McIndoe Procedure Research Articles

Management of partial müllerian agenesis: staged mcindoe procedure for the creation of a neovagina and utero-neovaginal unification

Management of partial müllerian agenesis: staged mcindoe procedure for the creation of a neovagina and utero-neovaginal unification

Flaps versus skin grafts in neovagina creation for vaginal agenesis

Background: Women with congenital uterovaginal agenesis have normal development of all secondary sexual characteristics. They face the cruel fact of being unable to bear children and enjoy sexual satisfaction. Good neo vaginal reconstruction is important in improving functional and psycho social impacts to womanhood. The aim of the study was to compare the three commonly done surgical procedures for vaginal reconstruction.Methods: All the vaginal agenesis patients who attended Department of plastic surgery Madras Medical College, Chennai during the period from August 2004 to April 2007 were included in our study.Results: In Abbe McIndoe procedure, graft take was full in all 7 cases with good cosmetic appearance. Flaps survived in all 10 patients underwent pudendal thigh flap surgery. 2 patients underwent horse shoe shaped labia minora flaps. The cosmetic appearance was fair because of the distortion of the labia. The mean vaginal depth obtained was 8 cm and width was 2 cm.Conclusions: Cosmetic appearance was good in patients who underwent McIndoe procedure as the genitalia were not distorted. Contracture rate was more in patients who underwent McIndoe procedure especially who were irregular in using stents. Flap procedure especially pudendal thigh flaps which has the least contraction rate is the preferable treatment option for such patients.

Tilapia fish skin as a new biologic graft for neovaginoplasty in Mayer-Rokitansky-Kuster-Hauser syndrome: a video case report

To describe a McIndoe procedure technique for surgical management of Mayer-Rokitansky-Kuster-Hauser syndrome with the use of Nile tilapia skin as a scaffold for the proliferation of new vaginal epithelium. Surgical video article. Local Institutional Review Board approval and written permission from the patient were obtained. There were no conflicts of interest. University hospital. A 17-year-old woman who presented at our gynecology department with the complaint of primary amenorrhea. At physical examination, she had a phenotypically normal vulva with no vaginal canal. Magnetic resonance imaging of the abdomen and pelvis revealed normal ovaries and absence of uterus and vaginal canal. No other congenital malformations were found. Karyotype was 46,XX. The McIndoe procedure involved only a vaginal approach. Labia minora were separated, and a transverse midline incision of 3cm was made. The vesicorectal space was progressively dissected. Blunt dissection was performed initially with digital separation of tissues. The neovagina was then inspected with the introduction of a vaginal speculum, allowing for review of hemostasis. Blunt dissection was continued with the aid of the speculum, to reach the appropriate vaginal dimensions. Subsequently, a vaginal acrylic mold covered with two pieces of processed and sterilized tilapia fish skin was inserted and accommodated into the newly created cavity. The external side of the tilapia skin, which maintained its grayish coloration after the removal of the scales, stayed in contact with the acrylic mold, while the white internal side of the tilapia skin, which was previously attached to the fish's muscle, stayed in contact with the walls of the neocavity. The mold was held in position by four multifilament polyglactin 1.0 sutures in the labia majora, thus preventing expulsion. Anatomic data, such as measurement of the final canal length, and histomorphologic analysis, 180days after surgery. The patient remained on bed rest for 9days, after which the tilapia fish skin had been partially reabsorbed. After this time, the acrylic mold was removed. A larger plastic mold was then inserted and the patient was advised to wear it day and night for the first postoperative month. The vaginal mold had to be worn each night until normal sexual intercourse was possible. The final canal length 180days after surgery was between 8 and 9cm. For the histopathologic analysis, fragments of the lateral vaginal wall were removed 180days after surgery and showed the presence of stratified squamous epithelium with five cell layers, ectasic blood vessels, and occasional desquamated epithelial cells. The procedure described offered this patient an anatomic and functional neovagina by means of a simple, safe, easy, effective, quick, and minimally invasive procedure. Limitations include the experimental nature of this study, based on a single case report with no long-term outcome results. The tilapia fish skin is a low-cost and widely available biomaterial.

