Meta-Analysis : Comparison of Neovagina Success Rate with Vecchietti's Laparoscopic Method and Davydov's Laparoscopic Method in Mayer-Rokitansky-Kuster-Hauser Syndrome (MRKH) Patients (original) (raw)
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Journal of Minimally Invasive Gynecology, 2020
Study Objective: To report a new improved laparoscopic Vecchietti vaginoplasty in patients with congenital vaginal agenesis and to investigate its efficacy and safety. Design: A retrospective descriptive and case-control study. Setting: Single academic institution. Patients: Women who were diagnosed with Mayer-Rokitansky-K€ uster-Hauster (MRKH) syndrome and underwent our new improved laparoscopic Vecchietti procedure from July 2010 to June 2019 were selected as the study group. The eligible participants had congenital vaginal agenesis with normal 46,XX karyotype and ovarian function. Age-matched, nulliparous, sexually active women were selected as the control group. Interventions: Women with MRKH syndrome in the study group underwent the novel improved laparoscopic Vecchietti procedure. All participants in both groups were required to complete Female Sexual Function Index and Female Genital Self-Image Scale questionnaires. Measurements and Main Results: The effects of our procedure, including the anatomic and functional efficacy of the neovagina, were the primary outcomes. The secondary outcomes consisted of the perioperative complications, surgical morbidities, and long-term postoperative discomfort. A total of 79 patients with MRKH syndrome underwent our new improved Vecchietti vaginoplasty, of whom 44 (55.7%) were diagnosed as Type I MRKH syndrome, whereas 35 (44.3%) were Type II MRKH syndrome. At a 30-month follow-up after surgery, an anatomic neovagina measuring 10.44 cm in length and 1.30 cm in width was achieved. All 79 patients obtained anatomic success with 92.41% of functional efficacy. Compared with 81 age-matched, nulliparous women in the control group, there was no statistical difference regardless of individual measure or total Female Sexual Function Index scores (p >.05). The Female Genital Self-Image Scale assessment showed a significantly lower score in patients undergoing the vaginoplasty (20.14 § 3.05 vs 22.95 § 2.12; p <.001). There were no severe perioperative complications except 1 mild bladder injury and 1 transient fever. Conclusion: Our novel improved laparoscopic Vecchietti vaginoplasty is a relatively safe and effective method for surgical treatment of congenital vaginal agenesis. It may be an alternative to neovagina creation for reaching satisfying anatomic and functional efficacy and improving patients' sexual function.
Creation of a neovagina in Rokitansky syndrome: comparison between two laparoscopic techniques
Fertility and Sterility, 2011
Objective: To compare Vecchietti's and Davydov's laparoscopic techniques for creation of a neovagina in patients with Rokitansky syndrome. Design: Comparative retrospective study. Setting: Tertiary referral center for the treatment of Rokitansky syndrome. Patient(s): Eighty patients with Rokitansky syndrome. Intervention(s): Patients underwent surgical creation of a neovagina. Fifteen patients who underwent the Vecchietti procedure from October 2003 to December 2004 and 30 patients who underwent the Davydov procedure from June 2005 to August 2008 were also included from two previously published studies. Follow-up lasted at least 12 months. Main Outcome Measure(s): Intraoperative parameters and anatomic results were compared. Functional results were compared through the Female Sexual Function Index. Epithelization of the neovagina was assessed in both groups through vaginoscopy and Schiller's test. Result(s): No major intraoperative complications were encountered in either group. Mean (AESD) duration of surgery was 30 AE 9.6 and 134 AE 24 minutes in Vecchietti's and Davydov's approach, respectively. At 12 postoperative months, length and width of the neovagina in the two groups were 7.5 AE 1.1 and 2.8 AE 0.6 cm, and 8.5 AE 1.6 and 2.8 AE 0.65, respectively. Epithelization of the neovagina at 6-month follow-up was 60% and 80%, respectively, and 100% in both groups at 12 postoperative months. Conclusion(s): Anatomic and functional outcomes of the two approaches tend to be comparable at 12-month follow-up; the only significant difference seems to be in greater length for the neovagina obtained by Davydov's approach.
