included data specific to transfeminine individuals; (2) were full-text randomized controlled studies, case reports, case series, retrospective cohort studies, prospective cohort studies, qualitative studies, and cross-sectional studies; and (3) included specific discussion of vaginal lubrication or fluid secretion following GAV utilizing penile skin, colonic tissue, or peritoneum. RESULTS We identified 580 studies, of which 28 met our inclusion criteria. Data on neovaginal lubrication were limited to qualitative clinician observations, patient-reported outcomes, and satisfaction measures. No studies quantifying neovaginal secretions were identified for any GAV graft or flap technique. Anatomically, penile and scrotal skin have no self-lubricating potential, though penile inversion vaginoplasty may produce some sexually responsive secretory fluid when urethral tissue is incorporated and lubricating genitourinary accessory glands are retained. Colonic and peritoneal tissues both have secretory capacity, but fluid production by these tissues is continuous, nonresponsive to sexual arousal, and likely inappropriate in volume, and so may not meet the needs or expectations of some patients. The impact of surgical tissue translocation on their innate secretory function has not been documented. CONCLUSIONS None of penile/scrotal skin, colon, or peritoneum provides functional neovaginal lubrication comparable to that of the adult natal vagina. Each tissue has limitations, particularly with respect to inappropriate volume and/or chronicity of secretions. The existing evidence does not support recommending one GAV technique over others based on lubrication outcomes. Finally, difficulty distinguishing between physiologic and pathologic neovaginal fluid secretion may confound the assessment of neovaginal self-lubrication, as many pathologies of the neovagina present with symptomatic discharge.
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Affiliation(s)
- Cormac O'Dwyer
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia V6T 1Z3, Canada
- Gender Surgery Program of British Columbia, Vancouver Coastal Health, Vancouver, British Columbia V5Z 1M9, Canada
| | - Sahil Kumar
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia V6T 1Z3, Canada
- Gender Surgery Program of British Columbia, Vancouver Coastal Health, Vancouver, British Columbia V5Z 1M9, Canada
| | - Richard Wassersug
- Gender Surgery Program of British Columbia, Vancouver Coastal Health, Vancouver, British Columbia V5Z 1M9, Canada
| | - Amir Khorrami
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia V6T 1Z3, Canada
- Gender Surgery Program of British Columbia, Vancouver Coastal Health, Vancouver, British Columbia V5Z 1M9, Canada
| | - Smita Mukherjee
- Gender Surgery Program of British Columbia, Vancouver Coastal Health, Vancouver, British Columbia V5Z 1M9, Canada
- Department of Urologic Sciences, University of British Columbia, Vancouver, British Columbia V5Z 1M9, Canada
| | - Peter Mankowski
- Gender Surgery Program of British Columbia, Vancouver Coastal Health, Vancouver, British Columbia V5Z 1M9, Canada
- Division of Plastic and Reconstructive Surgery, University of British Columbia, Vancouver, British Columbia V5Z 1M9, Canada
| | - Krista Genoway
- Gender Surgery Program of British Columbia, Vancouver Coastal Health, Vancouver, British Columbia V5Z 1M9, Canada
- Division of Plastic and Reconstructive Surgery, University of British Columbia, Vancouver, British Columbia V5Z 1M9, Canada
| | - Alexander G Kavanagh
- Gender Surgery Program of British Columbia, Vancouver Coastal Health, Vancouver, British Columbia V5Z 1M9, Canada
- Department of Urologic Sciences, University of British Columbia, Vancouver, British Columbia V5Z 1M9, Canada
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Habek D. Letter to the Editor: Sexuality After Laparoscopic-Assisted Davydov's Neovaginoplasty in Mayer-Rokitansky-Küster-Hauser Syndrome. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2023; 45:112-113. [PMID: 36925222 DOI: 10.1016/j.jogc.2022.08.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 08/19/2022] [Accepted: 08/22/2022] [Indexed: 03/16/2023]
Affiliation(s)
- Dubravko Habek
- University Department of Gynecology and Obstetrics, Clinical Hospital "Sveti Duh" Zagreb, School of Medicine Catholic University of Croatia, Collegium of the Surgical Medical Sciences, Croatian Academy of Medical Sciences, Zagreb, Croatia.
