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Coutinho SS, Braga LDM, Costa MES, Veloso MO, Alves APNN, Júnior EML, Bruno ZV, Filho MOM, Paier CRKP, Rodrigues FARR, Bezerra LRPS. NEOVAGINOPLASTY WITH NILE TILAPIA SKIN GRAFT IN A PATIENT WITH GONADAL DYSGENESIS: A CASE REPORT. J Pediatr Adolesc Gynecol 2024:S1083-3188(24)00257-2. [PMID: 39098545 DOI: 10.1016/j.jpag.2024.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Revised: 07/07/2024] [Accepted: 07/26/2024] [Indexed: 08/06/2024]
Abstract
BACKGROUND Gonadal dysgenesis, a genetic condition characterized by incomplete of defective formation of the gonads, can present with vaginal agenesis in individuals with 46,XY karyotype. CASE We report an innovative intervention in the management of vaginal agenesis in a 19-year-old female with gonadal dysgenesis. Despite initial attempts with vaginal dilators, the patient presented unresponsive, leading to the adoption of a neovaginoplasty using Nile Tilapia Fish Skin (NTFS) as graft. The procedure, based on the McIndoe technique, involved the creation of a 10cm x 3cm vaginal canal with an NTFS-wrapped acrylic mold without complications. DISCUSSION The use of NTFS as a graft for neovaginoplasty in gonadal dysgenesis, a novel approach not previously reported in medical literature for this diagnosis, demonstrated favorable outcomes in terms of functionality and patient well-being.
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Affiliation(s)
| | - L D M Braga
- Federal University of Ceará. Fortaleza, Brazil
| | - M E S Costa
- Federal University of Ceará. Fortaleza, Brazil
| | - M O Veloso
- Federal University of Ceará. Fortaleza, Brazil
| | | | | | - Z V Bruno
- Maternidade Escola Assis-Chateaubriand. Fortaleza, Brazil
| | - M O M Filho
- Federal University of Ceará. Fortaleza, Brazil
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Meyer H, Trosclair L, Clayton SD, O’Quin C, Crochet C, Colvin JC, Welch V, Alhaque A, Solitro G, Shah-Bruce M, Alexander JS, Sorrells DL. Histologic Analysis of 'Distraction Vaginogenesis' in a Rat Model. PATHOPHYSIOLOGY 2024; 31:298-308. [PMID: 38921727 PMCID: PMC11206798 DOI: 10.3390/pathophysiology31020022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Revised: 05/30/2024] [Accepted: 06/06/2024] [Indexed: 06/27/2024] Open
Abstract
Vaginal agenesis (VA) is frequently associated with mullerian agenesis. VA treatments include mechanical dilation and surgical vaginoplasty. We created a vaginal expansion sleeve (VES) as a novel device to progressively lengthen the vaginal canal. This study evaluated the histologic effects of the VES on rat vaginal tissue. The VES is a spring-like device made of proprietary woven cylindrical material and flat resin caps. The VESs were constructed as 25-30 mm, pre-contracted springs, which were secured into the vaginas of six Sprague Dawley rats and allowed to re-expand post-surgically. After one week, the VESs were removed, and the vaginas were harvested and measured in length. Test (n = 6) and control (n = 4) formalin-fixed paraffin-embedded tissues were stained with hematoxylin and eosin (H&E), Masson's trichrome, and anti-Desmin antibodies. The VESs achieved significant vaginal lengthening. The mean vaginal canal length increased from 20.0 ± 2.4 mm to 23.8 ± 1.2 mm after removal of the VESs (n = 6, p < 0.001), a 19% increase. There was a positive correlation between the expander/tension generated in the vagina and the amount of acute and chronic inflammation. H&E staining revealed increased submucosal eosinophilia in five of the six test tissues. One VES sample that was lengthened to 30 mm long showed evidence of lymphocytic and neutrophilic inflammation. Desmin immunostaining and Masson's trichrome stain revealed a thinner muscularis with more infiltrative fibrous tissue between muscle fibers in the test tissue compared to the control tissue. Although effective, the VES may provoke at least a transient increase in eosinophils consistent with a localized immune reaction during muscularis remodeling.
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Affiliation(s)
- Hannah Meyer
- Department of Surgery, LSU Health Shreveport, Shreveport, LA 71103, USA
| | - Lexus Trosclair
- Department of Surgery, LSU Health Shreveport, Shreveport, LA 71103, USA
| | - Sean D. Clayton
- Department of Surgery, LSU Health Shreveport, Shreveport, LA 71103, USA
| | - Collyn O’Quin
- Department of Surgery, LSU Health Shreveport, Shreveport, LA 71103, USA
| | - Carol Crochet
- Department of Surgery, LSU Health Shreveport, Shreveport, LA 71103, USA
| | - Joshua C. Colvin
- Department of Surgery, LSU Health Shreveport, Shreveport, LA 71103, USA
| | - Valerie Welch
- Department of Pathology, LSU Health Shreveport, Shreveport, LA 71103, USA
| | - Ahmed Alhaque
- Department of Molecular and Cellular Physiology, LSU Health Shreveport, Shreveport, LA 71103, USA (J.S.A.)
| | - Giovanni Solitro
- Department of Orthopedic Surgery, LSU Health Shreveport, Shreveport, LA 71103, USA
| | - Mila Shah-Bruce
- Department of Obstetrics and Gynecology, LSU Health Shreveport, Shreveport, LA 71103, USA
| | - J. Steven Alexander
- Department of Molecular and Cellular Physiology, LSU Health Shreveport, Shreveport, LA 71103, USA (J.S.A.)
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Mao M, Zhang Y, Fu H, Wang Q, Bai J, Guo R. Long-term Results of Sexual Function and Body Image After Vaginoplasty With Acellular Dermal Matrix in Women With Mayer-Rokitansky-Küster-Hauser Syndrome. J Minim Invasive Gynecol 2024; 31:37-42. [PMID: 37820829 DOI: 10.1016/j.jmig.2023.10.003] [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: 06/05/2023] [Revised: 10/03/2023] [Accepted: 10/04/2023] [Indexed: 10/13/2023]
Abstract
STUDY OBJECTIVE To describe the long-term anatomic and sexual functional results of vaginoplasty with acellular dermal matrix (ADM) in patients with Mayer-Rokitansky-Küster-Hauser (MRKH) and to evaluate the changes in body image pre- and postoperatively in these patients. DESIGN A retrospective study from March 2015 to September 2021. SETTING A tertiary teaching hospital. PATIENTS Forty-two patients with MRKH syndrome who underwent vaginoplasty with ADM (the MRKH group) and 30 sexually active, nulliparous, aged-matched women (the control group). INTERVENTION The relevant data were retrospectively collected via our electronic medical record system and were analyzed statistically. MEASUREMENTS AND MAIN RESULTS Vaginal length was assessed using a 3-cm-diameter mold. The Chinese version of the Female Sexual Function Index questionnaire was used to evaluate sexual function. The Chinese version of the modified body image scale was applied to evaluate body image. The median follow-up time was 57 months (range, 13-91 months). Granulomatous polyps in the neovagina were the most common postoperative complication (7 of 42, 16.7%). Patients with MRKH syndrome can achieve long-term satisfactory outcomes both anatomically and functionally after vaginoplasty with ADM, comparable with those of healthy control women. The vaginal length in the MRKH group was comparable to that in the control group ( 8.04 ± 0.51 cm vs. 8.15 ± 0.46 cm, respectively). The FSFI scores were similar between the MRKH (26.54 ± 3.44) and control (26.80 ± 2.23) groups. The modified body image scale score was significantly decreased after vaginoplasty with ADM. CONCLUSION Vaginoplasty with ADM is a minimally invasive and effective procedure for patients with MRKH syndrome.
