Evaluation of different techniques for vaginoplasty in the treatment of the syndrome of Mayer-Rokitansky-Küster-Hauser

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Rim Ben Hmid
Omar Touhami
Bechir Zouaoui
Fethi Ben Amara
Dorra Zghal
Faouzia Zouari
Sami Mahjoub
Hela Chelli

Abstract

Background: Rokitansky syndrome is an utero-vaginal aplasia with a frequency of 1 / 5000 female births. To correct this anomaly whose prognosis is mainly functional and psychological numerous surgical techniques have been described.
Aims: To report our experience about 13 patients with Rokitansky syndrome and having benefited from a vaginoplasty between 1993 and 2008 and to evaluate the results of the various anatomical techniques.
Methods: This is a retrospective study of 13 patients who underwent a vaginoplasty in the center of maternity and neonatal units, over a period from December 1993 to April 2008. During this period, two operative techniques were used: the technique of Mac-Indoe and the technique of Davydov.
Results: The mean age at the time of surgery was 22 years (15 years-32 years). In 6 patients operated using the technique of Davydov the average depth of neovagina was 6.83 cm, one treatment failure was noted. Among the 7 patients operated using the technique of Mac Indoe the average length of neovagina was 7 cm, 3 treatment failures were noted. It was noted that there was no failure of the anatomical results in patients who have had regular sex after surgery. It was noted that there was failure of the anatomical result in 4 of 9 patients who did not have sexual intercourse after the procedure regardless of the technique used, a failure rate of 44%.
Conclusion: The choice of technique will be based on the experience of the teams as each technique has similar anatomical and functional results in the literature. Both anatomical and functional, the main factor that determines the success of treatment seems to be the motivation of the patient to have a married life and sexual relationschip.

Keywords:

Rokitansky, vaginal aplasia, Vaginoplastiy

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References

  1. Morcel K, Guerrier D, Watrin T, Pellerin I, Levêque J. Le syndrome de Mayer-Rokitansky-Küster-Hauser (MRKH) : clinique et génétique. J Gynecol Obstet Biol Reprod 2008; 1016: 88-90.
  2. Azoury RS, Jones Jr HW. Cytogenetic findings in patients with congenital absence of the vagina. Am J Obstet Gynecol 1966;94:178-80.
  3. Sarto GE. Cytogenetics of fifty patients with primary amenorrhea. Am J Obstet Gynecol 1974;119:14-23.
  4. Folch M, Pigem I, Konje JC. Mullerian agenesis: etiology, diagnosis, and management. Obstet Gynecol Surv 2000;55:644- 49.
  5. Griffin JE, Edwards C, Madden JD, Harrod MJ, Wilson JD. Congenital absence of the vagina. The Mayer-Rokitansky-Kuster- Hauser syndrome. Ann Intern Med 1976;85:224-236.
  6. Carson SA, Simpson JL, Malinak LR, et al. Heritable aspects of uterine anomalies. Genetic analysis of Mullerian aplasia. Fertil Steril 1983;40: 86-90.
  7. Klingele CJ, Gebhart JB, Croak AJ, DiMarco CS, Lesnick TG, Lee RA. McIndoe procedure for vaginal agenesis: long-term outcome and effect on quality of life. Am J Obstet Gynecol 2003;189:1569-72.
  8. Hojsgaard A, Villadsen I. McIndoe procedure for congenital vaginal agenesis: complications and results. Br J Plast Surg 1995;48:97-102.
  9. Sensoz O, Kocer U, Percin AK. Treatment of vaginal agenesis with modified Abbe-McIndoe technique. Eur J Plast Surg 1995;18: 285-7.
  10. Borruto F, Chasen ST, Chervenak FA, Fedele L. The Vechietti procedure for surgical treatment of vaginal agenesis: comparison of laparoscopy and laparotomy. Int J Gynecol Obstet 1999;64:153-8.
  11. Fedele L, Frontino G, Restelli E, et al. Creation of a neovagina by Davydov's laparoscopic modified technique in patients with Rokitansky syndrome. Am J Obstet Gynecol 2010; 202:33.e1-6.
  12. Giannesi A, Marchiole P, Benchaib M, Chevret-Measson M, Mathevet P, Dargent D. Sexuality after laparoscopic Davydov in patients affected by congenital complete vaginal agenesis associated with uterine agenesis or hypoplasia. Hum Reprod 2005;20:2954-7.
  13. Soong YK, Chang FH, Lee CL, Lai YM. Vaginal agenesis treated by laparoscopically assisted neovaginoplasty. Gynecol Endosc 1994;3:217-20.
  14. Fedele L, Bianchi S, Zanconato G, Raffaelli R. Laparoscopic creation of neovagina in patients with Rokitanky syndrome: analysis of 52 cases. Fertil Steril 2000;74:384-9.
  15. Fedele L. Creation of a neovagina in Rokitansky patients with a pelvic kidney: comparison of long-term results of the modified Vecchietti and McIndoe techniques. Fertil Steril 2009; 20: 87-90.
  16. F. Borruto, F.S. Camoglio, N. Zampieri, L. Fedele, The laparoscopic Vecchietti technique for vaginal agenesis . International Federation of Gynecology and Obstetrics 2007 ; 900-2.
  17. Alessandrescu D, Peltecu GC, Buhimschi CS, Buhimschi IA. Neocolpopoiesis with split-thickness skin graft as a surgical treatment of vaginal agenesis: retrospective review of 201 cases. Am J Obstet Gynecol 1996;175:131-8.
  18. Hojsgaard A, Villadsen I. McIndoe procedure for congenital vaginal agenesis: complications and results. Br J Plast Surg 1995;48:97-102.
  19. Adamyan LV. Laparoscopic management of vaginal aplasia with or without functional noncommunicating rudimentary uterus. In: Arrequi F, Kathouda, Mckerman, Reich, editors. Principles of laparoscopic surgery. NewYork: Springer-Verlag 1995; 646-51.
  20. Soong Y-K, Chang F-H, Lai Y-M, Lee C-L, Chou H-H. Results of modified laparoscopically assisted neovaginoplasty in 18 patients with congenital absence of vagina. Hum Reprod 1996;11:200-3.
  21. Rosen R, Brown C, Heiman J, et al. The Female Sexual Fuction Index (FSFI): a multidimensional selfreport instrument for the assessment of female sexual function. J Sex Marital Ther 2000;26:191-208.
  22. Communal PH, Chevret-Measson M, Golfier F, Raudrant D. Sexuality after sigmoid colpopoiesis in patients with Mayer- Rokitansky-Kuster- Hauser Syndrome. Fertil Steril 2003;80:600- 6.
  23. Brun JL, Belleannee G, Grafeille N, Aslan AF, Brun GH. Longterm results after neovagina creation in Mayer-Rokitanski- Kuster-Hauser syndrome by Vecchietti's operation. Eur J Obstet Gynecol Reprod Biol 2002;103:168-72.