Average Vaginal Length Research Articles

Laparoscopic-assisted neo-cervico-vaginal anastomosis and neo-vagina creation in congenital atresia: A retrospective study measuring the outcome and success

We aimed to study the surgical outcomes of vaginoplasty and laparoscopic-assisted cervical-vaginoplasty carried out using our set-up from June 2016 to December 2022. Additionally, we measured the success of our modified laparoscopy-assisted neo-cervical creation. A retrospective study. The study was conducted in a tertiary care center and included all patients who underwent vaginoplasty and neo-cervico-vaginal creation using the rail-road method. A total of 33 patients were followed-up meticulously and their outcomes were noted. The study was retrospective and largely depended on patient compliance during follow-up. Of the 33 patients, 22 underwent vaginoplasty (McIndoe technique) and 11 underwent neo-cervico-vaginoplasty (rail-road method using both open and laparoscopic methods). The most common presentation was primary amenorrhea (cyclic abdominal pain with primary amenorrhea) and urinary retention. Four patients underwent hysteroscopy-guided hematometra drainage and none underwent hysterectomy. The average vaginal length measured during the follow-up was 5.2±1.90cm. Significant symptom relief was observed. Longest follow-up duration was 4.7 years with a mean duration of 210 (180) days. Although the procedure is strenuous, postoperative results showed satisfactory outcomes in improving the quality of life of patients. With expertise in the technique, the associated comorbidity is reduced, which provides relief for the patients.

Laparoscopic uterovaginal anastomosis in patients with congenital cervicovaginal atresia: An institutional experience with 23 patients

ObjectiveTo introduce our experience of laparoscopic uterovaginal anastomosis and operative outcomes following this technique and update the clinical management of congenital cervicovaginal atresia. Study designBetween March 2015 and January 2019, twenty-three patients with congenital cervicovaginal atresia underwent laparoscopic uterovaginal anastomosis and Luohu procedure. Their clinical characteristics, surgical outcomes and follow-up data were retrospectively reviewed. ResultsThe mean ± SD age of the cases was 16.4 ± 4.0 (11–26) years. All patients had a history of primary amenorrhea and cyclical abdominal pain, and the average delay in diagnosis from first symptoms was 33.5 ± 38 (1–156) months. Most of the patients had 1−3 cm long vaginal pouch. The operative procedure lasted 125 ± 32 (80–190) min. The average vaginal length at 1 month was 7.9 ± 1.3 (range 6–9) cm. All patients showed resumption of menstruation. The patients were followed for a mean of 27 ± 13 (12–56) months. During the follow-up, cervical stenosis did not occur in any of the cases. ConclusionLaparoscopic uterovaginal anastomosis with Luohu procedure provided a minimally invasive, safe, and effective surgical option for the patients with congenital cervicovaginal atresia. The technique is uncomplicated, easy to learn and perform, and provides a functional and anatomic satisfactory result. No special surgical instruments are required with this technique.

META-ANALYSIS : COMPARISON OF NEOVAGINA SUCCESS RATE WITH VECCHIETTI'S LAPAROSCOPIC METHOD AND DAVYDOV'S LAPAROSCOPIC METHOD IN MAYER-ROKITANSKY-KUSTER-HAUSER SYNDROME (MRKH) PATIENTS

ABSTRACT
 
 Background
 Mayer-Rokitansky-Kuster-Hauser Syndrome (MRKH) is caused by an embryological growth disorder of the mullerian duct. Laparoscopic Vecchietti and Davydov are laparoscopic surgery techniques that are often used for neovaginal surgery
 
 Objective
 This paper aims to compare the success rate of neovagina with the Vecchietti laparoscopic method and Davydov's laparoscopic method in patients with Mayer-Rokitansky-Kuster-Hauser Syndrome (MRKH)
 
 Methods: A systematic data search was performed on a medical database (PUBMED, MEDLINE, Cochrane Database, Google Scholar). Inclusion criteria: (1) randomized randomized study of the Vecchietti Laparoscopic Method with Davydov’s Laparoscopy, (2) all inclusive papers can be accessed completely, and (3) the data obtained can be accurately analyzed
 
