The Use of Urogenital Mobilization Extended by Two Flaps From the Redundant Distal Part of the Urethra in the Repair of the Severe Form of Distal Vaginal Agenesis

Abstract

To describe and present the results of the use of urogenital mobilization extended by two flaps from the redundant distal part of the urethra in the correction of a severe form of distal vaginal agenesis. During the past 4years (from December 2018 to March 2023), we have performed 2 vaginoplasties using the described procedure. The age of the patients at surgery was 13years. Two girls presented with primary amenorrhea associated with cyclic pelvic pain evolving over several months. Clinical examination revealed a blind vagina and an anterior pelvic mass. Ultrasound and magnetic resonance imaging showed a severe form of distal vaginal agenesis. One patient had a 47,XX+mark karyotype and right vesicoureteral reflux. Two patients underwent urogenital mobilization, guided by a tube introduced into the upper part of the vagina through an abdominal approach, and the use of two flaps from the redundant distal part of the urethra to extend the neovagina to the perineum. The esthetic results were very satisfactory with the disappearance of pelvic pain, and the restoration of a regular flow of menstrual blood without pain. Urinary continence was preserved in two patients. This is the first report of the use of urogenital mobilization extended two flaps from the redundant distal part of the urethra in the correction of a severe form of distal vaginal agenesis. This procedure yielded a very satisfactory esthetic and functional results.