Long term results of vaginal construction with the use of Frank dilation and a peritoneal graft Davydov procedure in patients with Mayer Rokitan Sky Kuster Syndrome

Capsule:
In the majority of patients with Mayer-Rokitansky-K€uster syndrome, a functional vagina could be created by Frank dilation and Davydov neovaginoplasty with the use of a peritoneal graft.

Authors:
Wim N. Willemsen, M.D., Ph.D., Kirsten Kluivers, M.D., Ph.D.

Volume 103, Issue 1, Pages 220-227

Abstract:

Objective:
To describe long-term outcomes after nonsurgical and surgical treatment of vaginal agenesis in a cohort of girls and women with Mayer-Rokitansky-Küster (MRK) syndrome.

Design:
Retrospective cohort study using a standardized case record form.

Setting:
University hospital.

Patient(s):
All girls and women with vaginal agenesis due to MRK syndrome, presenting during a 40-year period (1962–2012).

Intervention(s):
Frank dilation and surgical treatment (with the use of a peritoneal graft, i.e., the Davydov method) for vaginal agenesis.

Main Outcome Measure(s):
Functional vaginal depth and complications.

Result(s):
Two hundred fifty-four women with MRK visited the department. Urinary tract anomalies were found in 72 patients (31%), and other congenital anomalies in 59 (32%) of the patients with available data. One hundred sixty women were treated for vaginal agenesis. The mean follow-up time was 90 months (range 0–560 months). Sixty-eight patients had surgical treatment for vaginal agenesis with the use of a peritoneal graft (Davydov method) and reached a functional depth of the vagina of 7.8 cm (range 1–13 cm) Surgical therapy preceded by nonsurgical Frank dilation and/or attempted sexual intercourse did not result in more functional depth of the neovagina. The formation of granulation tissue (23%) and the tendency to obliterate (12%) were the major problems when using a peritoneal graft.

Conclusion(s):
Long-term results of both Frank dilation and Davydov neovagina procedure in experienced hands were good. The use of a peritoneal graft may be regarded as a good alternative to other widely used neovagina techniques using a graft, such as split-thickness skin graft or sigmoid neovagina.

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