Creation of a Neovagina with Single Staged Uterine Anastomosis.

Abstract

While vaginal agenesis most often occurs with an absent or rudimentary, nonfunctioning uterus, it may also occur with a fully developed uterine body. In these scenarios, anastomosis of the functional uterus to a neovagina allows for both egress of menstrual blood as well as potential preservation of fertility: case reports exist of spontaneous conception following creation of a neovagina. However, prior attempts at anastomosis have all included delayed surgery with anastomosis to the uterus several months following the creation of the neovagina. The patient was a 17-year-old female who presented with amenorrhea several years after thelarche. After noting a blind ending vagina and a 46XX karyotype, ultrasound and MRI revealed an apparently normal uterus with questionable presence of a cervix, and polycystic appearing ovaries, which may have accounted for the patients minimal hematometra. A multidisciplinary team including gynecology, urology, plastic surgery, and colorectal surgery was organized for creation of a neovagina and attempted anastomosis to the normal appearing uterus. In a single staged robotic procedure, a peritoneal neovagina created in a modified Davydov technique was successfully connected to the uterus. A foley catheter was placed in the uterine cavity to allow for canalization. Diagnostic hysteroscopy six weeks after surgery confirmed a canal into the uterus, and the patient reported ongoing cyclical bleeding with the use of oral contraceptives several months after surgery. In vaginal agenesis with a functional upper reproductive tract, peritoneal neovaginas may be successfully anastomosed to the uterus in a single stage robotic approach.