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Smith SM, Yuan N, Stelmar J, PA-C GL, Gupta A, Kim HL, Garcia MM. An Alternative Option for Gender-Affirming Revision Vaginoplasty: The Tubularized Urachus-Peritoneal Hinge Flap. Sex Med 2022; 10:100572. [PMID: 36183656 PMCID: PMC9780766 DOI: 10.1016/j.esxm.2022.100572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 08/19/2022] [Accepted: 08/26/2022] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION Gender-affirming peritoneal vaginoplasty has been described, and previous descriptions are modifications of the Davydov technique. AIM To describe our alternative technique for gender-affirming peritoneal vaginoplasty (PV) using a single-pedicled, urachus-peritoneal hinge flap, discussing proposed advantages. METHODS Retrospective review of all consecutive transfeminine patients with neovaginal shortening after prior penile inversion vaginoplasty (PIV) who underwent our PV technique from May 2019 to July 2022. PV was performed via combined transperineal and laparoscopic (robot-assisted) approaches. After spatulation of the neovaginal remnant, a midline, inferiorly based urachus-peritoneal hinge flap was elevated craniocaudally from the umbilicus to the mid-posterior bladder. The free end of the flap was flipped posteriorly and sutured to posterior edge of the open canal remnant, forming a peritoneal pouch. The lateral edges of the pouch were sutured together for water-tight closure. Patients resumed dilation on POD 6 and douching on POD 10. MAIN OUTCOME MEASURES Ten transfeminine patients underwent PV, with good outcomes. We measured: Pre-op penile and scrotal skin lengths, intra-op tubularized scrotal skin length, pre and post-op vaginal depth and width (immediate and at last follow-up). RESULTS Pre-op: mean neovaginal depth was 9.2cm (SD 1.5); width was 12cm. Immediate post-op: mean depth was 15.1 cm (SD 2.2 cm, mean net increase: 5.9 cm). At mean follow-up of 18.3 months, mean depth was 12.5 cm (SD 2.1 cm, mean net increase: 3.3 cm) and width was 12 cm. There were no immediate post-op complications. Eight (80%) of the 10 patients report satisfactory vaginal receptive intercourse. The other 2 have not yet attempted vaginal receptive intercourse. CLINICAL IMPLICATIONS Advantages of the proposed technique over existing techniques include no tension on peritoneal suture lines and total exclusion of the rectum. STRENGTHS AND LIMITATIONS Strengths include a short learning curve for urologic surgeons with robotic experience. The study is limited by small sample size. CONCLUSIONS Our PV technique is a safe and effective option for salvage peritoneal vaginoplasty after primary PIV. Smith SM, Yuan N, Stelmar J, et al. An Alternative Option for Gender-Affirming Revision Vaginoplasty: The Tubularized Urachus-Peritoneal Hinge Flap. Sex Med 2022;10:100572.
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Affiliation(s)
- Shannon M. Smith
- Cedars-Sinai Transgender Surgery and Health Program, Cedars-Sinai Medical Center, Los Angeles, CA, USA,Division of Urology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Nance Yuan
- Huntington Plastic Surgery Institute, Pasadena, CA, USA
| | - Jenna Stelmar
- Cedars-Sinai Transgender Surgery and Health Program, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Grace Lee PA-C
- Cedars-Sinai Transgender Surgery and Health Program, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Amit Gupta
- Beverly Hills Urology, Beverly Hills, CA, USA
| | - Hyung L. Kim
- Division of Urology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Maurice M. Garcia
- Cedars-Sinai Transgender Surgery and Health Program, Cedars-Sinai Medical Center, Los Angeles, CA, USA,Division of Urology, Cedars-Sinai Medical Center, Los Angeles, CA, USA,Departments of Anatomy and Urology, University of California San Francisco, San Francisco, CA, USA,Corresponding Author: Maurice M. Garcia, MD, MAS, 8635 W. Third St., Suite 1070W, Los Angeles, CA 90048, USA.
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Robotic Peritoneal Flap vs. Perineal Penile Inversion Techniques for Gender-Affirming Vaginoplasty. Curr Urol Rep 2022; 23:211-218. [PMID: 36040679 DOI: 10.1007/s11934-022-01106-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/27/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE OF REVIEW To discuss perineal and robotic approaches to gender-affirming vaginoplasty. RECENT FINDINGS The Davydov peritoneal vaginoplasty has its origins in neovaginal reconstruction for vaginal agenesis. It has been adapted as a robotic-assisted laparoscopic procedure and provides an alternative to perineal canal dissection in gender-affirming vaginoplasty. Both techniques represent variations of penile inversion vaginoplasty with successful outcomes and overall low rates of major complications reported in the literature. However, there are differing advantages and considerations to each approach. A perineal approach has been the gold standard to gender-affirming vaginoplasty for many decades. Robotic peritoneal gender-affirming vaginoplasty (RPGAV) is an emerging alternative, with potential advantages including less reliance on extragenital skin grafts in individuals with minimal genital tissue, especially among patients presenting with pubertal suppression, and safer dissection in revision vaginoplasty for stenosis of the proximal neovaginal canal. Additional risks of RPGAV include those associated with robotic abdominal surgeries.
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Sachan A, Jain P, Sharma P, Goel V. Male-to-Female Gender Affirmation Vaginoplasty via Laparoscopic Pedicled Peritoneal Flap—An Initial Experience. Indian J Plast Surg 2022; 55:211-215. [PMID: 36017411 PMCID: PMC9398517 DOI: 10.1055/s-0042-1749407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Objective
The objective of this study was to describe our early experience with laparoscopic pedicled peritoneal flap in patients undergoing male-to-female gender affirmation vaginoplasty.
Methods
This is a case series of five patients who underwent laparoscopic pedicled peritoneal flap vaginoplasty for gender reaffirmation from October 2020 to July 2021. The clinical and functional outcomes were recorded.
