Neovagina creation methods and their potential impact on subsequent uterus transplantation: a review

Abstract

Congenital uterovaginal aplasia commonly occurs in Mayer-Rokitansky-K€ uster-Hauser syndrome. Various methods of neovagina creation exist, including nonsurgical self-dilation, surgical dilation, and surgical procedures involving skin or intestinal transplants. Subsequent uterus transplantation is necessary to enable pregnancy. We review the main characteristics, advantages, and disadvantages of established neovagina creation methods and discuss their suitability regarding subsequent uterus transplantation. Suitability criteria include sufficient vaginal length, absence of previous major intra-abdominal surgery, a natural vaginal axis, and a natural vaginal epithelium. In conclusion, Vecchietti-based laparoscopically assisted neovagina creation provides ideal functional conditions for uterus transplantation. Nonsurgical self-dilation and Wharton-Sheares-George vaginoplasty may also be suitable.

Uterus Transplantation with Live Donors: Screening Candidates in One French Center

“…They were often performed until recently and we had to exclude 20% of the potential MRKH patients for this reason. Self-dilatation should be recommended [45] for all MRKH patients with vagina atrophy. MRKH is often associated with unique kidneys: some were included and obtained healthy children but had more preeclampsia [19] and renal toxicity, which is more frequent with immunosuppressive therapy.…”

Living-Donor Uterus Transplantation: Pre-, Intra-, and Postoperative Parameters Relevant to Surgical Success, Pregnancy, and Obstetrics with Live Births

“…Recipients had all undergone Vecchietti-based neovaginoplasty [17,18] or created a neovagina by self-dilation. Neovaginoplasty techniques based on tissue transplants, particularly bowel segments, constituted an exclusion criterion due to the increased risk of bowel secretion-related infection during immunosuppression [14].…”

“…While these treatment options enabled women with MRKHS to have vaginal intercourse, the absence of the uterus remained untreatable, preventing them from experiencing pregnancy and having their own biological children, particularly in countries such as Sweden and Germany, where surrogacy is illegal or not accepted [12,13]. Now that UTx is gradually becoming established, attention has also begun to focus on the potential impact the various neovaginoplasty techniques may have on subsequent UTx [14].…”

The role of laparoscopy in paediatric and adolescent gynaecology.

“…Good functionality results from the fact that neovagina is covered with typical vaginal epithelium shortly after surgery, and functional vaginal length is achieved within a few days [ 41 ]. The anatomical rate of effectiveness is as much as 97–99%, and the neovagina usually maintains the right size even in the absence of regular sexual intercourse and does not require long-term dilatation [ 43 ]. In addition, this method eliminates the need for foreign tissues such as skin, peritoneum, and intestine that cause visible scars [ 41 ].…”

“…In addition, this method eliminates the need for foreign tissues such as skin, peritoneum, and intestine that cause visible scars [ 41 ]. The risk of intraoperative damage to the ureter, rectum, or bladder is 1–1.8% [ 43 ]. However, the formation of a neovagina can change the previous anatomy, modifying the balance of the pelvic floor and leading to a change in the angle of the urethra, lack of support, and excessive mobility.…”