McIndoe Technique Research Articles

A rare case: Neovagina creation using McIndoe technique and total surgical approach in a patient with Mayer-Rokitansky-Küster-Hauser syndrome

This case report presents an 18-year-old female patient diagnosed with Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome, a rare congenital anomaly causing primary amenorrhea. MRI revealed vaginal agenesis and a left hemiuterus associated with hematosalpinx and cervical agenesis, while both ovaries were normal. The patient underwent successful neovagina creation using the McIndoe technique, involving a split-thickness skin graft from below the umbilicus. Postoperative follow-up showed excellent graft adherence and significant improvement in sexual function and quality of life. This case highlights the efficacy of the McIndoe technique for neovagina creation in MRKH syndrome and underscores the importance of a multidisciplinary approach in diagnosis and treatment, including psychological support.

Evaluating sexual satisfaction with the modified McIndoe technique in urogenital disorders by Barcelona Scale

Evaluating sexual satisfaction with the modified McIndoe technique in urogenital disorders by Barcelona Scale

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.

Outcomes of Vaginoplasty Using Pudendal Thigh Flap in a Tertiary Care Hospital

Objective: To evaluate the outcomes following vaginoplasty by pudendal thigh flap.
 Study Design: Retrospective longitudinal study.
 Place and Duration of the Study: Plastic surgery Department, Shifa International Hospital, Islamabad Pakistan, from Jan 2010 to Dec 2021.
 Methodology: Vaginal reconstruction was done using bilateral pudendal thigh flap in 20 patients with vaginal defects during eleven years, 2010-2021. 
 Results: All patients were adults with an age range from 18 to 41 years. Five were married, and 15 were unmarried patients at the time of surgery. Out of the 20 patients, 10(50%) were diagnosed with Mayer Rokitansky Kuster Hauser syndrome, 9(45%) with isolated vaginal atresia and 1(5%) with s/p resection angiosarcoma. The mean vaginal length was 9.0±0.46cm, one year post-operatively. Two patients (10%) developed necrosis of the distal part of the unilateral flap followed by infection, which was managed conservatively, and the other was managed with the McIndoe technique. One patient developed a cutaneous fistula which was excised. All flaps survived completely in the rest of the 19(95%) patients.
 Conclusion: Vaginoplasty using pudendal thigh flap was a safe and reliable method for vaginal reconstruction and showed adequate functional and aesthetic results.

Classical McIndoe Technique Versus the McIndoe Technique with a Neovaginal PACIENA Prosthesis® and No Skin Graft.

An observational, retrospective study was completed to compare the results of the PACIENA clinical trial (using the modified McIndoe technique) with a historical control group of nine patients who were operated on at San Juan University Hospital (1992–2015) using the classic technique. The PACIENA clinical trial included seven patients with vaginal agenesis who were operated on at two reference sites (May 2017–May 2018) using a neovaginal polylactic acid (PLA) prosthesis (PACIENA® prosthesis) and avoiding the use of a skin graft. The results illustrate a reduction in the length of surgery, 86.43 ± 4.75 min in the group with no skin graft compared to 155.56 ± 28.44 in the control group (p < 0.05); and reduction in the length of hospitalization time. Differences were also registered in the length of the neovagina, the average being 8.93 ± 1.42 cm for cases and 6.56 ± 1.13 cm for controls, with no differences in neovaginal epithelialization times or in the satisfaction of sexual relations occurring between groups. The modification of the classical McIndoe technique using the neovaginal PACIENA® prosthesis appears to be successful, obtaining good clinical results with shorter surgery and hospitalization times.

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.

Anatomical and Sexual Functions at Post Neovagina operation on Mayer Rokitansky Kuster Hauser Syndrome (MRKH) Patients with Sigmoid ,Amnion and Conventional Methods in Dr. Soetomo Hospital

ABSTRACT Background: The Mayer–Rokitansky–Kuster–Hauser (MRKH) syndrome is congenital malformation due to utero‐vaginal agenesis. For many years Dr Soetomo Hospital has been applying McIndoe technique using biomaterial amnion. Recently, in collaboration with digestive surgery, neovagina operation using sigmoid was performed. However, no data are available on the complications, anatomic, and functional results of the neovagina operation using sigmoid and amnion. Methods: MRKH patients who have performed neovagina operations from January 2011 to December 2014 were involved in this case review. The anatomical function was measured based on minimal vaginal length of more than 6 cm and width of 3 cm, while sexual performance is measured by Female Sexual Function Index (FSFI), which is above 23, and Female Sexual Distress Score Revised (FSDSR), whose score is &lt; 11. Result: In 4 years period, there were 6 cases of MRKH underwent neovagina (1 used sigmoid and 5 used amnion) at Dr Soetomo Hospital. All of them had a satisfying anatomical and sexual function. Even though neovagina operation significantly reduces sexual distress, but it does not necessarily mean alleviate as seen by the high FSDSR score. Neovagina using amnion has faster operation time and cheaper with the same length of hospital stay than sigmoid neovagina. Sigmoid neovagina has a better vaginal length, lubrication and no need dilatation after operation, but it has higher complication risk. Conclusion: The Neovagina technique should be used at Soetomo Hospital depends on patient wishes and circumstances. For those who have strong financial support and are not willing to do manual dilatation, they should use the sigmoid neovagina, while those who are able to do manual dilatation, then the amnion neovagina is a good choice.Keywords: Neovagina, MRKH, sigmoid, amnion, anatomic function