77: Long-term psychological and physical impacts of McIndoe reconstruction in Mayer-Rokitansky-Küster-Hauser syndrome

The purpose of this follow-up study was to evaluate the short- and long-term psychological and physical impacts of McIndoe reconstruction in women with vaginal agenesis due to Mayer-Rokitansky-Küster-Hauser syndrome. This study was a follow-up survey of patients who underwent the McIndoe procedure from 2001 through 2016 and a previously described cohort of patients who underwent the procedure before 2001. A total of 73 women with Mayer-Rokitansky-Küster-Hauser syndrome underwent a McIndoe procedure at Mayo Clinic from 1988 through 2016; 27 (37%) answered a comprehensive questionnaire relating to quality of life, sexual function and satisfaction, body image, and sexual and gender identity. After the McIndoe procedure, 67% of women reported an improved quality of life; 67% had an enhanced perception of overall body image; 84% were satisfied with their relationships; and 33% felt that more counseling at the time of diagnosis, and years later, would have been helpful. Several women described psychological distress related to reproductive capacity. Quality of life, sexual satisfaction, and body image improved after the McIndoe procedure in women with Mayer-Rokitansky-Küster-Hauser syndrome. Structured counseling may improve the psychological burden associated with the syndrome.

A modified neo-vagina procedure in a low resource urogynecological unit: a case report of a 21\xa0year old with Mayer-Rokitansky-K\xfcster-Hauser (mrkh) Syndrome operated at Mbarara referral hospital, Southwestern Uganda

BackgroundAlthough vaginal agenesis as may occur in Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome is a rare condition, it is associated with not only anatomical problems but also serious psychological and social problems like painful sexual intercourse, primary amenorrhea and infertility. Surgery, which is aimed at reconstruction of a vagina of adequate length and width to serve the function, is the main method of treatment. Many methods for vaginal reconstruction have been described but each has its complications and limitations. The most commonly preferred procedure for treating this condition is the McIndoe vaginoplasty which involves dissection into the recto-vesical space, inserting two split thickness skin grafts folded over a mold in this newly created space and regular dilatation of the neovagina postoperatively to avoid stenosis. However surgeons with this expertise in this part of the world are rare to find and where they are available, the special molds on which to fold the skin grafts into the neovaginal space are not readily available.Case presentationA 21-year-old female with vaginal agenesis was operated on using a modification of the McIndoe procedure using a cylinder of a 60cm3 syringe as a vaginal mold/form and kept in place. We left a Foley in place for 10 days and we did a dye test after removing the syringe to ensure that there was no leakage resulting from fistula formation.ConclusionThe operation was successful and on subsequent monthly reviews of the patient, she has a patent functional vagina of about 9 cm in length at 8 months after the operation with resumption of sexual intercourse.

Novel Use of Bakri Balloon as Mold for the Placement of a Vaginal Graft

To demonstrate the use of Bakri Balloon as a vaginal graft mold. Over the years, there have been various materials and devices used as molds for vaginal graft placement during a modified McIndoe procedure. However, no mold type is considered standard. In this video, we demonstrate the novel use of a Bakri Balloon as a vaginal graft mold. The advantages of the Bakri Balloon include the adjustability in size to fit individual patient's needs, relative availability in gynecologic settings, and its ease of use. Postoperative removal is aided by the ability to deflate the balloon. The patient in this video had a foreshortened vagina following two prior gynecologic surgeries. A split thickness skin graft was harvested from the lower abdomen and carefully sutured around the Bakri Balloon. The graft with balloon was then sutured in place in the vaginal canal. The postoperative course was uncomplicated. The Bakri Balloon was successfully employed to restore a normal vaginal length in this patient and should be considered as a vaginal graft mold in a modified McIndoe procedure.

Mayer-rokitansky-kuster-hauser syndrome associated with severe inferior vena cava stenosis.

Precis. The postoperative course of a neovagina creation procedure in a young woman with Meyer-Rokitansky-Kuster-Hauser syndrome was complicated, despite prophylaxis, by extensive pelvic deep venous thrombosis secondary to unsuspected severe inferior vena cava stenosis. Background. Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome is characterized by congenital vaginal agenesis and an absent or rudimentary uterus in genotypical females. Malformations of the inferior vena cava (IVC) are not commonly associated with MRKH syndrome. We report a case of a patient with MRKH syndrome with severe IVC stenosis that was diagnosed when the patient presented with extensive pelvic deep venous thrombosis (DVT) during the postoperative course of a neovagina creation. Case. A 19-year-old female underwent a McIndoe procedure. Despite DVT prophylaxis, extensive pelvic DVT of the femoral vein was diagnosed on postoperative day 7. Therapeutic anticoagulation was initiated, and pharmacological and mechanical thrombolysis were performed. During these procedures, a hypoplastic IVC was noted. Conclusion. MRKH syndrome can be associated with IVC malformations, which constitute an anatomical risk factor for postoperative DVT.