2021
Objective: To determine the sexual outcomes and motherhood plans of the Mayer Rokitansky Küster Hauser (MRKH) Syndrome patients operated with Uncu Modified Remnant-Supported Laparoscopic Double-Layer Peritoneal Pull-Down Vaginoplasty operation Design: Cohort Study Setting: Tertiary University Hospital Patients: Women with MRKH syndrome Methods: This study involves the patients with MRKH syndrome who underwent Uncu Modified Remnant-Supported Laparoscopic Double-Layer Peritoneal Pull-Down Vaginoplasty Operation between the years 2008-2020. The first step of the study is about our surgical technique outcomes. The second step consists of long-term results for sexual functioning which was assessed by female sexual function index (FSFI) survey and motherhood plans by another survey. Main Outcome Measure: FSFI and Motherhood Survey Results Results Total 42 patients with MRKH syndrome underwent vaginoplasty operation. At least one year after surgery all patients was physically examined. The...
Laparoscopic Creation of Neovagina
Journal of Urology and Renal Diseases, 2018
Background: MRKH syndrome is also defined as müllerian agenesis. There are several surgical as well as nonsurgical methods for the treatment of vaginal agenesis still there is not any standardized treatment established. The laparoscopic procedure is a simple surgical technique with good cosmetic outcome. Aims and objective: The objective of the study was to perform laparoscopic creation of neo-vagina and analyze the outcome for the same with slightly modification of method with available instruments which leads to reduction in overall cost. Materials and methods: A total of 8 patients with vaginal agenesis were enrolled and all were treated with laparoscopic procedure. Results: Patient were treated successfully with laparoscopic procedure with satisfactory sexual life however patient were also facing slight pain manageable by oral analgesics, patients were having dyspareunia & coital difficulty also. Laparoscopic procedure decreases operative time as well as post-operative hospitalization. No significant additional equipment required at hospital during surgical procedure. Conclusion: Laparoscopic creation of neovagina appears to be safe, simple and effective method.
Neovagina creation - laparoscopic Vecchetti-based approach with the new kit
South African Journal of Obstetrics and Gynaecology, 2013
Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome is characterised by absence of the vagina and uterus and the presence of normal ovaries. It is a rare congenital anomaly of the female genital tract with a prevalence of 1 in 5 000 female newborns. There is no standard treatment, but a few techniques for creating a vagina, allowing a normal sex life, have been described. We report on a new laparoscopic vaginoplasty procedure that will create a further option for patients with vaginal agenesis.
Journal of minimally invasive gynecology, 2017
To describe modifications to the double-layer peritoneal pull-down laparoscopic vaginoplasty technique (Davydov operation) and evaluate anatomic and functional outcomes of the new technique, known as the Uncu modification. Case series (Canadian Task Force classification III). Tertiary care university hospital. Women with Mayer-Rokitansky-Küster-Hauser syndrome (MRKHS) who underwent surgery between 2010 and 2016. Laparoscopic double-layer peritoneal pull-down vaginoplasty with paramesonephric remnant support to the neovagina. Long-term anatomic and functional satisfaction results. Twenty-seven women with MRKHS underwent surgery with the Uncu-modified Davydov procedure. At 1 year after surgery, the mean vaginal length in these patients was 7.91 ± 1.4 cm. Among the 23 patients who had regular vaginal intercourse, the mean functional satisfaction score was 8.65 ± 1.2. One patient had a perioperative bladder injury, and another patient had a rectovaginal fistula at 3 months after the ope...
Authorea - Authorea, 2022
BACKGROUND: About 8,800-34,200 Gender Dysphoria (GD)-and 39,000-650,800 Mayer-Rokitansky-Küster-Hauser (MRKH)patients undergo vaginoplasty annually. Various procedures are available, but comparisons are lacking. OBJECTIVES: To highlight information gaps, weaknesses and strengths of vaginoplasty techniques, to aid well-informed decision making by patients and healthcare professionals. SEARCH STRATEGY: A systematic search in Medline, EMBASE, Web of Science and Scopus until October 6, 2022, by PICO method and PROSPERO registration. SELECTION CRITERIA: Original retrospective studies on complete neovaginal creation in adult GD-and MRKH-patients and discussing anatomy, Quality of Life (QoL), satisfaction, sexual function, complications or complaints. DATA COLLECTION AND ANALYSIS: The 95% confidence intervals were calculated with DerSimonian and Laird random-effects. Methodological quality and potential bias were assessed. MAIN RESULTS: In total, 35 GD-and 16 MRKH-studies were eligible. Vagina length was 11.6 and 9.5 cm, respectively. In GD-patients, Hemorrhage (6%), prolapse (1%), gastrointestinal complications (1%), revisions (26%), pain (6%), regret (1%), fecal-(11%) and urinary issues (17%) were reported. Necrosis, stenosis, dyspareunia and revisions decreased, while duration increased with higher graft quantity. Intestinal-vaginoplasty reported 100% sensation. MRKH-patients reported more necrosis (17%) [McIndoe] and average satisfaction with sexual function (91%) and vaginal discharge (32%). They were more sexually active (86%) and had 100% anatomical satisfaction. Only Intestinal-vaginoplasty reported overall dissatisfaction. CONCLUSIONS: For GD-and MRKH-patients, multiple safe vaginoplasty techniques demonstrated acceptable outcomes, with significantly improved QoL and self-image. However, standardized validation tools are needed for well-informed decision-making. Direct technique comparisons per patient-cohort and exploration of tissue-engineering methods are critical for future surgical advancements.