 Data acquisition and analysis: We searched for a random blind study (RCT) with the following keywords: (1) Vecchietti Laparoscopy [title] AND (2) Davydov’s Laparoscopy [title] AND Mayer-Rokitansky-Kuster-Hauser syndrome [title]
 
 Results: Three RCTs comparing neovaginal success with the Vecchietti laparoscopic method and Davydov's laparoscopic method a total of 122 patients were analyzed. Average vaginal length (mean difference [MD] -0.70, and 95% [CI] -0.99 to -0.41 (P <0.00001), Average number of Female Sexual Function Index scores (mean difference [MD] -1.34, and 95% [CI] -1.71 through -0.96. (P <0.00001)
 
 Conclusion
 This meta-analysis concludes that Davydov’s Laparoscopic Method is better in terms of postoperative vaginal length and the Female Sexual Function Index Score
 
 Keywords
 Mayer-Rokitansky-Kuster-Hauser Syndrome,Laparoscopic Davydov,Laparoscopic Vecchietti,Vaginal Length,FSFI Score

Vaginal Reconstruction in Patients with Mayer-Rokitansky-Küster-Hauser Syndrome-One Centre Experience.

Background and Objectives: The Mayer–Rokitansky–Küster–Hauser syndrome is a congenital condition in which patients are born with vaginal and uterus agenesis, affecting the ability to have a normal sexual life and to bear children. Vaginal reconstruction is a challenging procedure for plastic surgeons. The aim of this study is to report our experience in the management of twelve patients with congenital absence of the vagina due to the MRKH syndrome. Materials and Methods: We performed a retrospective study on 12 patients admitted to the Plastic Surgery Department of the Clinical Emergency Hospital “Prof. Dr. Agrippa Ionescu”, Bucharest, Romania, for vaginal reconstruction within a period of eleven years (January 2009–December 2019). All patients were diagnosed by the gynaecologists with vaginal agenesis, as part of the Mayer–Rokitansky–Küster–Hauser syndrome. The Abbe‘–McIndoe technique with an autologous skin graft was performed in all cases. Results: The average age of our patients was 20.16 (16–28) years. All patients were 46 XX. The average surgical timing was 3.05 h (range 2.85–4h). Postoperative rectovaginal fistula was encountered in 1 patient. Postoperative average vaginal length was 10.4 cm (range 9.8–12.1 cm). Regular sexual life was achieved in 10 patients. Conclusion: Nowadays, there is no established standard method of vaginal reconstruction. In Romania, the McIndoe technique is the most applied. Unfortunately, even if the MRKH syndrome is not uncommon, less and less surgeons are willing to perform the procedure to create a neovagina.

A STUDY ON CONGENITAL VAGINAL MALFORMATIONS IN RURAL POPULATION OF NORTH MAHARASHTRA REGION

Objective: To find out types of vaginal malformations in rural population of North Maharashtra, to study various operative procedures designed for vaginal malformations and to evaluate the use of rubber mould for McIndoe operation. Method: Eighteen cases of congenital vaginal malformations were screened in OPD. We found seventeen patients of primary amenorrhea were having congenital vaginal malformation. One patient of stricture of upper vagina was having normal menstruation. They were investigated according to the standard protocol. After clinical examination patients were investigated by U.S.G. and I.V.P. sos and diagnostic laparoscopy, the investigations for operation were Hb, Urine (Alb. Sug. Microscopy), BSL (R), BUL, Serum creatine. Then all of them were operated between Jan.1985 to Oct. 2002 under general anaesthesia & the analysis was done. The type of operations done were 1) Mcindoe operation 2) Pull through operation 3) Excision of imperforate hymen. Results: Twelve cases of Rokitansky-Kuster-Hauster Syndrome were operated by McIndoe technique. None of the patients developed V.V.F. or R.V.F. The average vaginal length was 8.76 cms.; Four cases of imperforate hymen had undergone excision & Two cases of congenital stricture in upper vagina had undergone pull through operation Conclusions: Use of foam rubber mold is without any pressure necrosis of bladder or rectum.

