Customized Silicone Vaginal Stent.

Abstract

Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome, a congenital anomaly of the female genital tract, is characterized by vaginal agenesis, a rudimentary to absent uterus compromising the normal functions of the genital tract, thereby causing psychological trauma. This syndrome is estimated to occur in approximately 1 in every 4500 females [1]. Patients with vaginal agenesis in MRKH syndrome can be treated by both surgical and non-surgical procedures. However irrespective of the procedure opted, prosthetic vaginal dilators or long-term vaginal stents are required to prevent the possible contraction of the reconstructed vagina and to maintain vaginal width and depth to avoid vaginal stenosis. The use of prosthetic vaginal dilators for non-surgical procedure for the creation of neovagina for patients with complete Mullerian agenesis is usually considered the first line of treatment if suitable. Vaginal dilators (Hegar candles) are indicated only when the vaginal dimple is deep enough (2–4 cm). Due to its elastic nature, the vaginal tissue has the tendency to expand during the insertion of a dilator. To accomplish the tissue expansion, customized stents are made, with increasing measurements in its length and diameter over a period of time. However, vaginal stents are used postoperatively to maintain vaginal width and depth and to prevent contraction or shrinkage and stricture of neovagina, and it also serves as hemostat. Failure to wear a stent, even if it is inconvenient, is the major cause of failure. Several prefabricated or customized stents have been described for postoperative maintenance after vaginoplasty, such as ORFIT “S” vaginal stent, tissue expander, simple syringe, vacuum expandable condom mold, inflatable stents, and acrylic, hollow acrylic or acrylic stents lined with silicones [2, 3]. However, prefabricated stents made from medical grade plastics and acrylic are hard, costly, and are not suitable for all clinical situations owing to the varying anatomies of the defect. So far, the literature review has not revealed much information about complete silicone vaginal stent and fabrication of the same. In this case report, we have made a vaginal stent using silicone which not only maintains the shape but also provides comfort to the patient due to its soft nature. A thorough search has revealed that not much information has been reported in the literature regarding silicone vaginal stent. This case report describes the advantages, disadvantages, and procedure of fabrication of the customized silicone vaginal stents.