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Affiliation(s)
- Meng Mao
- Department of Obstetrics and Gynaecology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Ye Zhang
- Department of Obstetrics and Gynaecology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Hanlin Fu
- Department of Obstetrics and Gynaecology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Qian Wang
- Department of Obstetrics and Gynaecology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jing Bai
- Department of Obstetrics and Gynaecology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Ruixia Guo
- Department of Obstetrics and Gynaecology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
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Xiao Y, Zhang J, Tian Y, Zhang M, Du Y, Meng L, Liu Y, Zhang Z, Qiu L, Chen Y, Dong Q, Chen L, Gao J, Zheng J, Li Z, Li Q, Dai J, Huang X. Vaginal reconstruction with a double-sided biomembrane-a preclinical experimental study on large animals. Biomater Sci 2023; 11:7077-7089. [PMID: 37655798 DOI: 10.1039/d3bm00155e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
Tissue engineering techniques bring the promise of vaginal reconstruction with low invasiveness and fewer complications. However, existing biomaterial scaffolds remain limited in efficient vaginal recovery, focusing only on regenerating an epithelial layer, but muscle layers are missing or abnormal. The lack of a multi-tissue hierarchical structure in the reconstructed vagina leads to shrinking, stenosis, and fibrosis. Here, an acellular matrix named a double-sided biomembrane (DBM) is demonstrated for vaginal recovery. The regeneration of epithelial and muscle layers is achieved simultaneously since the smooth side of the DBM is helpful for guiding epithelial cell growth, while its loose and porous side guides muscle cell growth. In addition, the DBM demonstrates excellent mechanical properties similar to vaginal tissue, and hydrophilicity. Therefore, neovaginas were observed in the fourth and twelfth weeks after DBMs were transplanted to repair full-thickness vaginal defects (4 cm) that we established in large animals. The DBMs can effectively promote rapid epithelialization, the formation of large muscle bundles, higher rates of angiogenesis, and the restoration of physiological function in a neovagina. That is, the injured vagina achieves nearly complete recovery in anatomy and function, similar to a normal vagina. These preclinical results indicate that the DBM has prospects for vaginal injury repair.
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Affiliation(s)
- Yanlai Xiao
- Department of Obstetrics and Gynecology, The Second Hospital of Hebei Medical, University, 215 Heping West Road, Shijiazhuang, Hebei, China.
- Department of Obstetrics and Gynecology, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Jingkun Zhang
- Department of Obstetrics and Gynecology, The Second Hospital of Hebei Medical, University, 215 Heping West Road, Shijiazhuang, Hebei, China.
| | - Yanpeng Tian
- Department of Obstetrics and Gynecology, The Second Hospital of Hebei Medical, University, 215 Heping West Road, Shijiazhuang, Hebei, China.
| | - Mingle Zhang
- Department of Obstetrics and Gynecology, The Second Hospital of Hebei Medical, University, 215 Heping West Road, Shijiazhuang, Hebei, China.
| | - Yanfang Du
- Department of Obstetrics and Gynecology, The Second Hospital of Hebei Medical, University, 215 Heping West Road, Shijiazhuang, Hebei, China.
| | - Li Meng
- Department of Obstetrics and Gynecology, The Second Hospital of Hebei Medical, University, 215 Heping West Road, Shijiazhuang, Hebei, China.
| | - Yibin Liu
- Department of Obstetrics and Gynecology, The Second Hospital of Hebei Medical, University, 215 Heping West Road, Shijiazhuang, Hebei, China.
| | - Zhiqiang Zhang
- Department of Obstetrics and Gynecology, The Second Hospital of Hebei Medical, University, 215 Heping West Road, Shijiazhuang, Hebei, China.
| | - Linzi Qiu
- Key Laboratory for Nano-Bio Interface Research, Division of Nanobiomedicine, Suzhou Institute of Nano-Tech and Nano-Bionics, Chinese Academy of Sciences, Suzhou, China
| | - Yanyan Chen
- Key Laboratory for Nano-Bio Interface Research, Division of Nanobiomedicine, Suzhou Institute of Nano-Tech and Nano-Bionics, Chinese Academy of Sciences, Suzhou, China
| | - Qun Dong
- The DB Wuderegen Biomedical Technologies Co., Ltd, Zhenjiang, China
| | - Liang Chen
- Department of Anesthesiology, The Forth Hospital of Shijiazhuang, Shijiazhuang, Hebei, China
| | - Jingui Gao
- Department of Anesthesiology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Jiahua Zheng
- Department of Obstetrics and Gynecology, The Second Hospital of Hebei Medical, University, 215 Heping West Road, Shijiazhuang, Hebei, China.
| | - Zhongkang Li
- Department of Obstetrics and Gynecology, The Second Hospital of Hebei Medical, University, 215 Heping West Road, Shijiazhuang, Hebei, China.
| | - Qian Li
- Department of Obstetrics and Gynecology, The Second Hospital of Hebei Medical, University, 215 Heping West Road, Shijiazhuang, Hebei, China.
| | - Jianwu Dai
- Key Laboratory for Nano-Bio Interface Research, Division of Nanobiomedicine, Suzhou Institute of Nano-Tech and Nano-Bionics, Chinese Academy of Sciences, Suzhou, China
- State Key Laboratory of Molecular Development Biology, Institute of Genetics and Developmental Biology, Chinese Academy of Sciences, Beijing, 100101, China.
| | - Xianghua Huang
- Department of Obstetrics and Gynecology, The Second Hospital of Hebei Medical, University, 215 Heping West Road, Shijiazhuang, Hebei, China.
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Miles K, Miles S. Nonsurgical neovagina creation in congenital vaginal agenesis: a case report of movement-based dilator therapy. F S Rep 2023; 4:321-325. [PMID: 37719101 PMCID: PMC10504535 DOI: 10.1016/j.xfre.2023.05.007] [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: 01/17/2023] [Revised: 05/24/2023] [Accepted: 05/25/2023] [Indexed: 09/19/2023] Open
Abstract
Objective To report the use of progressive, high-frequency movement-based dilator therapy (MBDT) to create a neovagina in a patient with congenital vaginal agenesis. Design Case report. Setting Tertiary care military hospital. Patients A 22-year-old woman with congenital vaginal agenesis. Interventions Self-directed MBDT. Main Outcome Measures Vaginal elongation by self-directed MBDT. Results The patient achieved a 6.5-cm vaginal length after 6 pelvic health physical therapy sessions over a span of 4 months of progressive, high-frequency MBDT. Conclusions Progressive, high-frequency MBDT should be considered as part of a first-line dilator therapy regimen for patients with congenital vaginal agenesis interested in creating a neovagina.
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Affiliation(s)
- Katherine Miles
- Department of Gynecologic Surgery and Obstetrics, Uniformed Services University, Bethesda, Maryland
- Department of Gynecologic Surgery and Obstetrics, Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Shana Miles
- Department of Gynecologic Surgery and Obstetrics, Uniformed Services University, Bethesda, Maryland
- Department of Gynecologic Surgery and Obstetrics, Mike O’Callaghan Military Medical Center, Nellis Air Force Base, Nevada
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Meyer H, Trosclair L, Clayton SD, O’Quin C, Connelly Z, Rieger R, Dao N, Alhaque A, Minagar A, White LA, Solitro G, Shah-Bruce M, Welch VL, Villalba S, Alexander JS, Sorrells D. ‘Distraction Vaginogenesis’: Preliminary Results Using a Novel Method for Vaginal Canal Expansion in Rats. Bioengineering (Basel) 2023; 10:bioengineering10030351. [PMID: 36978742 PMCID: PMC10045428 DOI: 10.3390/bioengineering10030351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 03/04/2023] [Accepted: 03/07/2023] [Indexed: 03/16/2023] Open
Abstract
Vaginal atresia is seen in genetic disorders such as Mayer–Rokitansky–Küster–Hauser (MRKH) syndrome, which can cause significant sexual dysfunction. Current treatments include surgical reconstruction or mechanical dilation of the vaginal canal. Mechanical dilation requires patients to be highly motivated and compliant while surgical reconstruction has high rates of complications. This study evaluated a novel vaginal expansion sleeve (VES) method as an alternative treatment for vaginal atresia. The proprietary cylindrical VES is a spring-like device consisting of polyethylene terephthalate helicoid trusses capped at each end with a fixed diameter resin cap for fixation within tissues. Following the development of the VES and mechanical characterization of the force–length relationships within the device, we deployed the VES in Sprague Dawley rat vaginas anchored with nonabsorbable sutures. We measured the VES length–tension relationships and post-implant vaginal canal expansion ex vivo. Vaginal histology was examined before and after implantation of the VES devices. Testing of 30 mm sleeves without caps resulted in an expansion force of 11.7 ± 3.4 N and 2.0 ± 0.1 N at 50% and 40%, respectively. The implanted 20 mm VES resulted in 5.36 mm ± 1.18 expansion of the vaginal canal, a 32.5 ± 23.6% increase (p = 0.004, Student t test). Histological evaluation of the VES implanted tissue showed a significant thinning of the vaginal wall when the VES was implanted. The novel VES device resulted in a significant expansion of the vaginal canal ex vivo. The VES device represents a unique alternative to traditional mechanical dilation therapy in the treatment of vaginal atresia and represents a useful platform for the mechanical distension of hollow compartments, which avoids reconstructive surgeries and progressive dilator approaches.