Surgical neovagina reconstruction in mullerian agenesis

Introduction: Functional neovagina reconstruction is a challenge faced by plastic surgeons. Different patients with varied etiologies present for vaginal reconstruction as in congenital vaginal aplasia, transsexuals and acquired defects following trauma, resection of carcinoma. Different techniques are available for vaginoplasty. Aim: To evaluate the anatomical and functional outcomes of vaginoplasty using two well established surgical techniques McIndoe with split skin graft and vaginplasty using Full thickness skin graft Material and Methods: This is a prospective study conducted at the department of plastic surgery,at a tertiary care centre at Bangalore ,India over a period of 2 years from January 2013 to January 2015. Results: A total 19 patients in age group of 15 to 34 years were operated during this period. 10 patients underwent vaginoplasty using Full thickness skin graft and 9 patients underwent vaginoplasty using Mcindoe technique with split skin graft. Average vaginal length at 2 months for FTSG was 9.0cm and average vaginal length at 6 months for FTSG 9.25 cm. Average vaginal length in SSG cases at 2 months was 8.7 cm and average vaginal length at 6 months 8.9 cm. There was no statistical difference in two groups regarding vaginal length (p>0.01). Mean FSFI score in patient treated with vaginoplasty with SSG was 26.6 + 1.8 and FSFI in patients treated with FTSG was 30.4 + 1.1 ( p<0.01). Conclusion: From this study we found that vaginoplasty with FTSG was associated with lesser donor site morbidity and patients were more satisfied with scar and also that the early vaginal length was better in FTSG and none of the patients treated with FTSG needed dilatation under anaesthesia. Operative time was marginally increased in FTSG cases as compared to the SSG patients.

Optimizing the modified laparoscopic Vecchietti procedure

Objective: To enhance the modified laparoscopic Vecchietti procedure. Materials and Methods: A case series of five women with Mayer-Rokitansky-K&#x00FC;ster-Hauser syndrome at the Department of Obstetrics and Gynecology, King Abdulaziz University Hospital, Jeddah, Saudi Arabia underwent the modified laparoscopic Vecchietti procedure with intraperitoneal placement of sutures. This involved perforation of the vaginal dimple by a straight thread guide with two threads attached to the olive followed by pulling the two threads intra-peritoneally and through the abdominal wall to the traction device by grasping instruments under laparoscopic control. Results: Intraperitoneal placement of the sutures was easily done without complications in all five women. The operative time was 50 &#x00B1; 10 (mean &#x00B1; SD) minutes. After five postoperative days, the average vaginal length was seven to 7.5 cm. Two women were able to have vaginal intercourse without problems. After six months to one year of follow up, the vaginal length was at least ten cm and no postoperative complications occurred. Conclusions: Intraperitoneal placement of sutures makes the modified laparoscopic Vecchietti procedure easy and appealing. Furthermore, it avoids potential damage to the vital structures at the pelvic side walls.

Vaginal Reconstruction in Müllerian Agenesis with User- Friendly Indigenous Prosthetic Vaginal Dilators

ABSTRACT Objective Vaginal reconstruction in Müllerian agenesis through nonsurgical method, using serial vaginal dilators which were worn by the patients with the help of a T-shaped perineal bandage. Materials and methods Seven patients with Müllerian agenesis had attended the outpatient clinic between 2008 and 2013. The age of women ranged from 18 to 30 years. This clinical report describes the use of prosthesis, fabricated by a maxillofacial prosthodontist that enabled the patients to have custom made personalized vaginal dilators of increasing dimensions which they could wear with comfort with a tight perineal T-bandage. Results Seven women with Müllerian agenesis had consented for nonsurgical mode of vaginal reconstruction. Vagina was serially dilated with tailor made prosthesis worn using tight perineal T-bandage for a period of 3 to 4 months. Post dilatation average vaginal length was 11 to 13 cm which allowed introduction of Sims speculum with ease. Conclusion Nonsurgical vaginal dilatation using prosthetic vaginal dilators kept in place with tight perineal T-bandage is a well-accepted custom made and a successful technique in the creation of neovagina. How to cite this article Sangeetha K, Rani GU, Syamala O, Rukshana, Pushpalatha. Vaginal Reconstruction in Müllerian Agenesis with User-Friendly Indigenous Prosthetic Vaginal Dilators. J South Asian Feder Menopause Soc 2014;2(2):75-78.

