Obstet Gynecol Sci.  2024 Nov;67(6):541-549. 10.5468/ogs.24114.

Creation of neovagina in women with Müllerian agenesis (Mayer-Rokitansky-Küster-Hauser syndrome) using fresh human amnion

• Gari A
• Baradwan S
• Iskandarani R
• Alkhiary AY
• Abumohssin A
• Abu-Zaid A

• KMID: 2561017
• DOI: http://doi.org/10.5468/ogs.24114

Abstract

Objective
Several graft options can be used to construct a neovagina. This study aimed to evaluate the efficacy of creating a neovagina using a fresh human amnion in women with Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome.
Methods
Ten patients were analyzed retrospectively. Anatomical success was defined by a postoperative vaginal length ≥5 cm, and a width sufficient to comfortably accommodate the insertion of two fingers. Functional success was achieved when a score of >26.5 was attained on the Arabic validated version of the functional sexual function index (FSFI).
Results
Overall, the mean vaginal length before surgery was 2.15±0.85 cm (range, 1.5-4.5). The mean vaginal length after surgery was 5.5±0.53 cm (range, 5-6), and all patients (n=10) achieved anatomical success. The FSFI score after surgery was 29.2±2.4, and eight patients achieved functional success. The mean operative time and estimated blood loss were 83.5±50.31 minutes (range, 42-210) and 122.0±75.69 mL (range, 20-250), respectively. None of the patients required intraoperative blood transfusion or experienced injury to vital organs. Four patients developed postoperative leukocytosis within 48 hours, and one patient experienced chronic pelvic pain that lasted more than 6 months postoperatively. No major postoperative complications, such as pelvic abscesses, open wounds, chronic vaginal discharge, or reoperation, were reported.
Conclusion
In conclusion, surgical dissection of the vesicorectal space and utilization of fresh human amnion to create a neovagina over a vaginal mold are technically feasible and safe, and are linked to favorable anatomical and functional outcomes in MRKH patients with vaginal agenesis.

Keyword

Mullerian aplasia; Absence of vagina; Amnion; Sexuality; Saudi Arabia

Figure

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  Fig. 1 Photos of the fresh human amniotic membrane and the vaginal mold that were used for vaginoplasty in patients with vaginal agenesis. (A) Fresh human amniotic membrane was obtained from a patient who delivered within the last 6 hours prior to the vaginoplasty. The membrane was rinsed and cleaned repeatedly in normal saline solution and kept in this solution until used during vaginoplasty. (B) The rubber mold (vaginal dilator) was cut and adjusted prior to vaginoplasty. (C) The prepared amniotic membrane was sutured around the mold, with a condom acting as a barrier between them, before being inserted into the neovaginal cavity.

Reference

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