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Affiliation(s)
- Hannah Meyer
- Department of Surgery, LSU Health Shreveport, Shreveport, LA 71103, USA
| | - Lexus Trosclair
- Department of Surgery, LSU Health Shreveport, Shreveport, LA 71103, USA
| | - Sean D. Clayton
- Department of Surgery, LSU Health Shreveport, Shreveport, LA 71103, USA
| | - Collyn O’Quin
- Department of Surgery, LSU Health Shreveport, Shreveport, LA 71103, USA
| | - Zachary Connelly
- Department of Surgery, LSU Health Shreveport, Shreveport, LA 71103, USA
| | - Ross Rieger
- Department of Surgery, LSU Health Shreveport, Shreveport, LA 71103, USA
| | - Nhi Dao
- Department of Molecular and Cellular Physiology, LSU Health Shreveport, Shreveport, LA 71103, USA
| | - Ahmed Alhaque
- Department of Molecular and Cellular Physiology, LSU Health Shreveport, Shreveport, LA 71103, USA
| | - Andrew Minagar
- Department of Molecular and Cellular Physiology, LSU Health Shreveport, Shreveport, LA 71103, USA
| | - Luke A. White
- Department of Molecular and Cellular Physiology, LSU Health Shreveport, Shreveport, LA 71103, USA
| | - Giovanni Solitro
- Department of Orthopedic Surgery, LSU Health Shreveport, Shreveport, LA 71103, USA
| | - Mila Shah-Bruce
- Department of Obstetrics and Gynecology, LSU Health Shreveport, Shreveport, LA 71103, USA
| | - Valerie L. Welch
- Department of Pathology, LSU Health Shreveport, Shreveport, LA 71103, USA
| | - Stephanie Villalba
- Department of Biology, Louisiana State University in Shreveport, Shreveport, LA 71115, USA
| | | | - Donald Sorrells
- Department of Surgery, LSU Health Shreveport, Shreveport, LA 71103, USA
- Correspondence:
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Serrano S, Pereira I, Henriques A, Valentim Lourenço A. Neovagina in Mayer-Rokitansky-Küster-Hauser (MRKH) Syndrome: Vaginoplasty Using Ileal Flap. ACTA MEDICA PORT 2023. [PMID: 36599171 DOI: 10.20344/amp.18563] [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: 05/15/2022] [Accepted: 09/23/2022] [Indexed: 01/05/2023]
Abstract
INTRODUCTION Surgical treatment of patients with malformations of the female genital tract is a complex problem and there are different techniques described in the literature. The goal of all these techniques is the reconstruction of a neovagina that is anatomically similar to a vagina, with adequate length to facilitate sexual functioning and with the lowest risk of possible complications. The aim of this study is to describe the surgical technique for the reconstruction of a neovagina from an ileal segment without a vascular pedicle. MATERIAL AND METHODS Description of a surgical technique developed in our tertiary university center in a patient with Mayer-Rokitansky-Küster-Hauser syndrome. RESULTS The vaginoplasty surgery using ileal flap was performed in three steps. In the first part of the intervention a laparoscopic hysterectomy with bilateral salpingectomy was performed. The second step consisted of isolating the ileal segment, ileal anastomosis and preparing the ileal segment. After the isolated segment was prepared, it was repositioned in a vagina mold to configure the neovagina. Finally, the third step included the adaptation of the vaginal mold with the ileal mucosa to the vesicorectal space. CONCLUSION Ileal vaginoplasty without a vascular pedicle is an option that can be used to reconstruct the vagina, because it provides an excellent tissue for vaginal replacement. This technique can be used in patients with genital malformations of the genital tract with absence or vaginal hypoplasia.
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Affiliation(s)
- Sílvia Serrano
- Department of Obstetrics, Gynecology and Reproductive Medicine. Hospital de Santa Maria. Centro Hospitalar Universitário Lisboa Norte. Lisbon. Portugal
| | - Inês Pereira
- Department of Gynecology and Obstetrics. Hospital CUF Descobertas. Lisbon; Department of Gynecology and Obstetrics. Hospital CUF Torres Vedras. Torres Vedras. Portugal
| | - Alexandra Henriques
- Department of Obstetrics, Gynecology and Reproductive Medicine. Hospital de Santa Maria. Centro Hospitalar Universitário Lisboa Norte. Lisbon; Lisbon School of Medicine. Lisbon Academical Medical Center. Lisbon. Portugal
| | - Alexandre Valentim Lourenço
- Department of Obstetrics, Gynecology and Reproductive Medicine. Hospital de Santa Maria. Centro Hospitalar Universitário Lisboa Norte. Lisbon; Lisbon School of Medicine. Lisbon Academical Medical Center. Lisbon. Portugal
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Lih Yuan T, Sulaiman N, Nur Azurah AG, Maarof M, Rabiatul Adawiyah Razali, Yazid MD. Oestrogen-induced epithelial-mesenchymal transition (EMT) in endometriosis: Aetiology of vaginal agenesis in Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome. Front Physiol 2022; 13:937988. [PMID: 36582359 PMCID: PMC9793092 DOI: 10.3389/fphys.2022.937988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 11/21/2022] [Indexed: 12/15/2022] Open
Abstract
Endometriosis occurs when endometrial-like tissue forms and grows outside the uterus due to oestrogen-induced epithelial-mesenchymal transition in the female reproductive tract. Factors that suppress this event could become potential therapeutic agents against disease occurrence and progression. However, an overview of these studies is still lacking. This review assessed the impact of a number factors on oestrogen-mediated epithelial-mesenchymal transition in the emergence of several diseases in the female reproductive tract, primarily endometriosis. The association between epithelial-mesenchymal transition and Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome was also investigated. Oestrogen, Wnt4 and epithelial-mesenchymal transition were chosen as keywords in Scopus, PubMed, and Web of Science searches performed on 28th June 2021. Study selection was refined to cancer-irrelevant, English, original articles published between years 2011-2021. The full-text assessment was carried out for topic-related articles after title and abstract screening. Included studies were summarised and assessed for their risk of bias using the Office of Health Assessment and Translation tool. In this review, 10 articles investigating oestrogen and epithelial-mesenchymal transition in the female reproductive tract were summarised and classified into two groups: seven studies under 'factor'-modulated epithelial-mesenchymal transition and three studies under 'factor'-manipulated oestrogen-induced epithelial-mesenchymal transition. The current evidence proposes that epithelial-mesenchymal transition is one of the prime causes of reproductive-related disease. This event could be mediated by distinct stimuli, specifically oestrogen and Wnt4 aberration. The results of this review suggest that oestrogen and Wnt4 participate in epithelial-mesenchymal transition in vaginal epithelial cells in MRKH syndrome, adopting from the theories of endometriosis development, which could therefore serve as a foundation for novel target treatment, specifically related to vaginal epithelialisation, to ensure better surgical outcomes.