The Modified McIndoe Technique: A Scar-free Surgical Approach for Vaginoplasty With an Autologous Micromucosa Graft

To evaluate the effect of a scar-free surgical approach, the modified McIndoe technique, in cases of vaginal agenesis. Seven patients with Mayer-Rokitansky-Kuster-Hauser syndrome underwent vaginoplasty with the modified McIndoe technique. Mucosa grafts harvested from the vulva were minced into small particles and transplanted to the neovagina. Epithelization in the neovagina is approximately 20 times in size than that in the mucosa harvested from the donor site. An adequate vaginal length was obtained in all cases, with a minimal change in genital appearance and invisible scars. All 4 sex-active patients reported satisfactory sexual experiences, with spontaneous lubrication during intercourse. With the modified McIndoe technique, using an autologous micromucosa graft harvested from the vulva and the buccal cavity, we can physiologically reconstruct a new mucosa-lined vagina with minimal sacrifice.

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.

Amniotic Membrane as Allograft for Construction of Neovagina by McIndoe Technique in Vaginal Agenesis

&lt;p&gt;&lt;strong&gt;BACKGROUND: &lt;/strong&gt;To assess the anatomical and functional results of neovagina creation with amniotic membrane.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;METHODS: &lt;/strong&gt;We operated on three young women with vaginal agenesis two of whom had a diagnosis of Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome and the other mixed gonadal dysgenesis. The mean age was 29.67 years (range 28-33). A fresh amniotic membrane retrieved from a Cesarean section on the same operation date was prepared over a mould and inserted into the newly formed tunnel between the bladder and the rectum as per McIndoe technique. The patients were followed up for one year minimum. &lt;/p&gt;&lt;p&gt;&lt;strong&gt;RESULTS: &lt;/strong&gt;Mean vaginal depth achieved was 8, 10 and 7 cm (average 8.3 cm) at the 12 month follow-up clinic. Two patients expressed having satisfactory sexual life at follow-up interview. One patient who had infrequent coitus and neglected appropriate use of mould needed further follow-up in clinic and self-dilation.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;CONCLUSİONS: &lt;/strong&gt;McIndoe vaginoplasty with fresh-homologous amniotic membrane is an effective low-risk procedure. It can produce good results in fairly short time span with modest demand on patient compliance and rare morbidity.&lt;/p&gt;

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.

Evaluation of vaginal agenesis treated with the modified McIndoe technique: A retrospective study.

Retrospective analysis of cases that have undergone neovagina operation because of congenital vaginal agenesis was objected. Seven cases applying with the complaints of primary amenorrhea or inability to have sexual intercourse were in the study. The cases were diagnosed with congenital vaginal agenesis and operated at Mustafa Kemal University Training and Research Hospital between 2011 and 2014. Vaginoplasty by the modified McIndoe method was performed in all cases. The main complaint, chromosomal analysis, duration of operation, preoperative and postoperative vaginal length, complications, postoperative treatment, and satisfaction from the sexual intercourse were all evaluated. Average age of our patients was 28.14±8.61 (19-39) years. One patient was 46XX-45X0 mosaic Turner syndrome), 1 patient was 46XY (testicular feminization), and other 5 patients were 46XX. The average duration of operation was 2.7±0.56 (2-3.5 h). Postoperative infection was observed in 1 patient. In this infected patient, graft failure occurred and debridement was performed in reoperation. No early complications were seen in the others. Preoperative and postoperative average vaginal lengths were 1.85±0.62 (1-3 cm) and 8.71±1.11 (7-10 cm), respectively. Dyspareunia occurred in 2 cases that were not able to use dilatator regularly: 1 because of cancelation of marriage and the other because of postoperative infection; regular sexual life was achieved in remaining 5 (71%) cases. Although there is no consensus about the ideal method of making a functioning vagina among different specialties. The modified McIndoe technique is the most applied method by gynecologists and simple, minimally invasive and with low morbidity.

Restoration of a total vaginal closure following McIndoe vaginoplasty

Vaginal aplasia is a rare congenital anomaly, and McIndoe technique is the most preferred for this anomaly. Here, the authors present an unusual case with a total vaginal closure following McIndoe vaginoplasty, its management, and surgical tips and reviewed the related literature.