Results
Two patients underwent the surgery as a primary procedure, and three patients underwent surgery as a secondary deepening procedure after failed penile skin inversion. There were no complications after surgery, and the median length of hospital stay was 3 days. No patient developed vaginal stenosis in 6-month follow-up period, and the median vaginal depth was 6 inches with a healthy vaginal surface.
Conclusion
Laparoscopic pedicled peritoneal flap can be considered as a first choice in gender affirmation surgeries for patients with inadequate penoscrotal skin or failed penile skin inversion.
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Affiliation(s)
- Ashish Sachan
- Department of Gastrointestinal Surgery, Fortis Hospital, Shalimar Bagh, New Delhi, India
| | - Pradeep Jain
- Department of Gastrointestinal Surgery, Fortis Hospital, Shalimar Bagh, New Delhi, India
| | - Pankaj Sharma
- Department of Gastrointestinal Surgery, Fortis Hospital, Shalimar Bagh, New Delhi, India
| | - Vivek Goel
- Department of Gastrointestinal Surgery, Fortis Hospital, Shalimar Bagh, New Delhi, India
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Zhao X, Zhang Y, Zhang M, Zhang H, Tian Y, Kang S. Comparison of two laparoscopic vaginoplasties using a single peritoneal flap in patients with Mayer-Rokitansky-Küster-Hauser syndrome. Int Urogynecol J 2021; 33:2543-2549. [PMID: 34213603 DOI: 10.1007/s00192-021-04921-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 05/24/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION AND HYPOTHESIS To compare two laparoscopic vaginoplasties using a single peritoneal flap (SPF), namely the Hebei I technique and the Hebei II technique, for creation of a neovagina in patients with Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome. METHODS A comparative retrospective study was conducted at a university-based tertiary care hospital. From September 2008 to September 2019, 72 patients with MRKH syndrome underwent either the Hebei I technique (n = 49) or the Hebei II technique (n = 23). The perioperative results, complications and anatomical outcomes of two groups were recorded and compared. The functional results of patients who became sexually active were assessed through the Female Sexual Function Index (FSFI) questionnaire. RESULTS Two techniques achieved anatomical and functional success without intraoperative complications. There was no significant difference in perioperative results, anatomical findings and the FSFI scores between the two groups. Patients in the Hebei II group had a relatively shorter operative time than those in the Hebei I group (P = 0.064). What is more, compared with the Hebei I group, the Hebei II group had significantly fewer granulomatous polyps at the top of the neovagina (P = 0.029) and less mucous production of the neovagina (P = 0.025) during the first 3 months after surgery. CONCLUSIONS Both the Hebei I and Hebei II techniques are feasible approaches for creating a neovagina which can bring satisfactory anatomical and sexual outcomes in patients with MRKH syndrome. However, the Hebei II technique may be a good alternative to the Hebei I technique because of its relatively shorter operative time, fewer neovaginal secretions and fewer granulomatous polyps.
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Affiliation(s)
- Xiwa Zhao
- Department of Obstetrics and Gynaecology, Fourth Hospital of Hebei Medical University, 12 Jiankang Road, Shijiazhuang, 050011, People's Republic of China
| | - Yanan Zhang
- Department of Obstetrics and Gynaecology, Fourth Hospital of Hebei Medical University, 12 Jiankang Road, Shijiazhuang, 050011, People's Republic of China
| | - Mengmeng Zhang
- Department of Obstetrics and Gynaecology, Fourth Hospital of Hebei Medical University, 12 Jiankang Road, Shijiazhuang, 050011, People's Republic of China
| | - Haibo Zhang
- Department of Obstetrics and Gynaecology, Fourth Hospital of Hebei Medical University, 12 Jiankang Road, Shijiazhuang, 050011, People's Republic of China
| | - Yunjie Tian
- Department of Obstetrics and Gynaecology, Fourth Hospital of Hebei Medical University, 12 Jiankang Road, Shijiazhuang, 050011, People's Republic of China
| | - Shan Kang
- Department of Obstetrics and Gynaecology, Fourth Hospital of Hebei Medical University, 12 Jiankang Road, Shijiazhuang, 050011, People's Republic of China.