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Affiliation(s)
- Too Lih Yuan
- Centre for Tissue Engineering and Regenerative Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Cheras, Malaysia
| | - Nadiah Sulaiman
- Centre for Tissue Engineering and Regenerative Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Cheras, Malaysia
| | - Abdul Ghani Nur Azurah
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Cheras, Malaysia
| | - Manira Maarof
- Centre for Tissue Engineering and Regenerative Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Cheras, Malaysia
| | - Rabiatul Adawiyah Razali
- Centre for Tissue Engineering and Regenerative Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Cheras, Malaysia
| | - Muhammad Dain Yazid
- Centre for Tissue Engineering and Regenerative Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Cheras, Malaysia,*Correspondence: Muhammad Dain Yazid,
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Tsitoura A, Michala L. The Sexuality of Adolescents and Young Women With MRKH Syndrome: A Qualitative Study. J Sex Med 2021; 18:2012-2019. [PMID: 34649813 DOI: 10.1016/j.jsxm.2021.09.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 08/19/2021] [Accepted: 09/09/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Vaginal agenesis, most commonly referred as Mayer-Rokitansky-Küster-Hauser (MRKH) Syndrome, is mostly diagnosed as primary amenorrhea in teenage girls; although there is plenty of literature concerning the formation of a neovagina, limited research has focused on the psychological burden of this diagnosis to the girls. AIM To enlighten health providers into the finer aspects of sexuality through the own words and experiences of girls with MRKH under our care. METHODS Women currently undergoing vaginal dilation or who had completed vaginal dilation within the past year were recruited from February 2019 to January 2020. A gynecologist with training in Sexual Medicine conducted a semistructured interview, which was recorded and then transcribed to identify common themes among interviewees. OUTCOMES The main outcome explored was the narrative experiences of women with MRKH. RESULTS 7 women participated, with a mean age of 19.7 (range 17-22 years). None of the girls felt stigmatized, however one reported significant distress at diagnosis, stemming from the attitude of health care professionals and exacerbated by an earlier age at disclosure. All girls accepted that VDT was successful, when it was initiated after they had felt sexual interest and arousal. Exact quantification of the vaginal length at onset, worried 4 as they felt pressurized to achieve a specific length. A few girls reported anxiety over sharing the diagnosis with an intimate partner. All of them pretended at some point to have menses. Childbearing was an important issue for most of the interviewees, but it did not concern them for the time being. All girls had supporting families. However, 5 did not want to share information about VDT with them. One girl reported that openness in discussing genital anatomy, VDT and sexuality, helped her both in completing treatment and adapting in a sexual relationship. CLINICAL IMPLICATIONS A multidisciplinary team should aim for age-appropriate disclosure and consultation and guide women through VDT and their sexual relations. STRENGTHS AND LIMITATIONS This is a thorough account of women's perceptions regarding VDT and sexuality in MRKH. However, our conclusions may be limited by the small number of participants. CONCLUSION Gradual provision of information at disclosure and adjusted timing at VDT may reduce stress in girls with MRKH. Tsitoura A, Michala L. The Sexuality of Adolescents and Young Women With MRKH Syndrome: A Qualitative Study. J Sex Med 2021;XX:XXX-XXX.
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Affiliation(s)
- Anastasia Tsitoura
- 1st Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Alexandra General Hospital, Athens, Greece.
| | - Lina Michala
- 1st Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Alexandra General Hospital, Athens, Greece
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A case report: Common channel anomaly with vaginal agenesis and rectal stone after posterior sagittal anorectoplasty (PSARP). Int J Surg Case Rep 2021; 83:106032. [PMID: 34090199 PMCID: PMC8182425 DOI: 10.1016/j.ijscr.2021.106032] [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: 04/19/2021] [Revised: 05/22/2021] [Accepted: 05/23/2021] [Indexed: 11/30/2022] Open
Abstract
Introduction and importance We reported a case of common channel anomaly complicated with vaginal agenesis and rectal stone, which is a long-term complication of PSARP, a combination of very rare conditions with high morbidity and especially difficult treatment. Presentation of case A 15-year-old female presented with a chief complaint of cyclic abdominal pain. The patient had no history of menstruation before. Physical examination showed a common channel. The diameter of the common channel was approximately 1 cm and 0.3 cm in length. A sound (±2 mm thickness) was inserted to the small opening between the urethra and anal mucosa with the length of the canal 6 cm. At the end of the opening, a stone-like structure was felt. The management of this case was abdominal hysterectomy with right salpingectomy and stone evacuation. Discussion Cloacal malformation is thought to be associated with vaginal agenesis since both malformations are considered to have a similar pathophysiologic background. Treatment can be performed using posterior sagittal combined with laparotomy approach. After surgery, patients will need a long-term follow-up since the conditions may be associated with many possible urologic and gynecologic comorbidities, including recurrent urinary tract infections, hematosalpinx, and vesicourethral reflux, including stone formation. Conclusion Our case was considered one of the most complex common channel anomalies because it was complicated with a rare condition called vaginal agenesis and rectal stone after PSARP. A multidiscipline approach was necessary. Common channel anomaly with vaginal agenesis and rectal stone after PSARP is a complex rare condition. Requiring multiple diagnostic modalities Multidiscipline approach was needed.
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Robotic assisted ileo-vaginoplasty for vaginal atresia. J Pediatr Urol 2021; 17:273-274. [PMID: 33602611 DOI: 10.1016/j.jpurol.2021.01.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 12/19/2020] [Accepted: 01/20/2021] [Indexed: 11/24/2022]
Abstract
Vaginal agenesis is a rare congenital disorder of female genital tract. Vaginal reconstruction using bowel segment is usually offered last when dilatation and/or prior vaginal reconstruction attempts using graft or flap has failed. Traditionally accomplished using open surgical approach, we describe here our initial experience of robotic-assisted ileo-vaginoplasty. The index patient presents to us with inadequate vaginal depth after failed buccal mucosal graft vaginoplasty. With the patient in low lithotomy position, port placement and docking of the robot was done. Isolation of ileal segment, closure at its proximal end and end-to-end bowel anastomosis was accomplished successfully. However, in view of dense adhesions the subsequent pull-down of the ileal segment into the perineum could not be done safely. The procedure was completed using combined abdomino-perineal open approach. A vaginal stent (in the ileal segment) and a catheter (in the introitus) were placed post-operatively. Post-operative recovery was uneventful. At 2-weeks, 3 months and a subsequent 1 year follow-up Cystoscopy and examination under anesthesia revealed an adequate vaginal depth with patient reporting successful vaginal dilatation. Robotic reconstruction of vagina using bowel segment in select patient, is safe and feasible, but possible with formidable surgical experience.
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Wu M, Wang Y, Xu J, Dai H, Zhong X, Sun M, Lv C, Xue C. Vaginoplasty With Mesh Autologous Buccal Mucosa in Vaginal Agenesis: A Multidisciplinary Approach and Literature Review. Aesthet Surg J 2020; 40:NP694-NP702. [PMID: 32498090 DOI: 10.1093/asj/sjaa147] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Vaginal agenesis, a rare condition, is treated by various surgical techniques to achieve neovaginal reconstruction. The main difference between the approaches lies in the graft material used to cover the newly formed cavity. OBJECTIVES The purpose of this retrospective study was to describe the surgical procedure and outcomes of autologous buccal mucosal grafting in neovaginal reconstruction. METHODS Sixteen patients with vaginal agenesis admitted to our department between January 2016 and January 2019 were included in our study. A reconstruction procedure, described in detail here, involving autologous buccal mucosa as graft material was successfully conducted in all of the patients. Long-term anatomic and functional outcomes were evaluated. RESULTS The blood loss during operation was estimated to be 15 to 20 mL in all cases. No rectal or bladder injury occurred. The buccal mucosal wound completely healed 10 to 14 days after the operation. All patients had a well-formed neovagina 8 to 10 cm in length, with a mean diameter of >3 finger-breadths. CONCLUSIONS The application of autologous buccal mucosa in neovaginal construction is a simple procedure. Autologous buccal mucosa is an ideal material to achieve excellent cosmetic and functional results in patients with vaginal agenesis. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- Minliang Wu
- Department of Plastic Surgery, Changhai Hospital, Naval Medical University, Shanghai, People’s Republic of China
| | - Yuchong Wang
- Department of Plastic Surgery, Changhai Hospital, Naval Medical University, Shanghai, People’s Republic of China
| | - Jianguo Xu
- Department of Plastic Surgery, Changhai Hospital, Naval Medical University, Shanghai, People’s Republic of China
| | - Haiying Dai
- Department of Plastic Surgery, Changhai Hospital, Naval Medical University, Shanghai, People’s Republic of China
| | - Xueying Zhong
- Department of Plastic Surgery, Changhai Hospital, Naval Medical University, Shanghai, People’s Republic of China
| | - Mengyan Sun
- Department of Plastic Surgery, Changhai Hospital, Naval Medical University, Shanghai, People’s Republic of China
| | - Chuan Lv
- Department of Plastic Surgery, Changhai Hospital, Naval Medical University, Shanghai, People’s Republic of China
| | - Chunyu Xue
- Department of Plastic Surgery, Changhai Hospital, Naval Medical University, Shanghai, People’s Republic of China
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Herlin MK, Petersen MB, Brännström M. Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome: a comprehensive update. Orphanet J Rare Dis 2020; 15:214. [PMID: 32819397 PMCID: PMC7439721 DOI: 10.1186/s13023-020-01491-9] [Citation(s) in RCA: 89] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 08/05/2020] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome, also referred to as Müllerian aplasia, is a congenital disorder characterized by aplasia of the uterus and upper part of the vagina in females with normal secondary sex characteristics and a normal female karyotype (46,XX). MAIN BODY The diagnosis is often made during adolescence following investigations for primary amenorrhea and has an estimated prevalence of 1 in 5000 live female births. MRKH syndrome is classified as type I (isolated uterovaginal aplasia) or type II (associated with extragenital manifestations). Extragenital anomalies typically include renal, skeletal, ear, or cardiac malformations. The etiology of MRKH syndrome still remains elusive, however increasing reports of familial clustering point towards genetic causes and the use of various genomic techniques has allowed the identification of promising recurrent genetic abnormalities in some patients. The psychosexual impact of having MRKH syndrome should not be underestimated and the clinical care foremost involves thorough counselling and support in careful dialogue with the patient. Vaginal agenesis therapy is available for mature patients following therapeutical counselling and education with non-invasive vaginal dilations recommended as first-line therapy or by surgery. MRKH syndrome involves absolute uterine factor infertility and until recently, the only option for the patients to achieve biological motherhood was through gestational surrogacy, which is prohibited in most countries. However, the successful clinical trial of uterus transplantation (UTx) by a Swedish team followed by the first live-birth in September, 2014 in Gothenburg, proofed the first available fertility treatment in MRKH syndrome and UTx is now being performed in other countries around the world allowing women with MRKH syndrome to carry their own child and achieve biological motherhood. CONCLUSION Several advances in research across multiple disciplines have been made in the recent years and this kaleidoscopic review provides a current status of various key aspects in MRKH syndrome and provides perspectives for future research and improved clinical care.