The clinical, structural, and biological features of neovaginas: a comparison of the Frank and the McIndoe techniques

ObjectiveTo compare two methods of neovagina construction, the Frank and McIndoe techniques, in terms of structural and biological aspects. Study designA total of 55 subjects were included in this retrospective study: 43 underwent the Frank technique (FT) and 12 underwent the McIndoe technique (MT). A clinical evaluation and a comparison of the structural (color, shine, presence of hair, and histology) and biological (bacteriological, pH, and hormonal determinations) features were performed. Statistical analysis was performed using the Fisher and Mann–Whitney tests. ResultsThe time to achieve a functional neovagina using the FT was longer than when using the MT (9.8±5.3 versus 5.8±2.9 months) (p=0.01). The neovaginal wall of the MT skin grafts was more rigid and drier, and it did not exhibit a shine in the way that the FT skin grafts did. The lining of the cavity formed by the FT in all subjects was similar to that of vaginal mucosa, whereas the lining formed by the MT persisted as a skin graft in 83.3% of the cases. The pH was lower for the FT (p<0.01), and Döderlein bacilli were present in 90% of the FT neovaginas but absent from the MT neovaginas. In the latter, flora with anaerobic bacteria was present. Hormonal cytology showed estrogen activity in 100% of the FT neovaginas, but there was no such activity in the MT neovaginas. ConclusionsOur data suggest that the FT may be clinically, structurally, and biologically superior to the MT for the creation of neovaginas and is also less costly.

Activité sexuelle et qualité de vie chez les patientes atteintes d’un syndrome de Mayer-Rokitansky-Kuster-Hauser

ObjectivesThis study evaluated the sexual activity and the quality of life in patients with a Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome. Patients and methodsThe study is based on a series of patients hospitalized for the treatment of MRKH syndrome in CMCO between 1997 and 2010. Through the medical reports, we recovered information about the pathology, the treatment given and the psychological support proposed to or wished by the patients. The patients also had to answer a questionnary concerning the quality of the informations they received about the treatment, the different types of supports proposed and wanted, their life as a couple and how they communicated about their disease. ResultsEleven medical reports have been reviewed. The patients were aged 21 in average at the moment of the treatment. Three patients had some associated malformations. Different methods of treatment were represented (Frank's method, Vecchietti's technique, sigmoid vaginoplasty, McIndoe's technique). Sexual intercourse was assessed as satisfactory by 4 patients. In 8 cases, the partner accepted well the pathology. Only 4 out of the eleven medical reports mentioned a psychological support. Nine out of the eleven patients accepted to answer the questionnary. Discussion and conclusionThe review of the literature and our own results show that the patients with MRKH syndrome have a real need for psychological support. They are able to have sexual intercourse that is satisfactory in the domains of excitation, lubrification and desire, especially after treatment. The main problem is the inability to bear children, a problem which might by solved by the future researches about uterus graft and the evolution of the laws concerning gestational surrogacy.

English

Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome is a congenital malformation of vertical fusion defect of mullerian system characterized by an absence of the vagina associated with a variable abnormality of the uterus and the urinary tract but functional ovaries. We are reporting 21 years primary ammenorrhea case. Clinically it was diagnosed as Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome, which was confirmed, by sonography and laparoscopy. She was treated with Mcindoe technique. Counseling before the surgery was done followed by rehabilitation as both of them play pivotal role in such treatment. Counseling and rehabilitation after the vaginoplasty is equally important.

The Morphological Aspects of Neovaginoplasty Using Oxidized Cellulose Membrane (Interceed®)

Objective: The purpose of this study was to evaluate the postoperative morphologic aspects of neovaginoplasty by the McIndoe technique with the use of an oxidized cellulose membrane (Interceed®) – an absorbable adhesion barrier – to correct congenital vaginal defects. Design: This study was designed as a prospective study. Patients and Methods: The sample consisted of 10 patients treated at the Department of Urogynecology, Federal University of São Paulo, 7 patients with Mayer–Rokitansky–Küster–Hauser Syndrome, and 3 patients with congenital vaginal atresia. In order to evaluate the epithelization process, monthly biopsies for the first 3 months and then on the 9th month after neovaginoplasty using Interceed, were collected. Results: In all patients, lamina propria rich in blood vessels and epithelioid cells were found in a vaginal fragment after 1 month of the neovaginoplasty. Typical vaginal epithelium was also observed and the reaction for identification of glycogen (PAS) was positive 9 months after surgery in all cases. Conclusions: The oxidized cellulose membrane proved to be a suitable material to use as coating of the neovagina for the correction of congenital defects such as vaginal agenesis. It is possible to obtain a typical vaginal epithelium after the use of this absorbable adhesion barrier. (J GYNECOL SURG 29:169)

Letter to the Editor Report of surgical correction of a cervicovaginal agenesis case: cervicovaginal reconstruction with pudendal thigh flaps

Letter to the Editor Report of surgical correction of a cervicovaginal agenesis case: cervicovaginal reconstruction with pudendal thigh flaps

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.

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.