Reconstructive surgical management of cryptomenorrhea because of complex uterovaginal malformations with duplicate uterus and complete vaginal agenesis

Abstract

To describe the surgical reconstructive options in cases of cryptomenorrhea because of an obstructed functioning uterus with upper and lower vaginal agenesis. Assessment of operative, anatomic, and functional results after operative reconstruction over a 1-year follow-up period. University hospital and referral center for pediatric and adolescent gynecology. Three adolescent girls, aged 15 to 18 years with primary amenorrhea, cyclic abdominal pain, hematometra, and complete vaginal agenesis. A combinative vaginal and laparoscopic approach to reconstruct a neovagina by human amniotic membranes and establish the uterovaginal continuity. Anatomic success was defined by a vaginal length ≥8 cm, and a width allowing the introduction of two fingers. Functional success was evaluated according to the restoration of menstrual cycle resolving of pain and patients'sexual satisfaction. Neovaginal length was 9 to 12 cm and adequately wide. In all patients the uterovaginal continuity could successfully be restored. Satisfactory anatomic and functional results could be achieved, with no operative morbidity. Regular menstruation resumed with normal ultrasound findings during follow-up. In rare cases of an obstructed functioning uterus by complete vaginal agenesis, a combinative laparoscopic and vaginal surgical approach effectively restores anatomy and function, by an overall minimal operative morbidity. Human amnion provides excellent results in neovaginal reconstruction.