Treatment of vaginal agenesis in Mayer-Rokitansky-Küster-Hauser syndrome in Denmark: a nationwide comparative study of anatomical outcome and complications

In a nationwide study we compared the anatomical outcome and complications in different treatments of vaginal agenesis. Coital dilation had the best anatomical results and the lowest complication rate.

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Volume 110, Issue 4, Pages 746–753

Authors:

Morten Herlin, M.D., Anne-Mette Bay Bjørn, M.D., Ph.D., Laura Krogh Jørgensen, M.D., Birgitta Trolle, M.D., Michael Bjørn Petersen, M.D. DMSc

Abstract:

Objective

To compare the long-term anatomical outcome and complications in treatments of vaginal agenesis in Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome.

Design

A historical comparative follow-up study using medical chart reviews.

Setting

Public hospitals.

Patient(s)

A nationwide cohort of patients diagnosed with MRKH syndrome (n = 168).

Intervention(s)

McIndoe vaginoplasty (n = 54), self-dilation (n = 60), coital dilation (n = 20), Baldwin vaginoplasty (n = 4), Williams vaginoplasty (n = 3), Davydov vaginoplasty (n = 2), or no treatment (n = 29).

Main outcome measures(s)

Mean vaginal depth at follow-up, anatomical treatment success rates at levels of ≥6 cm, ≥7 cm, and ≥8 cm, complications, and resurgery.

Result(s)

Mean vaginal depths were 7.4 cm (95% confidence interval [CI] 6.8–8.1 cm), 7.3 cm (95% CI 6.7–7.9 cm), and 8.7 cm (95% CI 7.9–9.5 cm) at follow-up in patients treated by McIndoe vaginoplasty, self-dilation, and coital dilation, respectively. Overall complication rates in the three groups were 35/54 (65%), 21/52 (35%), and 1/20 (5%), respectively. Eighteen (33%) of the patients who underwent McIndoe vaginoplasty needed resurgery.

Conclusion(s)

Our findings support the current recommendations of dilation therapy as the first-line treatment of vaginal agenesis and emphasize the relevance of coital dilation in patients able to regularly engage in coital activity. However, further studies of functional outcome and patient satisfaction are needed.

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Fertility and Sterility

Editorial Office, American Society for Reproductive Medicine

Fertility and Sterility® is an international journal for obstetricians, gynecologists, reproductive endocrinologists, urologists, basic scientists and others who treat and investigate problems of infertility and human reproductive disorders. The journal publishes juried original scientific articles in clinical and laboratory research relevant to reproductive endocrinology, urology, andrology, physiology, immunology, genetics, contraception, and menopause. Fertility and Sterility® encourages and supports meaningful basic and clinical research, and facilitates and promotes excellence in professional education, in the field of reproductive medicine.

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