Modified McIndoe procedure using a combined graft of autologus skin and porcine derived matrix (matristem™) in a patient with mullerian agenesis

To present a modification of our traditional technique of performing the McIndoe procedure. The modification was required due to insufficient autologus split thickness skin graft due to the patient's small body habitus and limited surface area available for harvesting. The graft was made utilizing a partial split thickness skin-graft obtained from the patient and utilizing a porcine derived extracellular matrix sheet as an additional substance to ensure a large enough graft to cover the vaginal mold.

Treatment of vaginal agenesis using a modified McIndoe technique: Long-term follow-up of 23 patients and a literature review

Congenital vaginal agenesis is a rare malformation with an incidence of one in 4000 to 5000 female newborns. The purpose of vaginal agenesis treatment is not only to create an adequate passageway for penetration but also to facilitate satisfactory sexual intercourse. To present the results of a modified McIndoe technique with respect to sexual function, vaginal length and complication rates in patients with vaginal agenesis. Between 2002 and 2010, 23 patients with vaginal agenesis were admitted to the Gynecology Clinic of Istanbul University School of Medicine (Istanbul, Turkey) for vaginal reconstruction. All patients underwent a modified McIndoe procedure. The long-term results with a follow-up period ranging from 18 to 118 months are presented. The postoperative mean vaginal length was 8.4 cm (range 6 cm to 11 cm) in 19 patients who used the mould regularly. Among 14 patients who used the mould regularly and had partners, only one experienced severe pain during intercourse and 13 reported that they were engaging in satisfactory sexual activity with mild or no pain, and with good mucosal sensitivity. Conversely, two of three patients who used the mould irregularly experienced severe pain during intercourse and had a mean vaginal length of 6 cm (range 4 cm to 8 cm). The findings suggest that a modified McIndoe technique is a simple, effective procedure for the treatment of vaginal agenesis; however, proper mould use after surgery remains the cornerstone of the treatment.

Septate uterus with complete vaginal agenesis: an undescribed Müllerian malformation

Mullerian malformations are the consequence of failure in the fusion or resorption processes of the two Mullerian ducts at around 9 weeks of gestation. The mean prevalence in the general population is as high as 7 %. Vaginal agenesis is a rare female congenital tract anomaly. Diagnosis is often made in adolescence due to amenorrhea or cyclic abdominal pain, and its incidence is around 1 in 4,000 female births. Mayer–Rokitansky–Kuster–Hauser (MRKH) syndrome is the most frequent manifestation, with a vaginal dimple of varying depth (2–7 cm) and sometimes a rudimentary uterus or horn. In this particular case, the goal of treatment (surgical or nonsurgical) is to allow normal sexual intercourse, but restoring fertility is not possible. Different approaches have been described, such as Ingram’s modification of the Frank technique, the McIndoe procedure, the Vecchietti method, and the Williams vaginoplasty with its Creatsas modification. Here, we report the first case of complete vaginal agenesis associated with a septate uterus to be described in the literature.

Vaginoplasty with oxidized cellulose: anatomical, functional and histological evaluation

To present and evaluate the histological, anatomical and functional results of the McIndoe procedure, as modified by the application of oxidized cellulose (Surgicel™) in women with vaginal agenesis. Eleven patients with vaginal agenesis underwent vaginoplasty using a mould that had been wrapped with oxidized cellulose. The surgeries were performed between January 2009 and January 2010. Eight of the patients had been diagnosed with Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome, and the remaining three had been diagnosed with cervicovaginal agenesis (CVA). The mean follow-up time was 14 months (range, 6-24 months), and it included clinical examinations and evaluation of the Female Sexual Function Index (FSFI). Neovaginal biopsies were taken at the time of surgery and 1-12 months after surgery. The histology of the samples was evaluated to determine squamous epithelialization of the neovaginal tissue over time, and the total collagen content of the neovaginas were compared with normal control subjects. For statistical analysis we employed the ANOVA test and the t-test. At 6 months, anatomical success was achieved in 100% of the MRKH syndrome patients (neovaginal length ≥ 6 cm), and functional success was achieved in 100% of the patients who started their sexual life (FSFI score ≥ 30). Biopsy results showed complete epithelialization of the neovagina after 5 months in all samples, and the collagen content was comparable to that of a normal vagina. One major postoperative complication occurred in a patient with CVA, which culminated in death. The uterovaginal canalization procedure was unsuccessful at creating an outflow tract for regular menses in all cases. The procedure described here offers patients a functional vagina by means of a simple and low-cost procedure that elicits squamous epithelialization of the neovaginal vault, with total collagen content similar to that of normal vaginal tissue. It is a potential alternative therapeutic approach for MRKH syndrome but not applicable to cases of CVA.

