Successful Staged Management of Cervico Vaginal Agenesis- Seven Cases

Abstract

<h3>Study Objective</h3> Cervicovaginal Agenesis with a functional Uterine Corpus, poses a unique challenge. Earlier, hysterectomy was the resultant treatment as initial canalization attempts reported fatal ascending infections and failures. We report our successful staged approach to create a neovagina for its coital function and save the functional uterine corpus for its menstrual and reproductive functions. <h3>Design</h3> retrospective single center experience. <h3>Setting</h3> tertiary referral center. <h3>Patients or Participants</h3> Seven girls confirmed to have Cervicovaginal Agenesis with hematometra after clinical and MRI evaluation. Five had associated endometrioma. <h3>Interventions</h3> They were planned for staged management. At the first stage, they underwent laparoscopic assessment of pelvis, correction of endometrioma and creation of neovagina. All had an anomalous uterine corpus. Hematosalphinx and endometriosis were treated when noted. Neovagina was created in four by conventional Mc Indoe's vaginoplasty, one needed a simple Frank's method. Girls were taught self vaginal dilatation in between for 3 months to obtain a wide and long neo vaginal lumen with mature epithelial lining. They were given GnRH to be symptom free in between. At the second stage once the neovagina matures girls underwent laparoscopic utero-neovaginal anastomosis. After preparing both the lower uterine segment and neovaginal apex for at least 0.5 cm, anastomosis was done using 0 barbed sutures. A silicone Foley stent was used in the initial period. To make it a tension free anastomosis, ligaments were released to mobilize the corpus down, carefully preserving uterine vascularity. After 3 months of cyclical pills a hysteroscopic assessment of the anastomosis and endometrial cavity was done. <h3>Measurements and Main Results</h3> On long follow-up, now all have established menstrual cycles. Two are married, having vaginal intercourse presently considering fertility options. <h3>Conclusion</h3> The staged procedure helps relieve immediate symptoms, manage endometriosis, directly assess the corpus, reduces ascending infection at first and then help the neovaginal graft mature and pliable for a successful anastomosis at second stage.