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Affiliation(s)
- Morten Krogh Herlin
- Department of Clinical Genetics, Aalborg University Hospital, Aalborg, Denmark.
- Department of Clinical Genetics, Aarhus University Hospital, Brendstrupgårdsvej 21C, DK-8200, Aarhus N, Denmark.
| | - Michael Bjørn Petersen
- Department of Clinical Genetics, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Mats Brännström
- Department of Obstetrics and Gynecology, Sahlgrenska Academy, Gothenburg, Sweden
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Neovagina Creation: A Novel Improved Laparoscopic Vecchietti Procedure in Patients with Mayer-Rokitansky-Küster-Hauster Syndrome. J Minim Invasive Gynecol 2020; 28:82-92. [PMID: 32283327 DOI: 10.1016/j.jmig.2020.04.006] [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: 01/07/2020] [Revised: 04/01/2020] [Accepted: 04/02/2020] [Indexed: 11/22/2022]
Abstract
STUDY OBJECTIVE To report a new improved laparoscopic Vecchietti vaginoplasty in patients with congenital vaginal agenesis and to investigate its efficacy and safety. DESIGN A retrospective descriptive and case-control study. SETTING Single academic institution. PATIENTS Women who were diagnosed with Mayer-Rokitansky-Küster-Hauster (MRKH) syndrome and underwent our new improved laparoscopic Vecchietti procedure from July 2010 to June 2019 were selected as the study group. The eligible participants had congenital vaginal agenesis with normal 46,XX karyotype and ovarian function. Age-matched, nulliparous, sexually active women were selected as the control group. INTERVENTIONS Women with MRKH syndrome in the study group underwent the novel improved laparoscopic Vecchietti procedure. All participants in both groups were required to complete Female Sexual Function Index and Female Genital Self-Image Scale questionnaires. MEASUREMENTS AND MAIN RESULTS The effects of our procedure, including the anatomic and functional efficacy of the neovagina, were the primary outcomes. The secondary outcomes consisted of the perioperative complications, surgical morbidities, and long-term postoperative discomfort. A total of 79 patients with MRKH syndrome underwent our new improved Vecchietti vaginoplasty, of whom 44 (55.7%) were diagnosed as Type I MRKH syndrome, whereas 35 (44.3%) were Type II MRKH syndrome. At a 30-month follow-up after surgery, an anatomic neovagina measuring 10.44 cm in length and 1.30 cm in width was achieved. All 79 patients obtained anatomic success with 92.41% of functional efficacy. Compared with 81 age-matched, nulliparous women in the control group, there was no statistical difference regardless of individual measure or total Female Sexual Function Index scores (p >.05). The Female Genital Self-Image Scale assessment showed a significantly lower score in patients undergoing the vaginoplasty (20.14 ± 3.05 vs 22.95 ± 2.12; p <.001). There were no severe perioperative complications except 1 mild bladder injury and 1 transient fever. CONCLUSION Our novel improved laparoscopic Vecchietti vaginoplasty is a relatively safe and effective method for surgical treatment of congenital vaginal agenesis. It may be an alternative to neovagina creation for reaching satisfying anatomic and functional efficacy and improving patients' sexual function.
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15
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Handaya AY, Setyawan N, Pangastuti N, Marijata, Barmawi A, Sofii I, Rahman MN, Setyawati IA, Hafiq HM. Double Pedicle Artery Rotation Sigmoid Vaginoplasty for Vaginal Aplasia Management. Ann Coloproctol 2020; 36:198-203. [PMID: 31991533 PMCID: PMC7392576 DOI: 10.3393/ac.2018.10.30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 10/30/2018] [Indexed: 11/18/2022] Open
Abstract
Sigmoid vaginoplasty has been popular for neovagina reconstruction in vaginal aplasia. The most common surgical complication was vaginal stenosis caused by inadequate vascularization and tension because of graft length. Therefore, ischemia ensued and disrupted wound healing. The selection of double pedicle artery rotation sigmoid vaginoplasty is expected to reduce this problem. Five patients from April to December 2016 were diagnosed with vaginal aplasia; 4 had history of neovagina stenosis. These patients underwent sigmoid vaginoplasty with double pedicle artery rotation. No complications occurred during or after the procedure. Assessment postsurgery was conducted at 1 year. These results suggest that double pedicle artery rotation sigmoid vaginoplasty is a safe and acceptable technique for management of vaginal aplasia. The procedure decreased tension inside vascular pedicles as a result of maintaining abundant vascularization supply. Consequently, this procedure could avert graft necrosis, leakage, and severe stenosis. All of the patients exhibited regular menstrual cycle and satisfactory sexual activity. The outcomes were excellent with remarkable anatomical and functional results.
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Affiliation(s)
- Adeodatus Yuda Handaya
- Division of Digestive Surgery, Department of Surgery, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, Indonesia
| | - Nurcahya Setyawan
- Division of Digestive Surgery, Department of Surgery, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, Indonesia
| | - Nuring Pangastuti
- Department of Obstetrics and Gynecology, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, Indonesia
| | - Marijata
- Division of Digestive Surgery, Department of Surgery, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, Indonesia
| | - Agus Barmawi
- Division of Digestive Surgery, Department of Surgery, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, Indonesia
| | - Imam Sofii
- Division of Digestive Surgery, Department of Surgery, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, Indonesia
| | - Muhamad Nurhadi Rahman
- Department of Obstetrics and Gynecology, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, Indonesia
| | - Ida Ayu Setyawati
- Department of Obstetrics and Gynecology, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, Indonesia
| | - Hamzah Muhammad Hafiq
- Division of Digestive Surgery, Department of Surgery, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, Indonesia
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Kölle A, Taran FA, Rall K, Schöller D, Wallwiener D, Brucker SY. Neovagina creation methods and their potential impact on subsequent uterus transplantation: a review. BJOG 2019; 126:1328-1335. [PMID: 31338951 DOI: 10.1111/1471-0528.15888] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/15/2019] [Indexed: 01/07/2023]
Abstract
Congenital uterovaginal aplasia commonly occurs in Mayer-Rokitansky-Küster-Hauser syndrome. Various methods of neovagina creation exist, including nonsurgical self-dilation, surgical dilation, and surgical procedures involving skin or intestinal transplants. Subsequent uterus transplantation is necessary to enable pregnancy. We review the main characteristics, advantages, and disadvantages of established neovagina creation methods and discuss their suitability regarding subsequent uterus transplantation. Suitability criteria include sufficient vaginal length, absence of previous major intra-abdominal surgery, a natural vaginal axis, and a natural vaginal epithelium. In conclusion, Vecchietti-based laparoscopically assisted neovagina creation provides ideal functional conditions for uterus transplantation. Nonsurgical self-dilation and Wharton-Sheares-George vaginoplasty may also be suitable. TWEETABLE ABSTRACT: This review discusses the main advantages and disadvantages of neovagina creation methods with regard to subsequent uterus transplantation.