Vaginal reconstruction using no grafts with evidence of squamous epithelialization in neovaginal vault: A simple approach

To present a simple approach for vaginal reconstruction, without lining of the neovagina by means of any grafts. This was an observational prospective cohort study. Twenty-five patients with a known diagnosis of vaginal agenesis were enrolled in this study between 2003 and 2009. All patients underwent vaginoplasty in which the McIndoe procedure was used with no grafts. Then we assessed vaginal depth, quality of life, sexual function, self-image and surgical complications with an interview, examination and by filling in the standard questionnaires in regards to the outcome of the surgery. Moreover, punch biopsy was taken from the neovagina at 3-12 months after surgery and the histology of samples was evaluated to determine squamous epithelialization of the neovagina. Most of the patients in our study were satisfied with the outcome of surgery due to few complications. Moreover, punch biopsy after vaginal reconstruction determined complete epithelialization of the neovagina in six out of seven patients. The procedure described here offers patients a near-normal vagina with a simple, less invasive, low-cost procedure that provides squamous epithelialization of the neovaginal vault.

Should Progressive Perineal Dilation be Considered First Line Therapy for Vaginal Agenesis?

In women with vaginal agenesis progressive perineal dilation provides a minimally invasive method to create a functional vagina without the attendant risks or complications of traditional surgical options. We report our 12-year experience with this technique. Patients with vaginal agenesis treated at our institution were analyzed retrospectively and followed prospectively using case report forms and semistructured interviews. Patients diagnosed with vaginal agenesis were counseled on vaginal reconstruction options. Those electing progressive perineal dilation were instructed on the proper use of vaginal dilators by one of us (MRL) and advised to dilate 2 or 3 times daily for 20 minutes. All patients received physician, nursing and social work education and counseling. Parameters reviewed included primary diagnosis, start and end of vaginal dilation, dilation frequency, dilator size, sexual activity and whether the patient experienced pain or bleeding with dilation or sexual activity. Functional success was defined as the ability to achieve sexual intercourse, vaginal acceptance of the largest dilator without discomfort or a vaginal length of 7 cm. Univariate and multivariate analysis was performed to identify factors associated with successful neovaginal creation. From 1996 to 2008 we enrolled 69 females with vaginal agenesis in a progressive perineal dilation program. The primary diagnosis was Mayer-Rokitansky-Küster-Hauser syndrome in 64 patients. Mean age at the start of vaginal dilation was 17.5 years (range 14 to 35) Mean followup was 19 months (range 0 to 100). Four patients (5.7%) were lost to followup. In 7 of the remaining 65 patients (12%) treatment failed due to noncompliance and 50 (88%) achieved functional success at a median of 18.7 months. Patients who dilated frequently (once daily or greater) achieved a functional neovagina at a mean +/- SD of 4.3 +/- 2.4 months. Functional success correlated positively with frequent (once daily or greater) dilation and the initiation of sexual activity. Complications were minor. Three patients reported infrequent pain and 2 reported a single episode of bleeding with dilation. A total of 18 sexually active patients reported satisfactory intercourse without dyspareunia. Progressive perineal dilation for neovaginal creation is a valuable, minimally invasive therapy to create a functional vagina with a high success rate and a much lower complication rate than that in published surgical series. Given these findings, progressive perineal dilation should be offered as first line therapy in adolescents with a congenitally absent vagina.

Squamous Papilloma With Hyperpigmentation in the Skin Graft of the Neovagina in Rokitansky Syndrome: Literature Review of Benign and Malignant Lesions of the Neovagina

Background It is rare for a benign or malignant neoplasm to develop in a neovagina. Case This is the first report of a squamous papilloma with hyperpigmentation which developed in the neovagina 12 years after a McIndoe procedure was done with a split-thickness skin graft from the patient's buttock. The patient had congenital absence of the vagina and uterus (Rokitansky syndrome, Mayer-Rokitansky-Küster-Hauser syndrome, MRKH syndrome). It presented as post-coital blood spotting for 3 months. Conclusion As a routine, all cases of vaginal construction regardless of the reason for the surgery or the lining of the neovagina should have a continuous annual examination and careful inspection of the entire vagina. Biopsy of any unusual finding should be done. Despite the dark color of the vaginal lesion, bleeding and rapid appearance our patient had a benign tumor. Radiation therapy to the neovagina and prolonged treatment with podophyllin and cauterization should be avoided.

