Laparoscopic reconstruction of an iatrogenic perforation of the neovagina and urinary bladder by a neovaginal dilator in a patient with Mayer–Rokitansky–Küster–Hauser syndrome
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Introduction and hypothesis
Mayer–Rokitansky–Küster–Hauser syndrome (MRKH) is a rare genital aplasia syndrome. Patients with MRKH regularly dilate their neovagina with vaginal dilatators.
A 23-year-old MRKH syndrome patient came to our department complaining of a lost vaginal dilator, which she had inserted 2 days previously. She had no bleeding or abdominal pain, but did have occasional urine loss. She had a history of abdominal exploration for an acute abdomen and the creation of a neovagina at the age of 16. An abdominal CT scan located the dislocated dilator intravesically. After diagnostic laparoscopy, the dilator was removed through the vesico-neovaginal perforation. The vagina was closed and covered by a pedicled peritoneal flap, followed by closure of the urinary bladder. An omental J-flap was then fixed between the vagina and bladder.
The operative time was 185 min, with no significant blood loss, injuries or need for conversion/revision. The indwelling catheter was removed 7 days later after cystography, followed by normal micturition and an adequate bladder capacity. Vaginal dilation and sexual activity was resumed 1 month postoperatively. Follow-up was uneventful.
Laparoscopic vaginal dilator removal with immediate repair of the perforation of the neovagina and the urinary bladder directly after an acute trauma in a patient with MRKH syndrome may be a management option. It is a feasible, safe and viable operation in the hands of experienced laparoscopists.
KeywordsLaparoscopic reconstructive surgery Mayer–Rokitansky–Küster–Hauser syndrome Vesico-vaginal fistula Traumatic urinary bladder injuries
Written informed consent was obtained from the patient for publication of this video article and any accompanying images.
Conflicts of interest
We disclose any commercial association that might pose a conflict in connection with the submitted article.
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