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Affiliation(s)
- A Kölle
- Department of Obstetrics and Gynaecology, University of Tübingen, Tübingen, Germany
| | - F-A Taran
- Department of Obstetrics and Gynaecology, University of Tübingen, Tübingen, Germany
| | - K Rall
- Department of Obstetrics and Gynaecology, University of Tübingen, Tübingen, Germany
| | - D Schöller
- Department of Obstetrics and Gynaecology, University of Tübingen, Tübingen, Germany
| | - D Wallwiener
- Department of Obstetrics and Gynaecology, University of Tübingen, Tübingen, Germany
| | - S Y Brucker
- Department of Obstetrics and Gynaecology, University of Tübingen, Tübingen, Germany
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Adams Hillard PJ. Dilators for the Vajayjay. J Pediatr Adolesc Gynecol 2019; 32:347-348. [PMID: 31511175 DOI: 10.1016/j.jpag.2019.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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18
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Dear J, Creighton SM, Conway GS, Williams L, Liao LM. Sexual Experience before Treatment for Vaginal Agenesis: A Retrospective Review of 137 Women. J Pediatr Adolesc Gynecol 2019; 32:300-304. [PMID: 30582973 DOI: 10.1016/j.jpag.2018.12.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 12/11/2018] [Accepted: 12/16/2018] [Indexed: 10/27/2022]
Abstract
STUDY OBJECTIVE To summarize the self-reported sexual experiences of women with vaginal agenesis before treatment and discuss the clinical implications. DESIGN A retrospective review of pretreatment baseline sexuality data and medical records of women with vaginal agenesis seeking vaginal construction. SETTING A specialist multidisciplinary center for women with genital differences associated with diverse sex development. PARTICIPANTS One hundred thirty-seven women with untreated vaginal agenesis associated with Mayer-Rokitansky-Küster-Hauser Syndrome and complete androgen insensitivity syndrome aged 15 to 41 years (mean age, 20 years). INTERVENTIONS Gynecological examination and completion of questionnaires. MAIN OUTCOME MEASURES (1) Sexual Experiences Questionnaire; (2) Multidimensional Sexuality Questionnaire; (3) Vaginal Self-Perceptions; and (4) vaginal length. RESULTS A sizable proportion of women reported having had sexually intimate experiences before any medical intervention on the vagina. Vaginal length, which ranged from dimple to 7 cm and averaged 2.7 cm for the cohort, was unrelated to the range of sexual experiences. Most women perceived their vagina as being too small, but less than half believed that a sexual partner would notice this. Two-thirds of the cohort subsequently completed the dilation program, which was not predicted by pretreatment vaginal length or sexual experience. CONCLUSION Contrary to the assumption that a vagina of certain dimensions is a prerequisite for women to "have sex," many women with Mayer-Rokitansky-Küster-Hauser syndrome and complete androgen insensitivity syndrome reported having experienced genital and nongenital sexual activities with no medical interventions. It is recommended that treatment providers affirm women's capacity for sexual intimacy, relationships, and enjoyment before they introduce the topic of vaginal construction as a non-urgent choice.
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Affiliation(s)
- Joanna Dear
- Women's Health Division, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Sarah M Creighton
- Women's Health Division, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Gerard S Conway
- Women's Health Division, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Louise Williams
- Women's Health Division, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Lih-Mei Liao
- Women's Health Division, University College London Hospitals NHS Foundation Trust, London, United Kingdom.
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19
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The Methods and Mechanisms to Differentiate Endothelial-Like Cells and Smooth Muscle Cells from Mesenchymal Stem Cells for Vascularization in Vaginal Reconstruction. Mol Biotechnol 2018; 60:396-411. [DOI: 10.1007/s12033-018-0079-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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20
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Patel V, Hakim J, Gomez-Lobo V, Amies Oelschlager AM. Providers' Experiences with Vaginal Dilator Training for Patients with Vaginal Agenesis. J Pediatr Adolesc Gynecol 2018; 31:45-47. [PMID: 28826904 DOI: 10.1016/j.jpag.2017.07.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 05/30/2017] [Accepted: 07/31/2017] [Indexed: 11/28/2022]
Abstract
STUDY OBJECTIVE To examine providers' experiences with vaginal dilator training for patients with vaginal agenesis. DESIGN AND SETTING Anonymous electronic survey. PARTICIPANTS Members of the North American Society for Pediatric and Adolescent Gynecology. INTERVENTIONS AND MAIN OUTCOME MEASURES How providers learn about vaginal dilator training, common techniques, and methods used for patient training, assessment of patient readiness, common patient complaints, issues leading to early discontinuation. RESULTS There were a total of 55 completed survey responses of which 31 respondents (56%) had been in practice for more than 10 years. Forty-nine were gynecologists (89%), 20 had completed a fellowship in pediatric and adolescent gynecology (36%), and 6 were reproductive endocrinologists (11%). Thirty-one respondents had first learned about vaginal dilator training through lectures (56%) whereas only 9 through mentorship and fellowship (16%). According to respondents, the most common issue leading to early discontinuation was lack of patient motivation and readiness (n = 42; 76%). The most common complication was pain or discomfort (n = 45; 82%). More than half of respondents determined dilator therapy was successful when patients reported comfortable sexual intercourse (n = 30; 55%) and 65% (n = 35) did not delineate any restrictions to initiation of sexual intercourse. Most respondents (87%) requested further vaginal dilator training at either a clinical meeting (n = 26; 47%) or with a training video (n = 22; 40%). CONCLUSION Our study in an experienced cohort of pediatric gynecology providers highlights the need for further research and training on vaginal dilation education.
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Affiliation(s)
- Vrunda Patel
- MedStar Washington Hospital Center and Children's National Medical Center, Washington, DC.
| | - Julie Hakim
- Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
| | - Veronica Gomez-Lobo
- MedStar Washington Hospital Center and Children's National Medical Center, Washington, DC
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Ketheeswaran A, Morrisey J, Abbott J, Bennett M, Dudley J, Deans R. Intensive vaginal dilation using adjuvant treatments in women with Mayer-Rokitansky-Kuster-Hauser syndrome: retrospective cohort study. Aust N Z J Obstet Gynaecol 2017; 58:108-113. [PMID: 28960241 DOI: 10.1111/ajo.12715] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Accepted: 08/15/2017] [Indexed: 01/09/2023]
Abstract
AIMS To evaluate the effect of adjuvants during intensive vaginal dilator therapy for functional and anatomical neovagina creation in women with Mayer-Rokitansky-Kuster-Hauser syndrome (MRKH). METHODS This retrospective cohort study included 75 women with MRKH undergoing intensive vaginal dilator treatment between 2000 and 2014. One specialist nurse performed non-surgical vaginal dilation aided by adjuvants, during inpatient admissions for several dilation sessions per day. Following discharge, women continued dilation at home and were advised to attend fortnightly follow-up appointments. RESULTS Outcomes from 68 women were analysed. The median age of starting treatment was 18 years (range: 13-36). There was a mean of 3 days per admission (range 1-5) with a median of 10 dilation sessions per admission. Adjuvant treatment was used by 48/68 (71%) women: oestriol cream 29/68 (43%), 50:50 nitrous oxide and oxygen 44/68 (65%), diazepam 8/68 (12%), lidocaine ointment 26/68 (39%), paracetamol 35/68 (51%) and naproxen 2/68 (3%). There were no statistically significant differences for changes in vaginal parameters. Women receiving adjuvants had a median increase of 4.5 cm (0.5-7 cm) in neovaginal length compared with women not receiving adjuvants who had a median increase of 3.25 cm (0-7 cm) during intensive treatment. Women who received adjuvants tolerated more dilation sessions per day (10 vs 6.5 median sessions respectively) than those who did not (P < 0.001). Of those with documented length at discharge, 42/56 (75%) women had an anatomical neovagina of 7 cm or greater length. CONCLUSIONS Vaginal dilation delivered by intensive treatment and supplemented by adjuvant treatments in a multi-disciplinary centre is a rapid and effective method for creation of a neovagina in women with MRKH.