Functional and anatomic results of amnion vaginoplasty in young women with Mayer-Rokitansky-Küster-Hauser syndrome

To evaluate the surgical outcome and the long-term anatomic and functional results in young women with Mayer-Rokitansky-Küster-Hauser Syndrome (MRKH) undergoing neovaginal creation with amniotic membranes. Evaluation of surgical and functional outcome according to clinical records and validated questionnaires about sexuality (Female Sexual Function Index [FSFI]) over a 1.5-year follow-up period. University hospital and referral center for pediatric and adolescent gynecology. Seven patients with congenital vaginal aplasia with a mean age of 20.86 +/- 3.56 years (range 17-26 years). McIndoe procedure modified by the application of human freeze-dried amniotic membranes. Anatomic success was defined by a vaginal length >or=8 cm, and a width allowing the easy introduction of two fingers. FSFI scores were applied to define functional results. Mean neovaginal length was 9.3 cm (range 4-12 cm). The mean FSFI score was 30.0 +/- 6.9. Major operative complications occurred in one patient. In six out of seven patients satisfactory anatomic and functional results were achieved. The surgical dissection of the vesicorectal space and the application of human amnion over a vaginal mold to create a neovagina results in satisfying anatomic and functional outcome with low perioperative morbidity in MRKH patients.

Anatomic and histological characteristics of vagina reconstructed by McIndoe method

Congenital absence of vagina is known from ancient times of Greek. According to the literature data, incidence is 1/4 000 to 1/20 000. Treatment of this anomaly includes non-operative and operative procedures. McIndoe procedure uses split skin graft by Thiersch. The aim of this study was to establish anatomic and histological characteristics of vagina reconstructed by McIndoe method in Mayer Küster-Rockitansky Hauser (MKRH) syndrome and compare them with normal vagina. The study included 21 patients of 18 and more years with congenital anomaly known as aplasio vaginae within the Mayer Küster-Rockitansky Hauser syndrome. The patients were operated on by the plastic surgeon using the McIndoe method. The study was a retrospective review of the data from the history of the disease, objective and gynecological examination and cytological analysis of native preparations of vaginal stain (Papanicolau). Comparatively, 21 females of 18 and more years with normal vaginas were also studed. All the subjects were divided into the groups R (reconstructed) and C (control) and the subgroups according to age up to 30 years (1 R, 1C), from 30 to 50 (2R, 2C), and over 50 (3R, 3C). Statistical data processing was performed by using the Student's t-test and Mann-Writney U-test. A value of p < 0.05 was considered statistically significant. The results show that there are differences in the depth and the wideness of reconstructed vagina, but the obtained values are still in the range of normal ones. Cytological differences between a reconstructed and the normal vagina were found. A reconstructed vagina is smaller than the normal one regarding depth and width, but within the range of normal values. A split skin graft used in the reconstruction, keeps its own cytological, i.e. histological and, so, biological characteristics.

Distension versus traction in laparoscopically assisted balloon vaginoplasty for management of vaginal aplasia

Creation of a neovagina in women with vaginal aplasia using laparoscopically assisted balloon vaginoplasty (LAB-V) has been described previously [1]. The creation of the neovagina depends on the traction and distension of the Foley catheter balloon. Alternative procedures such as sigmoid neovaginoplasty, McIndoe procedure, and peritoneoplasty are more technically demanding and have higher complication rates [1]. Preliminary results attest to the safety and effectiveness of LAB-V [1,2]. It is possible that traction contributes length to the neovagina, while distension contributes width. The most important contributing factor to satisfactory sexual intercourse is unknown. The aim of the present prospective study was to compare the effects of postoperative predominant traction and predominant distension on penetration and sexual satisfaction among women undergoing LAB-V and their partners. Eighteen women with vaginal aplasia were included in the study. Sexual satisfaction was measured using a visual analogue scale from zero to 100 and divided into 10 compartments, with 100 representing maximum satisfaction and 0 representing no satisfaction. Each woman's partner was assessed using a similar scale to measure depth of penetration and sexual satisfaction. After counseling about the procedure and the alternatives, the patients were randomly allocated to either the predominant distension group (PD) or the predominant traction group (PT) after informed consent was obtained. Ethical approval was granted by the Department of Obstetrics and Gynecology. The operative procedure was the same for both groups [1] and was performed by one of the authors [AME]. Postoperative care consisted of preventing infection [1], and controlled traction and distension in each group but at different levels. In the PD group, the balloon was distended at 5 mL/day to a maximum of 40 mL reached on the seventh postoperative day. The catheter was then removed the following day. Tractionwas performed at a rate of 1 cm per day. In the PT group, traction was done daily using the catheter to the level of patient tolerance (maximum 3 cm) and controlled distension at a rate of 3 mL every other day. Counter traction was applied in both groups every 20–30 minutes during the