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Dy GW, Blasdel G, Shakir NA, Bluebond-Langner R, Zhao LC. Robotic Peritoneal Flap Revision of Gender Affirming Vaginoplasty: a Novel Technique for Treating Neovaginal Stenosis. Urology 2021; 154:308-314. [PMID: 33823174 DOI: 10.1016/j.urology.2021.03.024] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 03/13/2021] [Accepted: 03/14/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To present the technique and early outcomes of salvage neovaginal reconstruction using robotic dissection and peritoneal flap mobilization. METHODS Twenty-four patients underwent robotic peritoneal flap revision vaginoplasty from 2017 to 2020. A canal is dissected between the bladder and rectum towards the stenosed vaginal cavity, which is incised and widened. Peritoneal flaps from the posterior bladder and pararectal fossa are advanced and sutured to edges of the stenosed cavity. Proximal peritoneal flap edges are approximated to form the neovaginal apex. Patient demographics, comorbidities, surgical indications, and operative details are described. Outcome measures include postoperative neovaginal dimensions and complications. RESULTS Mean age at revision was 39 years (range 27-58). All patients had previously undergone PIV, with revision surgery occurring at a median 35.3 months (range 6-252) after primary vaginoplasty. Surgical indications included short or stenotic vagina or absent canal. Average procedure length was 5 hours. At mean follow up of 410 days (range 179-683), vaginal depth and width were 13.6 cm (range 10.9-14.5) and 3.6 cm (range 2.9-3.8), respectively. There were no immediate or intraoperative complications related to peritoneal flap harvest. No patient had rectal injury. One patient had post-operative canal bleeding requiring return to the operating room for hemostasis. CONCLUSIONS Robotic peritoneal flap vaginoplasty is a safe, novel approach to canal revision after primary PIV with minimal donor site morbidity.
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Affiliation(s)
- Geolani W Dy
- Department of Urology, Oregon Health & Sciences University, Portland, OR
| | - Gaines Blasdel
- Department of Urology, New York University Langone Medical Center, New York, NY
| | - Nabeel A Shakir
- Department of Urology, New York University Langone Medical Center, New York, NY
| | - Rachel Bluebond-Langner
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Medical Center, New York, NY
| | - Lee C Zhao
- Department of Urology, New York University Langone Medical Center, New York, NY.
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Surgical Video Tutorial: Treatment of Congenital Vaginal Agenesis: Laparoscopic Modified Davydov in 8 Steps. J Minim Invasive Gynecol 2021; 28:1564. [PMID: 33556582 DOI: 10.1016/j.jmig.2021.02.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 01/26/2021] [Accepted: 02/04/2021] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To describe the different steps of the Davydov surgical technique for creating a neovagina, emphasizing visualization of the rectovesical cleavage and peritoneal-vaginal anastomosis by laparoscopic and vaginal approaches. DESIGN Production of a step-by-step surgical video tutorial with narrative video footage. SETTING Uterovaginal agenesis is a rare congenital defect, observed in 1 case per 4000 to 5000 newborn female infants [1]. Vaginal agenesis treatment can be performed by different nonsurgical and surgical techniques that are based on neocavity creation. The Davydov intervention uses the pelvic peritoneum as "covering" tissue for a neocavity and avoids the use of allogenic or autologous transplants, traction devices, or specialized surgical equipment. It is a minimally invasive technique that provides long-term functionality and anatomically satisfying results [2]. INTERVENTIONS We treated an 18-year-old patient with Mayer-Rokitansky-Küster-Hauser syndrome who underwent the Davydov procedure after dissatisfaction with the Franck self-expansion method. We created a neovagina using peritoneal flaps that were obtained after rectovesical cleavage by laparoscopic approach and were then fastened to the introitus by vaginal approach. Finally, the vaginal vault was reconstructed laparoscopically, and an intravaginal dilator was left in place. The result after 1 year showed the transition from a narrow vaginal dimple 2 cm in length to a neovagina 10 cm in length, permeable, well epithelialized, and correctly healed without associated stenosis. Sexual intercourse is satisfying for both partners. CONCLUSION The Davydov technique is less invasive than other surgical techniques and allows good outcomes [3,4] without the invasive use of sigmoidal grafts, cutaneous flaps, or prostheses. It should be proposed to patients experiencing failure with the Franck nonsurgical method.
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Mayer-Rokitansky-Küster-Hauser syndrome with rare findings of inferior crossed-fused renal ectopia and Gartner's duct cyst: a video case report. Fertil Steril 2020; 115:525-527. [PMID: 33069370 DOI: 10.1016/j.fertnstert.2020.08.1433] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 08/27/2020] [Accepted: 08/31/2020] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To describe the treatments of a patient using the laparoscopic Davydov's method for Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome and ureteral reimplantation for hydronephrosis and hydroureter. DESIGN Surgical video article. A consent form from the patient was obtained as appropriate; the nature of the study did not necessitate ethics committee approval. There were no conflicts of interest. SETTING University hospital. PATIENT(S) A 28-year-old woman who presented at our gynecology department with the symptoms of primary amenorrhea and difficult intercourse. She had repaired congenital rectovestibular fistula and imperforate anus at the age of 8. At physical examination, she had a phenotypically normal vulva with a vaginal small pouch (0.5 cm). Magnetic resonance imaging of the pelvis revealed normal ovaries, a primordial uterus, absence of vaginal canal, and a 4.0 × 4.2 × 4.0 cm cystic structure posterior to the bladder. Magnetic resonance urography showed right to left renal crossed-ectopia with inferior fusion, and hydronephrosis and hydroureter from the superior kidney with Grade Ⅳ vesicoureteral reflux. Karyotype was 46, XX. INTERVENTION(S) Saline solution 300 mL was