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Affiliation(s)
| | - Jennifer Morrisey
- Paediatric and Adolescent Gynaecology, Royal Hospital for Women, Sydney, New South Wales, Australia
| | - Jason Abbott
- University of New South Wales, Sydney, New South Wales, Australia.,Paediatric and Adolescent Gynaecology, Royal Hospital for Women, Sydney, New South Wales, Australia
| | - Michael Bennett
- University of New South Wales, Sydney, New South Wales, Australia
| | - Jan Dudley
- Paediatric and Adolescent Gynaecology, Royal Hospital for Women, Sydney, New South Wales, Australia
| | - Rebecca Deans
- University of New South Wales, Sydney, New South Wales, Australia.,Paediatric and Adolescent Gynaecology, Royal Hospital for Women, Sydney, New South Wales, Australia
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Zhang X, Liu Z, Yang Y, Yao Y, Tao Y. The clinical outcomes of vaginoplasty using tissue-engineered biomaterial mesh in patients with Mayer-Rokitansky-Küster-Hauser syndrome. Int J Surg 2017; 44:9-14. [DOI: 10.1016/j.ijsu.2017.06.026] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2017] [Revised: 05/19/2017] [Accepted: 06/06/2017] [Indexed: 11/29/2022]
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24
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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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Rall K, Kraemer D, Wallwiener D, Brucker S. Genitale Rekonstruktion bei angeborenen Aplasien. DER GYNÄKOLOGE 2015. [DOI: 10.1007/s00129-015-3805-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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26
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Acién P, Acién M. The presentation and management of complex female genital malformations. Hum Reprod Update 2015; 22:48-69. [DOI: 10.1093/humupd/dmv048] [Citation(s) in RCA: 105] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Accepted: 10/14/2015] [Indexed: 11/13/2022] Open
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Londra L, Chuong FS, Kolp L. Mayer-Rokitansky-Kuster-Hauser syndrome: a review. Int J Womens Health 2015; 7:865-70. [PMID: 26586965 PMCID: PMC4636170 DOI: 10.2147/ijwh.s75637] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
The congenital aplasia or severe hypoplasia of mullerian structures is infrequent. However, the features of normal female endocrine function paired with the absence of a functional uterus and vagina makes it a fascinating entity. The diagnosis and work-up in these patients has become very efficient, thanks to the use of imaging, and there are multiple successful procedures for the creation of a neovagina. In recent years, infertility treatment options through in vitro fertilization have also become available as part of the long-term care of these patients.
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Affiliation(s)
- Laura Londra
- Division of Reproductive Endocrinology and Infertility, Department of Gynecology and Obstetrics, Johns Hopkins University, Baltimore, MD, USA
| | - Farah S Chuong
- Division of Reproductive Endocrinology and Infertility, Department of Gynecology and Obstetrics, Johns Hopkins University, Baltimore, MD, USA
| | - Lisa Kolp
- Division of Reproductive Endocrinology and Infertility, Department of Gynecology and Obstetrics, Johns Hopkins University, Baltimore, MD, USA
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Le A, Wang Z, Shan L, Xiao T, Zhuo R, Luo G. Peritoneal vaginoplasty by Luohu I and Luohu II technique: a comparative study of the outcomes. Eur J Med Res 2015; 20:69. [PMID: 26297245 PMCID: PMC4546317 DOI: 10.1186/s40001-015-0165-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Accepted: 08/14/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Surgical vaginoplasty is the standard treatment for women suffering from Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome. This study compares the advantages and disadvantages of Luohu I technique or its modification, Luohu II technique. METHODS Women with MRKH syndrome undergoing laparoscopic peritoneal vaginoplasty using either the Luohu I (N = 145) or Luohu II (N = 155) technique were recruited. We compare the effectiveness of the Luohu II and one of Luohu I. Sexual satisfaction was checked by Female Sexual Function Index. RESULTS There was no significant difference in the mean operation time, volume of intraoperative blood loss, time for the first passage of gas, sexual satisfaction (and hospital stay for patients in either group (P > 0.05). But patients in the Luohu II group had a significantly lower incidence of complications than patients in the Luohu I group. All patients had vaginal depths more than 9 cm over 3 months post-surgery. CONCLUSIONS Compared with the traditional Luohu I laparoscopic peritoneal vaginoplasty, the Luohu II operation is easier to perform and causes less damage to the bladder and rectum. The physiological and anatomical features of the artificial vagina resemble the normal vagina in both techniques.
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Affiliation(s)
- Aiwen Le
- Department of Obstetrics and Gynecology, Affiliated Shenzhen Nanshan People's Hospital of Guaongdong Medical University, Shenzhen, 518052, Guangdong, China
| | - Zhonghai Wang
- Department of Obstetrics and Gynecology, Affiliated Shenzhen Nanshan People's Hospital of Guaongdong Medical University, Shenzhen, 518052, Guangdong, China.
| | - Lili Shan
- Department of Obstetrics and Gynecology, Affiliated Shenzhen Nanshan People's Hospital of Guaongdong Medical University, Shenzhen, 518052, Guangdong, China
| | - Tianhui Xiao
- Department of Obstetrics and Gynecology, Affiliated Shenzhen Nanshan People's Hospital of Guaongdong Medical University, Shenzhen, 518052, Guangdong, China
| | - Rong Zhuo
- Department of Obstetrics and Gynecology, Affiliated Shenzhen Nanshan People's Hospital of Guaongdong Medical University, Shenzhen, 518052, Guangdong, China
| | - Guangnan Luo
- Department of Obstetrics and Gynecology, Affiliated Shenzhen Luohu People's Hospital of Guaongdong Medical University, Shenzhen, 518052, Guangdong, China
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Rogers BC, Merideth KL. Sonographic Detection of Mayer-Rokitansky-Küster-Hauser Syndrome. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2015. [DOI: 10.1177/8756479314557279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Mayer-Rokitansky-Küster-Hauser syndrome is a disorder affecting the female reproductive system, which can result in an absent uterus and vagina or a partially absent vagina with a normal uterus. While this female reproductive disorder can be difficult to diagnose, transabdominal sonography is often the initial imaging modality used to evaluate the female pelvis in this patient population as many females are not diagnosed with the disorder until primary amenorrhea is noted around puberty. This case study presents a young female who is diagnosed with an absent uterus and vagina but normal ovaries and discusses the role that sonography plays in diagnosing Mayer-Rokitansky- Küster-Hauser syndrome.
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Laparoscopically assisted neovaginoplasty in vaginal agenesis: a long-term outcome study in 240 patients. J Pediatr Adolesc Gynecol 2014; 27:379-85. [PMID: 25256875 DOI: 10.1016/j.jpag.2014.02.002] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2013] [Revised: 02/02/2014] [Accepted: 02/10/2014] [Indexed: 11/23/2022]
Abstract
STUDY OBJECTIVE To assess the long-term outcome of an optimized minimally invasive neovaginoplasty technique in vaginal agenesis. DESIGN Combined retrospective and prospective study. SETTING University hospital. PARTICIPANTS 240 patients with congenital vaginal agenesis. INTERVENTIONS Patients with an indication for neovagina creation underwent laparoscopically assisted neovaginoplasty involving vaginoabdominal blunt perforation and intracorporeal traction using tension threads and an abdominally positioned extracorporeal traction device. MAIN OUTCOME MEASURES Long-term anatomic success, functional success compared with similar-aged controls, long-term complications, and incidence of human papilloma virus (HPV) infections. RESULTS During median follow-up for 16 (range 11-141) months, mean functional neovaginal length remained stable at 9.5 cm in all patients, including those who had no sexual intercourse and had stopped wearing the vaginal dummy. Median dummy wearing time was 8.6 months. Time to epithelialization depended on the time of onset and frequency of sexual intercourse. At long-term follow-up, median total Female Sexual Function Index score was 30.0, comparable with similar-aged controls. No common long-term complications occurred. Four patients required cauterization of granulation tissue. 7/240 (2.9%) patients were HPV-positive with low- to high-grade squamous intraepithelial lesions, 3 patients reverting to HPV-negative status at long-term follow-up. CONCLUSIONS Our technique creates a neovagina of adequate size and secretory capacity for normal coitus, requiring no prolonged dilation postoperatively, even in the absence of sexual intercourse. The procedure is fast, effective and minimally traumatic, has a very low long-term complication rate and provides very satisfactory long-term functional results.