Dilation and surgical management in vaginal agenesis: a systematic review

The management of vaginal agenesis is currently determined by geographical location and surgeon preference. The optimal treatment is unknown and the majority of articles on technique and outcome focus on personal case series with little standardisation of reporting and follow-up. Six thousand six hundred and ninety-one articles concerning the management of vaginal agenesis were systematically reviewed, with 162 fitting the inclusion criteria. Only one randomised control trial was included with the remaining articles made up of case series or case reports. The bowel vaginoplasty method was most commonly reported historically with 945 patients and 45 articles included. The Vecchietti procedure had the shortest operative time, but the highest number of urological injuries (2.1%). The split thickness procedure had the highest infection rate (4.2%) and re-operation rate (7.84%). Overall, the conservative method using dilation had the fewest complications, with an average vaginal length of 6.65cm (± 1.39cm). However, with an operative procedure full consent is imperative, as is an understanding of the need for postoperative dilation with the majority of techniques.

An Assessment of Organ-at-Risk Dose and Interfraction Variability Using 4 Different Applicators for Intracavitary Gynecologic HDR Brachytherapy

There are dosimetric advantages associated with the use of multi-channel (MC) cylinders for intracavitary gynecologic brachytherapy, including reduced dose to organs at risk (OAR) and the ability to shape target coverage. Single-channel (SC) cylinders have been shown to have reproducible doses to OAR between fractions (i.e., inter-fraction variability), but this has not been shown for MC cylinders. This study aimed to assess doses to OAR and inter-fraction variability amongst three different MC cylinders and one SC cylinder for HDR brachytherapy. Forty-eight women (38 endometrial cancer, 10 cervical cancer) were included. MC vaginal cylinders were used in 27 (7 13-channel applicator, 11 CET MC Cylinder [CET], 9 Ovoid and Cylinder [O&C]) and one SC cylinder (electronic applicator) was used in 21 patients. The CET cylinder is an MC cylinder designed in-house with 4 outer channels and 1 central channel. CT scans were obtained at treatment planning and prior to each fraction. D0.1 cc, D1 cc and D2 cc doses were recorded for the OAR including the rectum (R), bladder (B) and sigmoid (S) for each CT scan. Re-optimization of plans was not performed between fractions. OAR doses from the treatment planning CT (CT[p]) were compared to the average of OAR doses calculated at each treatment (CT[t]). One hundred seventy-eight fractions were delivered with a median dose per fraction of 6 Gy. Patients were treated with a median of 3 fractions to an average vaginal length of 4 cm and median prescription depth of 2 mm (range, 0 - 5 mm). Mean OAR doses for each applicator are shown in the Table. No significant difference was noted between OAR doses calculated at CT(p) and CT(t) for any applicator. Multivariate analysis was carried out adjusting for age, number of fractions, treatment length and prescription depth, assessing OAR doses for the CET MC cylinder versus the others. Rectal D0.1, 1 and 2 cc doses determined from the CT(t) scan dosimetry were 9.7%, 9.7%, and 9.3% (p < 0.05) less, respectively, for the CET MC cylinder compared with the other applicators. Differences in bladder and sigmoid doses between applicators were not observed. OAR doses did not significantly vary between planning and treatment delivery for any of the applicators. This suggests that after verifying a reproducible insertion, re-planning is not required between fractions for MC cylinders. Comparison of OAR doses between applicators revealed that the CET MC cylinder was associated with the lowest dose to the rectum.Poster Viewing Abstract 2568; TableMean OAR D0.1, 1, and 2 cc doses as % of prescription dose (with standard error) at CT(t) and CT(p)13-channel applicator (CT[p])13-channel applicator (CT[t])CET (CT[p])CET (CT[t])O&C (CT[p])O&C (CT[t])Electronic Applicator (CT[p])Electronic Applicator (CT[t])RD0.1 cc85.9 (+/-6.2)83.2 (+/-6.0)69.7 (+/-4.9)71.9 (+/-4.8)81.8 (+/-5.5)82.1 (+/-5.3)91.6 (+/-3.6)98.2 (+/-3.4)RD1.0 cc72.8 (+/-5.0)71.7 (+/-4.5)57.6 (+/-4.0)59.6 (+/-3.6)70.0 (+/-4.4)69.7 (+/-4.0)72.7 (+/-2.9)77.9 (+/-2.6)RD2.0 cc66.2 (+/-4.7)65.5 (+/-4.2)51.7 (+/-3.8)53.6 (+/-3.3)63.5 (+/-4.2)63.3 (+/-3.7)64.2 (+/-2.7)69.0 (+/-2.4)BD0.1 cc80.8 (+/-7.4)77.0 (+/-8.7)66.8 (+/-5.9)68.2 (+/-7.0)85.6 (+/-6.5)79.7 (+/-7.7)87.6 (+/-4.3)81.9 (+/-5.0)BD1.0 cc70.6 (+/-6.2)67.2 (+/-6.2)57.0 (+/-5.0)57.3 (+/-5.0)74.8 (+/-5.4)68.9 (+/-5.4)69.9 (+/-3.6)64.4 (+/-3.6)BD2.0 cc65.9 (+/-5.8)62.7 (+/-5.5)53.9 (+/-4.6)52.5 (+/-4.4)69.0 (+/-5.1)63.6 (+/-4.8)62.1 (+/-3.4)56.9 (+/-3.2)SD0.1 cc53.6 (+/-12.8)59.6 (+/-11.9)63.5 (+/-10.4)57.2 (+/-9.5)38.9 (+/-13.2)39.3 (+/-11.9)47.6 (+/-12.3)60.0 (+/-11.1)SD1.0 cc46.2 (+/-8.4)48.8 (+/-8.1)45.5 (+/-6.8)43.5 (+/-6.5)30.8 (+/-8.7)30.7 (+/-8.1)34.0 (+/-8.3)38.5 (+/-7.6)SD2.0 cc45.0 (+/-7.2)45.0 (+/-6.9)39.4 (+/-5.9)38.2 (+/-5.5)27.5 (+/-7.4)27.5 (+/-6.9)26.4 (+/-7.2)31.2 (+/-6.4) Open table in a new tab