injected into the rectovesical space with an infusion of diluted adrenaline (1:200,000). The goal of this injection was to aid in the identification of tissue planes and reduce blood loss. The space between urethra/bladder and rectum progressively was dissected. Blunt dissection was performed initially with digital separation of tissues. Then, an 8-cm-long neovaginal vault of about 3 cm in diameter was created. The mobilized peritoneum was pulled downward with eight Vicryl sutures and connected to the vaginal epithelium. By cystoscope, we found the left orifice but could not find the right orifice of the hydroureter. Then we ligated the hydroureter by 2-0 absorbable suture near the cyst and cut off the hydroureter, and then incised of all the layers at the top of the bladder to make a bladder flap. We placed the 5 Fr double J stent in the hydroureter and the bladder and anastomozed with the ureteral stump (3-0 Vicryl). Then we removed the cyst laparoscopically. We performed a purse-string stitch to create the apex of the neovagina by taking posterior serosa of the bladder, the pelvic peritoneum between the ovary and rectum, primordial uterus, and anterior rectal serosa. MAIN OUTCOME MEASURE(S) Measurement of the final canal length, sexual function (Female Sexual Function Index), and degree of hydronephrosis. RESULT(S) Three days later, we started to change the vaginal mold and the patient was advised to wear it day and night for the first postoperative month. The vaginal mold had to be worn each night until normal sexual intercourse was possible. Findings confirmed the cyst was Gartner's duct cyst. One year after the surgery, the final canal length was 9 cm and Female Sexual Function Index score was 28. The ultrasound showed that the degree of hydronephrosis of upper moiety was mild. CONCLUSION(S) The distal Wolffian ducts in the female are absorbed but may persist as vestigial remnants (Gartner's duct cysts). A few cases of the combined urogenital-Wolffian anomalies are reported; most of them are associated with the anomalies of müllerian duct fusion, such as Herlyn-Werner-Wunderlich syndrome (uterus didelphys, obstructed hemivagina, and mesonephric duct anomalies). The embryogenesis of the combined anomalies is not completely understood. With comprehensive preoperative assessments, laparoscopic surgery could be a safe and effective treatment to these cases.
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Weijenborg PTM, Kluivers KB, Dessens AB, Kate-Booij MJ, Both S. Sexual functioning, sexual esteem, genital self-image and psychological and relational functioning in women with Mayer-Rokitansky-Küster-Hauser syndrome: a case-control study. Hum Reprod 2020; 34:1661-1673. [PMID: 31418785 DOI: 10.1093/humrep/dez130] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 06/19/2019] [Indexed: 01/08/2023] Open
Abstract
STUDY QUESTION Do sexual functioning, sexual esteem, genital self-image and psychological and relational functioning in women with Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome differ from a comparison group of women without the condition? SUMMARY ANSWER In comparison to controls, women with MRKH with a non-surgically or surgically created neovagina did not differ in psychological and relational functioning but reported lower sexual esteem and more negative genital self-image, intercourse-related pain, clinically relevant sexual distress and sexual dysfunction, with sexual esteem levels strongly associated with sexual distress and sexual dysfunction. WHAT IS KNOWN ALREADY Studies on sexual functioning measured with standardized questionnaires in women with MRKH syndrome compared with women without the condition have yielded contradictory results. Factors associated with sexual functioning in this patient population have rarely been investigated. STUDY DESIGN, SIZE, DURATION Between November 2015 and May 2017, 54 women with MRKH syndrome with a neovagina and 79 age-matched healthy women without the condition were enrolled in this case-control study. PARTICIPANTS/MATERIALS, SETTING, METHODS All participants had to be at least 18-years old and had to live in a steady heterosexual relationship. Women with MRKH syndrome were asked to participate by their (former) gynecologists at three university hospitals and by MRKH peer support group. Controls were recruited via advertisement in local newspapers and social media. Standardized questionnaires were administered to assess sexual functioning, sexual esteem, genital self-image and psychological and relational functioning. MAIN RESULTS AND THE ROLE OF CHANCE Women with MRKH syndrome with a surgically or non-surgically created neovagina reported significantly more pain during intercourse (P < 0.05, d = 0.5), but did not differ in overall sexual functioning from control women. More women with MRKH syndrome reported clinically relevant sexuality-related distress (P < 0.05, odds ratio (OR): 2.756, 95% CI 1.219-6.232) and suffered a sexual dysfunction (P < 0.05, OR: 2.654, 95% CI: 1.088-6.471) in comparison with controls. MRKH women scored significantly lower on the sexual esteem scale (SES) (P < 0.01, d = 0.5) and the female genital self-image scale (FGSIS) (P < 0.01, d = 0.6) than controls. No significant differences were found between the two groups regarding psychological distress, anxiety and depression, global self-esteem and relational dissatisfaction. Sexual esteem was significantly associated with the presence of clinically relevant sexual distress (ß = 0.455, P = 0.001) and suffering a sexual dysfunction (ß = 0.554, P = 0.001) and explained, respectively, 40% and 28% of the variance. LIMITATIONS, REASONS FOR CAUTION Given the nature of the study focusing on sexual functioning, a potential selection bias cannot be excluded. It is possible that those women with the most severe sexual and/or psychological disturbances did or did not choose to participate in our study. WIDER IMPLICATIONS OF THE FINDINGS The study results add new data to the very limited knowledge about psychosexual functioning of women with MRKH syndrome and are of importance for more adequate counseling and treatment of these women. STUDY FUNDING/COMPETING INTEREST(S) The research was financially supported by the Dutch Scientific Society of Sexology (Nederlandse wetenschappelijke Vereniging Voor Seksuologie). The funding was unrestricted, and there was no involvement in the conduct of the research. There are no conflicts of interest to declare.
