14 Surgical management of mid- and upper-vaginal constriction rings

Abstract

To review the diagnosis of mid- and upper-vaginal constriction rings and describe our technique for surgically correcting vaginal constriction rings. Causes of vaginal constriction include surgery, vaginal atrophy, conditions of the vulvovaginal skin, and radiation. It is imperative for the pelvic surgeon to be able to identify and adequately address vaginal constriction. In this video, we discuss the diagnosis and management of mid- and upper-vaginal constriction rings, an entity with an undefined etiology. Initial medical management may include vaginal dilation with use of vaginal estrogen. We present three techniques for surgical management: lysis of the constriction band, lysis of the band with use of a flap, and lysis of the band with use of a biologic graft. In our experience, lysis of the constriction ring perpendicular to its axis with immediate use of vaginal estrogen and vaginal dilators is sufficient for most cases. Cases of severe stenosis, prior failed surgical management, or a combination of stenosis and foreshortening may necessitate the use of a biologic graft or local flap. Pelvic surgeons should be familiar with the diagnosis and management of vaginal constriction rings. In this video, we review diagnosis and medical management and present 3 techniques for surgical correction of this condition.