A study on congenital vaginal malformations in rural population of North Maharashtra Region

ObjectiveTo find out types of vaginal malformations in rural population of North Maharashtra, to study various operative procedures designed for vaginal malformations and to evaluate the use of rubber mould for McIndoe operation.MethodEighteen cases of congenital vaginal malformations were screened in OPD. We found seventeen patients of primary amenorrhea were having congenital vaginal malformation. One patient of stricture of upper vagina was having normal menstruation. They were investigated according to the standard protocol. After clinical examination patients were investigated byU.S.G. and I.V.P. sos and diagnostic laparoscopy, the investigations for operation were Hb, Urine (Alb. Sug. Microscopy), BSL (R), BUL, Serum creatine. Then all of them were operated between Jan.1985 to Oct. 2002 under general anaesthesia &amp; the analysis was done. The type of operations done were 1) Mcindoe operation 2) Pull through operation 3) Excision of imperforate hymen.ResultsTwelve cases of Rokitansky-Kuster-Hauster Syndrome were operated by McIndoe technique. None of the patients developed V.V.F. or R.V.F. The average vaginal length was 8.76 cms.; Four cases of imperforate hymen had undergone excision &amp; Two cases of congenital stricture in upper vagina had undergone pull through operation.ConclusionsUse of foam rubber mold is without any pressure necrosis of bladder or rectum.

Laparoscopy-insisted vaginoplasty with peritoneum in patients with androgen insensitivity syndrome

To investigate the technique and therapeutic effect of laparoscopy-insisted vaginoplasty with peritoneum in patients with androgen insensitivity syndrome. From May. in the Fifth People' s Hospital of Shenzhen. The therapeutic effect was retrospectively analyzed. Laparoscopy-insisted vaginoplasty was successfully completely with peritoneum in patients with androgen in 4 cases. Ileumtivity segyndroment was used instead of peritoneum in one case. Open operation was not adopted in any cases. The ectopic testicles were removed during operation in 4 cases. The average operation time and bleeding volume was 60 min and 20 ml, respectively. Rectum, bladder and urethra were not injured in any case. The average vaginal length was 9 cm (range 8-10 cm) 21-28 days after operation. 6 months after operation, the surface of reconstructed vagina was smooth, ruddy and flexible, with satisfactory anatomical and functional results. Normal sexual activity was achieved in 2 cases. Laparoscopy-insisted vaginoplasty with peritoneum could be used for female patients with androgen insensitivity syndrome. The ectopic testicles should be removed. Estrogen supplement and psychological guide after operation are also important.