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Affiliation(s)
- P T M Weijenborg
- Outpatient Clinic Psychosomatic Gynaecology and Sexology, Department of Gynaecology, Leiden University Medical Centre, Leiden, The Netherlands
| | - K B Kluivers
- Department of Gynaecology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - A B Dessens
- Department of Child and Adolescent Psychiatry and Psychology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - M J Kate-Booij
- Department of Gynaecology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - S Both
- Outpatient Clinic Psychosomatic Gynaecology and Sexology, Department of Gynaecology, Leiden University Medical Centre, Leiden, The Netherlands
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Pedicled Peritoneal Flap Vaginoplasty in Male-to-Female Gender Affirmation Surgery: A Case Report. Female Pelvic Med Reconstr Surg 2020; 26:e23-e26. [PMID: 32604197 PMCID: PMC7390498 DOI: 10.1097/spv.0000000000000888] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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14
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Sexual satisfaction in patients with Mayer-Rokitansky-Küster-Hauser syndrome after surgical and non-surgical techniques: a systematic review. Int Urogynecol J 2019; 30:353-362. [DOI: 10.1007/s00192-018-3854-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 12/11/2018] [Indexed: 12/25/2022]
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Zhang N, Qin X, Zhang J, Zhang Z, Li Y, Xie Y, Kong D, Du R, Huang X, Xu Y. Bone Marrow Mesenchymal Stem Cells Accelerate the Morphological and Functional Recovery of Neovaginas. Artif Organs 2018; 42:1206-1215. [DOI: 10.1111/aor.13297] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 04/18/2018] [Accepted: 05/24/2018] [Indexed: 12/14/2022]
Affiliation(s)
- Ning Zhang
- Department of Obstetrics and Gynecology; The Second Hospital of Hebei Medical University
| | - Xijing Qin
- Department of Obstetrics and Gynecology; The Second Hospital of Hebei Medical University
| | - Jingkun Zhang
- Department of Obstetrics and Gynecology; The Second Hospital of Hebei Medical University
| | - Zhiqiang Zhang
- Department of Obstetrics and Gynecology; The Second Hospital of Hebei Medical University
| | - Yanan Li
- Department of Obstetrics and Gynecology; The Second Hospital of Hebei Medical University
| | - Yanling Xie
- Department of Obstetrics and Gynecology; The Second Hospital of Hebei Medical University
| | - Desheng Kong
- Department of Obstetrics and Gynecology; The Second Hospital of Hebei Medical University
| | - Runxuan Du
- Department of Obstetrics and Gynecology; The Second Hospital of Hebei Medical University
| | - Xianghua Huang
- Department of Obstetrics and Gynecology; The Second Hospital of Hebei Medical University
| | - Yanfang Xu
- Department of Pharmacology; Hebei Medical University; Shijiazhuang China
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Cheikhelard A, Bidet M, Baptiste A, Viaud M, Fagot C, Khen-Dunlop N, Louis-Sylvestre C, Sarnacki S, Touraine P, Elie C, Aigrain Y, Polak M. Surgery is not superior to dilation for the management of vaginal agenesis in Mayer-Rokitansky-Küster-Hauser syndrome: a multicenter comparative observational study in 131 patients. Am J Obstet Gynecol 2018; 219:281.e1-281.e9. [PMID: 30036500 DOI: 10.1016/j.ajog.2018.07.015] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2018] [Revised: 07/06/2018] [Accepted: 07/16/2018] [Indexed: 01/13/2023]
Abstract
BACKGROUND Vaginal agenesis in Mayer-Rokitansky-Küster-Hauser syndrome can be managed either by various surgeries or dilation. The choice still depends on surgeon's preferences rather than on quality comparative studies and validated protocols. OBJECTIVE We sought to compare dilation and surgical management of vaginal agenesis in Mayer-Rokitansky-Küster-Hauser syndrome, in terms of quality of life, anatomical results, and complications in a large multicenter population. STUDY DESIGN Our multicenter study included 131 patients >18 years, at least 1 year after completing vaginal agenesis management. All had an independent gynecological evaluation including a standardized pelvic exam, and completed the World Health Organization Quality of Life instrument (general quality of life) as well as the Female Sexual Function Index and Female Sexual Distress Scale-Revised (sexual quality of life) scales. Groups were: surgery (N = 84), dilation therapy (N = 26), and intercourse (N = 20). One patient was secondarily excluded because of incomplete surgical data. For statistics, data were compared using analysis of variance, Student, Kruskal-Wallis, Wilcoxon, and Student exact test. RESULTS Mean age was 26.5 ± 5.5 years at inclusion. In all groups, World Health Organization Quality of Life scores were not different between patients and the general population except for lower psychosocial health and social relationship scores (which were not different between groups). Global Female Sexual Function Index scores were significantly lower in the surgery and dilation therapy groups (median 26 range [2.8-34.8] and 24.7 [2.6-34.4], respectively) than the intercourse group (30.2 [7.8-34.8], P = .044), which had a higher score only in the satisfaction dimension (P = .004). However, the scores in the other dimensions of Female Sexual Function Index were not different between groups. The Female Sexual Distress Scale-Revised median scores were, respectively, 17 [0-52], 20 [0-47], and 10 [10-40] in the