Colon Replacement of the Vagina to Restore Menstrual Function

Abstract

PURPOSE Colon replacement of vagina to restore menstrual function in girls with painful hematometra. MATERIAL AND METHODS A prospective study of 8 girls (12 – 18 years age) who underwent vaginal reconstruction for partial or complete vaginal agenesis with painful hematometra. All wished to preserve menstrual function and refused hysterectomy. Associated malformations included Ventricular septal defect 1, Anorectal malformation 3, Ear anomaly 2, Eye anomaly 1, Vesicoureteric reflux 2, neurogenic bladder 1, solitary kidney 1, crossed fused ectopia 1. All patients underwent sigmoid replacement of the vagina with the upper end of the vaginal substitute anastomosed to the posterior uterine wall (6 patients) or the upper vagina (2 patients). A portion of the myometrium of the posterior uterine wall was excised prior to the anastomosis between it and the neovagina to allow a large anastomosis and prevent subsequent stenosis. RESULTS At follow up ranging from 3 months to 4 years all of the patients have regular menstruation without pain. None have had hematometra, pyometra or excessive vaginal discharge. None have required vaginal dilations. CONCLUSIONS Colovaginaoplasty is a well established procedure for vaginal agenesis, Our study shows that the technique can be modified to allow normal menstruation in girls refusing hysterectomy This procedure fulfills the patients desire to have normal menstruation although pregnancy is not possible in most patients. Discussion:# 16:53 to 17:05