Single-incision mesh repair for the treatment of neovaginal prolapse

Abstract

The MayereRokitanskyeKustereHauser syndrome is a congenital disorder characterized by the absence of the uterus and the upper two thirds of the vagina, but with normal ovarian function and karyotype. The incidence rate of this disorder is estimated to be one in 4000e5000 female live births [1]. These patients present with primary amenorrhea and seek medical consultation when they become adolescents. At present, nonsurgical vaginal dilator therapy is the treatment of choice recommended by the American College of Obstetricians and Gynecologists. The treatment has a reported success rate of approximately 86% in creating a functional vagina [2]. Several surgical techniques have been developed for patients who had unsuccessful passive vaginal dilatation. Some of the surgical procedures useful in this regard are the surgical creation of a neovaginal space, vulvovaginoplasty, bowel vaginoplasty, and the Vecchietti operation. However, whether a neovagina is created by passive dilatation or surgery, it is not apically or laterally suspended by endopelvic fascial attachments. The absence of these anatomical supports, or a defect in their normal functioning, increases the risk of prolapse. The Anterior Elevate system (American Medical Systems, Minnetonka, MN, USA) is one of the single-incision mesh kits available, and is reported to have favorable outcomes and acceptable adverse events for the treatment of prolapse [3,4]. To eliminate the recurrence of prolapse and reinforce the weakness of the native tissue, the mesh is put in place for the correction of cystocele and rectocele. Because of its efficacy and efficiency, synthetic meshes are being increasingly used worldwide. To date, very limited data are available on the treatment of neovaginal prolapse. We herein