surgery, dilation therapy, and intercourse groups (P = .38), with sexual distress in 71% of patients. Median vaginal depth was shorter in dilatation therapy group (9.6 cm [5.5-12]) compared to surgery group (11 cm [6-15]) and intercourse group (11 cm [6-12.5]) (P = .039), but remained within normal ranges. One bias in the surgery group was the high number of sigmoid vaginoplasties (57/84, 68%), but no differences were observed between surgeries. Only 4 patients achieved vaginas <6.5 cm. Delay between management and first intercourse was 6 months (not significant). Seventy patients (53%) had dyspareunia (not significant), and 17 patients all from the surgery group had an abnormal pelvic exam. In the surgery group, 34 patients (40.5%) had complications, requiring 20 secondary surgeries in 17 patients, and 35 (42%) needed postoperative dilation. In the dilation therapy group, 13 (50%) needed maintenance dilation. CONCLUSION Surgery is not superior to therapeutic or intercourse dilation, bears complications, and should therefore be only a second-line treatment. Psychological counseling is mandatory at diagnosis and during therapeutic management.
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Affiliation(s)
- Alaa Cheikhelard
- Departments of Pediatric Surgery and Urology, Assistance Publique - Hôpitaux de Paris, Hôpital Necker, Paris, France; National Reference Center for Rare Gynecological Diseases (PGR), Assistance Publique - Hôpitaux de Paris, Hôpital Necker, Paris, France.
| | - Maud Bidet
- Department of Pediatric Endocrinology, Gynecology, and Diabetology, Assistance Publique - Hôpitaux de Paris, Hôpital Necker, Paris, France; National Reference Center for Rare Gynecological Diseases (PGR), Assistance Publique - Hôpitaux de Paris, Hôpital Necker, Paris, France
| | - Amandine Baptiste
- Clinical Research Unit/Clinical Investigation Center, Assistance Publique - Hôpitaux de Paris, Hôpital Necker, Paris, France
| | - Magali Viaud
- Department of Pediatric Endocrinology, Gynecology, and Diabetology, Assistance Publique - Hôpitaux de Paris, Hôpital Necker, Paris, France; National Reference Center for Rare Gynecological Diseases (PGR), Assistance Publique - Hôpitaux de Paris, Hôpital Necker, Paris, France
| | - Christine Fagot
- Department of Pediatric Endocrinology, Gynecology, and Diabetology, Assistance Publique - Hôpitaux de Paris, Hôpital Necker, Paris, France
| | - Naziha Khen-Dunlop
- Departments of Pediatric Surgery and Urology, Assistance Publique - Hôpitaux de Paris, Hôpital Necker, Paris, France; Université Paris Descartes, Paris, France
| | | | - Sabine Sarnacki
- Departments of Pediatric Surgery and Urology, Assistance Publique - Hôpitaux de Paris, Hôpital Necker, Paris, France; Université Paris Descartes, Paris, France
| | - Philippe Touraine
- Department of Endocrinology and Reproductive Medicine, Assistance Publique - Hôpitaux de Paris, Institut Endocrinologie, Médecine Interne et Maladies Métaboliques, Hôpital Pitié-Salpêtrière, Paris, France; Médecine Sorbonne Université, Paris, France
| | - Caroline Elie
- Clinical Research Unit/Clinical Investigation Center, Assistance Publique - Hôpitaux de Paris, Hôpital Necker, Paris, France
| | - Yves Aigrain
- Departments of Pediatric Surgery and Urology, Assistance Publique - Hôpitaux de Paris, Hôpital Necker, Paris, France; National Reference Center for Rare Gynecological Diseases (PGR), Assistance Publique - Hôpitaux de Paris, Hôpital Necker, Paris, France; Université Paris Descartes, Paris, France
| | - Michel Polak
- Department of Pediatric Endocrinology, Gynecology, and Diabetology, Assistance Publique - Hôpitaux de Paris, Hôpital Necker, Paris, France; Université Paris Descartes, Paris, France
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Abstract
Among surgical procedures for constructing a neovagina, positive outcomes are reported in literature for bowel vaginoplasty for male-to-female transgenders and patients with vaginal aplasia. This systematic review shows outcomes of bowel vaginoplasty procedures, and rates the quality of evidence of the included studies. A search of the literature was performed in PubMed, Medline, Cochrane Library and SveMed+, in accordance with the PRISMA statement, between January 2016 and February 2018. The PICOS (patients, intervention, comparator, outcomes and study design) approach was used as inclusion criteria. Among 251 analyzed studies only 34 met inclusion criteria. Quality of evidence and methodology were rated according to GRADE and MINORS, respectively. Data from the included studies were extracted based on study characteristics, participants? specifics, type of intervention/treatment and type of outcome measures into data extraction forms. All studies were non-randomized with a high risk of bias and very low quality of evidence according to GRADE. Vaginal reconstruction with isolated bowel segments provides a self-lubricating neovagina with low rates of failure and revision, and without routine dilatation need. Furthermore, the use of laparoscopic techniques offers a better postoperative cosmetic appearance of the abdomen and a shorter hospital stay. Vaginoplasty using bowel segment is a safe and effective procedure that obtains excellent long-term results as reported by the included studies. Despite that further researches are needed improving methodology with larger populations, retrospective qualitative studies and report of outcome measurements using standardized evaluation tools as the Female Sexual Function Index.