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Abstract
BACKGROUND The nonobstructive group of anatomic variants involving the reproductive tract includes vaginal agenesis as well as the congenital anomalies of the vagina and uterus, occurring without pain during the pubertal years. OBJECTIVE The objective is to discuss the non-obstructive morphologic variations in anatomy of the uterus and vagina. DESIGN Systematic review using the GRADE system. RESULTS These congenital anomalies are not associated with abnormalities of the external genitalia and therefore may be missed on routine physical examination. When these anomalies do cause symptoms they may be as minor as difficulty with menstrual hygiene or more significant such as primary amenorrhea, dyspareunia, recurrent pregnancy loss, and reproductive complications. CONCLUSIONS Women with non-obstructive reproductive tract anomalies present at various ages due to the asymptomatic nature or late symptom onset of certain conditions. An MRI is the gold standard in evaluation of such conditions to aid in confirming the müllerian variant. Each condition requires careful counseling because obstetric and gynecologic risks and consequences may differ. Treatment is individualized in cases of uterovaginal agenesis with both nonsurgical and surgical options available for neovagina creation. In cases of uterine or vaginal septae, the treatment timing may vary depending on patient history. Finally, in cases of non-obstructive communicating uterine horns, the risk of ectopic pregnancy is high in the remnant horn. Should a pregnancy occur in this small underdeveloped horn, therefore, excision is recommended.
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Affiliation(s)
- Jennifer E Dietrich
- Division of Pediatric and Adolescent Gynecology, Department of OBGYN, Baylor College of Medicine, Houston, TX
| | - Debra M Millar
- Department of OBGYN, University of British Columbia, Vancouver, BC
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Robbins JB, Broadwell C, Chow LC, Parry JP, Sadowski EA. Müllerian duct anomalies: Embryological development, classification, and MRI assessment. J Magn Reson Imaging 2014; 41:1-12. [DOI: 10.1002/jmri.24771] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Accepted: 08/28/2014] [Indexed: 11/10/2022] Open
Affiliation(s)
- Jessica B. Robbins
- Department of Radiology; University of Wisconsin School of Medicine and Public Health; Madison Wisconsin USA
| | - Christy Broadwell
- Department of Obstetrics and Gynecology; University of Wisconsin School of Medicine and Public Health; Madison Wisconsin USA
| | - Lawrence C. Chow
- Department of Radiology; Oregon Health and Science University; Portland Oregon USA
| | - John P. Parry
- Department of Obstetrics & Gynecology; University of Mississippi Medical Center; Jackson Mississippi USA
| | - Elizabeth A. Sadowski
- Department of Radiology; University of Wisconsin School of Medicine and Public Health; Madison Wisconsin USA
- Department of Obstetrics and Gynecology; University of Wisconsin School of Medicine and Public Health; Madison Wisconsin USA
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Callens N, Weyers S, Monstrey S, Stockman S, van Hoorde B, van Hoecke E, De Cuypere G, Hoebeke P, Cools M. Vaginal dilation treatment in women with vaginal hypoplasia: a prospective one-year follow-up study. Am J Obstet Gynecol 2014; 211:228.e1-228.e12. [PMID: 24681288 DOI: 10.1016/j.ajog.2014.03.051] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Revised: 02/19/2014] [Accepted: 03/21/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Vaginal dilation treatment has been shown to be a (cost) effective first-line alternative to surgery in normalizing vaginal length and improving sexual function in women with vaginal hypoplasia. There remains, however, a need for prospective studies, with long-term assessment of multiple outcomes. STUDY DESIGN This was a prospective, single-centre observational study of 16 women with Mayer-Rokitansky-Küster-Hauser syndrome (n = 12) or 46,XY disorders of sex development (n = 4). All women underwent an outpatient vaginal dilation program supervised by a psychologist and physiotherapist. At baseline (T0), stop of treatment (T1) and 1 year follow-up (T2), semistructured interviews, and validated questionnaires assessed sexual function and distress, self-esteem, vaginal perceptions, and health-related quality of life. Gynecological examinations evaluated vaginal dimensions. RESULTS Ten women completed the program, 3 are still in the program, and dilation failed in 3 and chose vaginoplasty. Sixty-nine percent reached a normal vaginal length (≥6.5 cm) in 5.8 ± 3.3 months. Seventy percent were sexually active with pleasurable experiences at T1, 57% at T2. The significant decrease in sexual distress at T1 (P < .05) was followed by a nonsignificant increase at T2. Depressive mood symptomatology remained high at T1 and T2, related to loss of bodily integrity and fertility. The majority refused further psychological counseling. CONCLUSION Vaginal dilation treatment should remain the cornerstone of treatment in women with vaginal hypoplasia. However, the diagnosis remains to have a negative impact on emotional well-being in the long term. The role of psychological intervention as both a primary and adjuvant treatment needs clear evaluation.
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Affiliation(s)
- Nina Callens
- Department of Pediatric Endocrinology, Ghent University and University Hospital Ghent, Ghent, Belgium
| | - Steven Weyers
- Department of Obstetrics and Gynecology, Ghent University and University Hospital Ghent, Ghent, Belgium
| | - Stan Monstrey
- Department of Plastic Surgery, Ghent University and University Hospital Ghent, Ghent, Belgium
| | - Sabine Stockman
- Department of Urology, Ghent University and University Hospital Ghent, Ghent, Belgium
| | - Birgit van Hoorde
- Department of Sexology and Gender Problems, Ghent University and University Hospital Ghent, Ghent, Belgium
| | - Eline van Hoecke
- Department of Pediatric Psychology, Ghent University and University Hospital Ghent, Ghent, Belgium
| | - Griet De Cuypere
- Department of Sexology and Gender Problems, Ghent University and University Hospital Ghent, Ghent, Belgium
| | - Piet Hoebeke
- Department of Urology, Ghent University and University Hospital Ghent, Ghent, Belgium
| | - Martine Cools
- Department of Pediatric Endocrinology, Ghent University and University Hospital Ghent, Ghent, Belgium.
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Borsos A. [Pediatric gynecological operations based on 40 years' experience]. Orv Hetil 2014; 155:1132-9. [PMID: 25016444 DOI: 10.1556/oh.2014.29929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The author analyzes more than 40 years of his own experience concerning the outcome of pediatric gynecology patients who underwent surgery in the Department of Gynecology and Obstetrics, Debrecen University in Hungary. Traditional surgical interventions were performed, and, some new methods elaborated by the author. The age of patients who underwent surgery ranged from infancy to 18 years. The objective of this publication is to describe general principles to support the work of those who are currently active in this area or have chosen the area for their future activity. Types of surgical interventions, conditions of proper management and insitutional background, together with requirements of qualified personnel and diagnostic performance are analyzed. Possible sources of errors and their prevention are pointed out. Different procedures are discussed in separate groups. The author's own procedure modifications based on the original procedure elaborated by Vecchietti for treatment of vaginal aplasia are described. Concluding from results of more than 60 successful modified Vecchietti procedures the author recommends his own procedure.
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Affiliation(s)
- Antal Borsos
- Debreceni Egyetem, Klinikai Központ, Általános Orvostudományi Kar Szülészeti és Nőgyógyászati Klinika Debrecen Nagyerdei körút 98. 4012
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Callens N, De Cuypere G, De Sutter P, Monstrey S, Weyers S, Hoebeke P, Cools M. An update on surgical and non-surgical treatments for vaginal hypoplasia. Hum Reprod Update 2014; 20:775-801. [DOI: 10.1093/humupd/dmu024] [Citation(s) in RCA: 107] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
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Lankford JC, Mancuso P, Appel R. Congenital Reproductive Abnormalities. J Midwifery Womens Health 2013; 58:546-51. [DOI: 10.1111/jmwh.12020] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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