Sensibility of vagina reconstructed by McIndoe method in Mayer-Küster-Rokitansky-Hauser syndrome

Congenital absence of vagina is a failure present in Mayer-Küster-Rokitansky-Hauser syndrome. Treatment of this anomaly includes nonoperative and operative procedures. McIndoe procedure uses split skin graft by Thiersch. The aim of this study was to determine sensitivity (touch, warmness, coldness) of a vagina reconstructed by McIndoe method in Mayer-Küster-Rokitansky-Hauser syndrome and compare it with the normal vagina. A total of 21 female persons with reconstructed vagina by McIndoe method and 21 female persons with normal vagina were observed. All female persons were devided into groups and subgroups (according to age). Sensibility to touch, warmness and coldness were examined, applying VonFrey's esthesiometer and termoesthesiometer for warmness and coldness in three regions of vagina (enter, middle wall, bothom). The number of positive answers was registrated by touching the mucosa regions for five seconds, five times. The obtained results showed that female patients with a reconstructed vagina by McIndoe method, felt touch at the middle part of wall and in the bottom of vagina better than patients with normal one. Also, the first ones felt warmness at the middle part of wall and coldness in the bottom of vagina, better than the patients with normal vagina. Other results showed no difference in sensibility between reconstructed and normal vagina. Various types of sensibility (touch, warmness, coldness) are better or the same in vaginas reconstructed by McIndoe method, in comparison with normal ones. This could be explaned by the fact that skin grafts are capable of recovering sensibility.

The management of vaginal agenesis: report of 104 cases

To present the results obtained in 104 cases of vaginal aplasia resolved with self-dilatation or with surgical procedures such as the McIndoe or Williams operations. Retrospective study. Departments of obstetrics and gynecology of universities in Bologna, Modena, and Messina, Italy. One hundred four cases of vaginal aplasia. Self-dilatation and surgical procedures such as the McIndoe or Williams operations. Outcome of the treatment. From 1977 to 2002, 104 cases of vaginal agenesis were treated. The mean age of the treated patients was 16.5 years old (range, 13-18 years). After 6 months of self-dilatation, 41 subjects obtained a new cavity of about 10-12 cm in length. In 14 patients, a space ranging from 3 to 5 cm was obtained. The technique failed in 49 patients. Fourteen patients underwent the Williams surgical procedure, while the remaining 49 patients underwent to the McIndoe procedure. All patients were successfully treated, and the only complication, a rectovaginal fistula that was repaired, occurred in one case of the McIndoe operation. Self-dilatation should be the first approach because of its high success rate; the Williams surgical approach should be chosen when self-dilatation partially fails or when previous surgical attempts are unsuccessful. Finally, the McIndoe procedure and its variants should be used when self-dilatation completely fails.

A detachable porous vaginal mold facilitates reconstruction of a modified McIndoe neovagina

Objective To release a new design for a detachable porous vaginal mold to facilitate reconstruction of a modified McIndoe vaginal mold. Design We constructed a detachable, porous vaginal mold with a plastic laboratory centrifuge tube with multiple holes throughout the entire tube. Setting Patients in a national tertiary medical center. Patient(s) Four patients of congenital vaginal agenesis received the modified McIndoe procedure. Intervention(s) Two full-thickness skin grafts removed from the inguinal region were used to cover the detachable porous plastic vaginal mold; the mold was then inserted into the neovaginal cavity and kept in place by sutures between the mold and labia majora. The vaginal mold was removed on day 12 after the operation. All patients adhered to the follow-up instructions. Main outcome measure(s) Description of the accessibility of a neovaginal mold. Result(s) The vaginal mold is helpful in taking care of the vaginal wound in that it allows easy removal of wound secretion and local cleansing douches. All grafts took completely and recovered well. No detachment of the graft occurred. Conclusion(s) The advantages of the detachable porous vaginal mold made from a plastic centrifuge tube are that it is readily available, allows for easy wound care, and, as a fixed point, prevents graft detachment or inversion and thus may lead to a promising result for a modified McIndoe vaginal reconstruction.