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Affiliation(s)
- Konstantinos Georgas
- a Department of Plastic Surgery , Sahlgrenska Universitetssjukhuset , Göteborg , Sweden
| | - Valerio Belgrano
- b Department of Surgery, Institute of Clinical Sciences , Sahlgrenska Academy at the University of Gothenburg, Sahlgrenska University Hospital , Gothenburg , Sweden
| | - My Andreasson
- c Department of Plastic Surgery , Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg , Göteborg , Sweden
| | - Anna Elander
- d Department of Plastic Surgery , Institute of Clinical Sciences , Göteborg , Sweden
| | - Gennaro Selvaggi
- e Department of Plastic Surgery , Sahlgrenska Akademin , Gothenburg , Sweden
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Kriplani A, Karthik SDS, Kriplani I, Kachhawa G. Laparoscopic Peritoneal Vaginoplasty for Mayer–Rokitansky–Küster–Hauser Syndrome: An Experience at a Tertiary Care Center. J Gynecol Surg 2018. [DOI: 10.1089/gyn.2017.0076] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Alka Kriplani
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | | | - Isha Kriplani
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Garima Kachhawa
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
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Vatsa R, Bharti J, Roy KK, Kumar S, Sharma JB, Singh N, Singhal S, Meena J. Evaluation of amnion in creation of neovagina in women with Mayer-Rokitansky-Kuster-Hauser syndrome. Fertil Steril 2017. [PMID: 28624115 DOI: 10.1016/j.fertnstert.2017.05.026] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To assess the outcome of amnion vaginoplasty in cases of vaginal agenesis due to Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome managed at the authors' institution. DESIGN Retrospective study. SETTING Tertiary care hospital. PATIENT(S) Fifty women with MRKH who underwent neovaginoplasty. INTERVENTION(S) Modified McIndoe's vaginoplasty was done in all the patients, using human amnion graft. MAIN OUTCOME MEASURE(S) Functional status assessed by Female Sexual Function Index, anatomic status (length and width of neovagina), and epithelialization of vagina. RESULT(S) Mean (±SD) vaginal length after surgery was 8.2 ± 1 cm. Mean vaginal length at 6-month follow-up in sexually active patients was significantly longer as compared with the patients who were not sexually active after surgery (8.4 ± 1.04 cm vs. 6.6 ± 2.4 cm). Mean Female Sexual Function Index score was 30.8 ± 2.1. Vaginal biopsy showed complete epithelialization of vaginal mucosa. CONCLUSION(S) In a developing nation like India, McIndoe's method with amnion graft seems to be a promising option owing to its low cost, easy availability, and safety, ease of the procedure not requiring any special instrument, physiologic outcome with respect to epithelialization of the vagina without hair growth, and satisfying functional outcome.
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Affiliation(s)
- Richa Vatsa
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Juhi Bharti
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India.
| | - Kallol Kumar Roy
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Sunesh Kumar
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Jai Bhagwan Sharma
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Neeta Singh
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Seema Singhal
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Jyoti Meena
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
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Skinner B, Quint EH. Nonobstructive Reproductive Tract Anomalies: A Review of Surgical Management. J Minim Invasive Gynecol 2017; 24:909-914. [PMID: 28499629 DOI: 10.1016/j.jmig.2017.05.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Revised: 04/29/2017] [Accepted: 05/01/2017] [Indexed: 11/29/2022]
Abstract
Müllerian anomalies include a spectrum of anatomic variants of the genital tract arising from abnormal embryologic development, ranging from incomplete resorption of uterine septa to complete vaginal agenesis. Nonobstructive anomalies are often recognized later than obstructive anomalies, because women do not present with pain. However, nonobstructive anomalies frequently have a negative impact on sexual and reproductive health, and careful evaluation and management of these disorders is warranted. This review focuses on the surgical management of nonobstructive Müllerian anomalies.
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Affiliation(s)
- Bethany Skinner
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan.
| | - Elisabeth H Quint
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan
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