Twenty years of experience with Krzeski’s cystovaginoplasty for vaginal agenesis in Mayer‐Rokitansky‐Küster–Hauser syndrome: anatomical, histological, cytological and functional results

Abstract

RESULTSThe anatomical result was good in 37 patients during a mean (range) follow-up of 9 (0.25-19) years; the result was good in 30 patients, but seven developed vaginal stenosis that was successfully repaired. There were two cases of post-coital vesicovaginal fistula (VVF) at 18 months after CVP. Vaginal biopsies showed epithelialization of the posterior vaginal wall and gradual metaplastic changes from urothelium to stratified nonsquamous epithelium. Cytological smears showed a normal biphasic pattern and neovaginal susceptibility to hormonal milieu. In all, 27 patients (73%) responded to the questionnaire. All had sexual partners and started sexual intercourse at a mean of 14 months after CVP; 89% experience orgasms and in 48% the vagina was the source; 40% sometimes used lubricants and seven (26%) used vaginal dilators. Lower urinary tract symptoms (LUTS) after CVP were reported by 19 (66%) of the women and in six the LUTS were persistent. One patient was not satisfied with the functional and anatomical result of CVP, 89% declared that it improved sexual life, 93% would undergo CVP again and in 92% the quality of their sexual life was improved. All patients, when asked, stated that they would recommend CVP to another patient with MRKHS. CONCLUSIONSVaginal reconstruction by CVP is characterized by good anatomical and functional results, sustained by long-term observation. The resultant epithelium is very similar to that of the native vagina in histology and function. All vaginas are functional and the level of patient satisfaction was high. The level of complications was acceptable, but in some patients LUTS can persist. KEYWORDS PATIENTS AND METHODSBetween 1981 and 2000, 38 patients (mean age 22.5 years, range 18-40) with MRKHS underwent CVP. A physical examination was used to evaluate the anatomical results, 27 patients had vaginography, and biopsies of the neovaginal wall and cytohormonal smears were taken in two. Functional sexual and urinary results, and opinions on CVP, were evaluated by an inventory mailed to 37 patients in 2000.

FUNCTIONAL AND ANATOMICAL RESULTS AFTER M c INDOE VAGINOPLASTY

“…13 This similarity of neovagina to the normal one extended to include the epithelial lining. 14 Although most of studies reported a high success rate of Mc Indoe procedure to restore normal sexual function which varied from 75% in some series up to 100% in other studies, 15 yet none of them used a specific surveying scale to accurately assess the whole sexual satisfaction. 16 Instead of that, most of these studies relied only on the presence of lubrication and orgasm or absence of pain as an indicator of sexual function.…”

Creation of a neovagina after Creatsas modification of Williams vaginoplasty for the treatment of 200 patients with Mayer-Rokitansky-Kuster-Hauser syndrome

“…The neovaginal coating tissue normally requires a long period of time to acquire adequate elasticity, as the epidermal squamous layer needs to diminish its regenerative keratinization (31). Rejection of the skin graft (4%) as well as hair growth in the reconstructed tract has also been reported (31,33,(37)(38)(39).…”

“…Graft shrinkage, due to the development of granulomatous tissue (33), may cause neovaginal stenosis and dyspareunia. Lack of lubrication is also a problem when the neovagina is constructed with skin (34).…”

“…Major complications of the method are the risk of injuries of the neighboring organs, such as the bladder or the rectum, during the dissection as well as dehiscences, fistulae, and retention cysts, mainly caused by local infections with bacteria from the rectal flora and/or prolonged continuous pressure exerted by the vaginal mould on the urethra and rectum (33). Graft shrinkage, due to the development of granulomatous tissue (33), may cause neovaginal stenosis and dyspareunia.…”

An observational study of women with müllerian agenesis and their need for vaginal dilator therapy

“…There is a risk of scarring which can cause stenosis, with resultant dyspareunia or apareunia (5). Inadvertent damage to bowel and bladder can occur, and vesicovaginal fistulae have been reported (5)(6)(7).…”