A Study on Reconstructive Options for Vaginal Agenesis

Prabhakar, U (2007) A Study on Reconstructive Options for Vaginal Agenesis. Masters thesis, Madras Medical College, Chennai.

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Abstract

INTRODUCTION: Congenital absence of vagina occurs in 0.001 to 0.025 percent of population. Incidence is 1:5000 to 1:10000 live births. It is the main noticeable manifestation of Rokitansky sequence. The primary defect is the disturbance in the development of the caudal end of paramesonephric ducts. With normal development of all secondary sexual characteristics, these females with congenital utero- vaginal agenesis must face the cruel fact of being unable to bear children and enjoy sexual satisfaction, affecting both their mates and themselves. Considering these functional and psycho social impacts to womanhood, there is no reason for not making any endeavor in pursuing excellent results in neovaginal reconstruction. The scientific literature indicates that there have been more than 100 methods for vaginal reconstruction and still we are looking for a more effective method. Surgeons often say that if there is more than one operation for a condition then the ideal procedure does not exist. In our study we have tried to compare various techniques and arrive at better understanding of this rare but complicated disease. AIM OF THE STUDY: This study on reconstructive options for vaginal agenesis was done with following aims. 1) To study various clinical features of vaginal agenesis. 2) To study the effectiveness of VCUAM classification in the diagnosis and management of vaginal agenesis. 3) To study the various reconstructive options and treatment methods for vaginal agenesis. 4) To compare the effectiveness and complications of various treatment methods for vaginal agenesis. MATERIALS AND METHODS: All the vaginal agenesis patients who attended our department during the period from August 2004 to April 2007 were included in our study. Only vaginal agenesis cases were included in our study, other cases such as testicular feminization syndrome, ambiguous genitalia, intersex and androgen insensitivity syndrome were excluded from our study. Thorough history taking and physical examination were done to find the cause of primary amenorrhea and associated anomalies. Then the necessary investigations such as Karyotyping, ultra sonogram of abdomen, kidneys and pelvis were done to confirm the diagnosis and to find associated anomalies. The diagnostic laparoscopy was done. Then the patients were given counseling regarding the diagnosis and possible treatment outcomes. After the investigations for the anesthetic assessment, surgery was done. In our institution we perform three surgical procedures namely Abbe Mc Indoe, Neuro vascular pudendal thigh flaps and Horse shoe shaped labia minora flaps. Patient’s abdomen, perineum and thighs were shaved. Lower bowel preparation was given the night before and the morning of the surgery. Under spinal anesthesia patient was placed in the lithotomy position. The whole abdomen perineum and both thighs were prepared, bladder was catheterized. DISCUSSION: A total of 24 patients underwent our study. In our study the youngest patient was aged 12 years and the oldest was aged 30 years (mean age 20 years). The commonest age group was 16 to 20 years. John A Rock describes the commonest presentation are usually at the age of 14 to 15 years by the gynecologist. Lisa Jane describes the commonest age of presentation is 15 to 18 years. The average of discovery is 17 years in other studies. Whatever may be the age of presentation, the referral to plastic surgeon is usually from the gynecologist as in our study. Previously the opinion regarding the ideal age for surgery was considered as just before marriage or when regular sexual activity was anticipated. The introduction of flap procedures had changed the management to an earlier age, probably during her teenage itself so as to psychologically adjust to the world and also to improve the self esteem of the patients. CONCLUSION: After this study the following conclusions were made. 1. Our patients present little later than the western world and a considerable number of patients present late even after marriage. 2. All the patients were phenotypically and genetically 46XX females with normal secondary sexual characters. 3. The renal anomalies were not detected as frequently as in the literature. 4. The terminology used for diagnosis by the primary referring physicians was not consistent. 5. The VCUAM classification gives better diagnosis and useful in the management. 6. Only 79.2% of patients accepted surgical treatment, the remaining 20.8% patients did not accept surgical treatment or dilation therapy. 7. The Abbe-McIndoe procedure was simple, safe procedure with good aesthetic results and had least complication rate. 8. The pudendal thigh flap procedure was simple, safe procedure with fair aesthetic results and had acceptable complication rate. 9. The Horse shoe flap procedure was technically difficult procedure with fair aesthetic results and had high contraction rate. 10. Most of our patients were very irregular in follow up and stent usage. So, flap procedure especially pudendal thigh flaps which has the least contraction rate is the preferable treatment option for such patients.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Reconstructive Options ; Vaginal Agenesis.
Subjects: MEDICAL > Plastic and Reconstructive Surgery
Depositing User: Kambaraman B
Date Deposited: 12 Oct 2017 01:32
Last Modified: 12 Oct 2017 01:32
URI: http://repository-tnmgrmu.ac.in/id/eprint/3483

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