Abstract
Introduction
The objectives of this video are to provide a brief overview of Müllerian agenesis, discuss a case of partial vaginal agenesis with a functional uterus, and present the steps of a staged McIndoe procedure for the creation of a neovagina and utero-neovaginal unification.
Methods
We give an overview of Mayer–Rokitansky–Küster–Hauser syndrome, and review its incidence, clinical presentation, diagnostic evaluation, and treatment options. We present the case of a 23-year-old woman with partial vaginal agenesis, and her clinical course through conservative management with hormonal suppression and dilator therapy leading up to urogynecological surgical treatment. We describe a staged surgical approach that highlights the value of cystoscopy and laparoscopy to better delineate our patient’s anatomical variations. Additionally, a mini-laparotomy and placement of an intrauterine Malecot catheter allowed for the drainage of prominent hematometra, relief of menstrual outflow obstruction, and epithelialization of a tract between the uterus and the planned neovaginal space. Ultimately, a neovagina was created using a staged McIndoe technique, leading to utero-neovaginal unification and unobstructed menses.
Conclusion
In conclusion, our approach should be considered a feasible option for anatomical restoration via the creation of a neovagina in patients with Müllerian anomalies, even in the presence of a functional uterus.
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Written informed consent was obtained from the patient for publication of this video article and any accompanying images.
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A. Gómez-Viso and B. May declare that they have no conflicts of interest. C. Kisby has received research sponsorship from RION LLC. Her research is supported by the Duke K12 Urologic Research Career Development Program (K12DK100024) and the Duke Office of Physician Scientist Development Fund to Retain Clinician Scientists.
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Gómez-Viso, A., May, B. & Kisby, C. Management of partial Müllerian agenesis: staged McIndoe procedure for the creation of a neovagina and utero-neovaginal unification. Int Urogynecol J 34, 1983–1985 (2023). https://doi.org/10.1007/s00192-023-05485-6
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DOI: https://doi.org/10.1007/s00192-023-05485-6