BACKGROUND: About 430,000-1,000,000 Gender Dysphoria- and Mayer-Rokitanksy-Küster-Hauser-patients undergo vaginoplasty each year. Various surgical procedures are available, but direct comparisons are lacking. This inhibits well-informed decision making by patients and healthcare professionals. OBJECTIVES: Highlight information gaps, weaknesses and strengths of todays vaginoplasty techniques. SEARCH STRATEGY: A systematic search in Medline, EMBASE, Web of Science and Scopus until March 8, 2022 was conducted, by PICO method and PROSPERO registration. SELECTION CRITERIA: Original retrospective studies on complete neovaginal creation in adult Gender Dysphoria- and Mayer-Rokitanksy-Küster-Hauser-patients and discussing anatomical outcome, Quality of Life, satisfaction, sexual function, complications and/or complaints. DATA COLLECTION AND ANALYSIS: Data was extracted and methodological quality and potential bias were assessed. The 95% confidence intervals were calculated with DerSimonian ...
Sexual Function after Modified Laparoscopic Vecchietti’s Vaginoplasty
Journal of Pediatric and Adolescent Gynecology, 2011
Study Objective: To report on minor modification of laparoscopic Vecchietti vaginoplasty and to examine the quality of sexual life after the operation. Design: A retrospective study to examine the role of minor modification during laparoscopic Vecchietti operation to prevent injuries and to evaluate the sexual function of patients with neovagina. Setting: Department of Obstetrics and Gynecology, University of P ecs, Faculty of Medicine, a tertiary supply center in Hungary. Paticipants: Twenty-three adolescents or young adults, ages 16 to 26 with vaginal agenesis (Mayer-Rokitansky-K€ uster-Hauser syndrome) were operated. Twenty-five sexually active patients with matched age served as controls.
Fertility and Sterility, 2010
Objective: To describe sexual function and satisfaction after laparoscopic Davydov vaginoplasty in patients with an absent vagina due to Mayer-Rokitansky-Kuster-Hauser syndrome or androgen insensitivity syndrome compared with a control female population. Design: A descriptive study of standardized, validated psychosexual and functional outcomes using a self-report questionnaire. Setting: Two tertiary care hospitals at an academic medical center. Patient(s): Six women with Mayer-Rokitansky-Kuster-Hauser syndrome or androgen insensitivity syndrome who underwent laparoscopic Davydov. Intervention(s): Patients postoperatively completed a self-report survey of their medical, surgical, and sexual history and the standardized, validated Female Sexual Function Index (FSFI) and select questions from the Golombok Rust Inventory of Sexual Satisfaction (GRISS). Main Outcome Measure(s): Total scores and domain scores (desire, arousal, lubrication, orgasm, pain, satisfaction) on the FSFI were compared with a published control population of women. Descriptive results of domain questions on the selected questions of the GRISS were identified. Result(s): Six patients, aged 20-52 years, returned the questionnaires. Responses to the modified GRISS are represented by visual frequency of response bar graphs. Compared with the control population, the patients' scores were lower for arousability, lubrication, orgasm, and comfort on the FSFI. Conclusion(s): Sexual function appears impaired in these six women who underwent laparoscopic Davydov as assessed by the FSFI. This may reflect characteristics of the patient population, as well as the inclusion of all patients' data even if they did not attempt vaginal intercourse in the previous month.