Vaginoplasty: An Innovative Method of Making the Mould QC08-QC11
Dr. Sudhir Kumar Mehta,
Professor, Department of Plastic and Reconstructive Surgery, Maharishi Markendeshwar Institute
of Medical Sciences and Research, Mullana, Haryana-133203, India.
Introduction: Vaginal agenesis is a rare congenital malformation of female genital tract. It is often associated with other organ anomalies. The patient generally presents with primary amenorrhoea in late puberty or early adolescent age. Various surgical and non-surgical methods have been used to create a functional neovagina. McIndoe’s vaginoplasty with its various modifications has been mentioned in the literature. Putting a graft and usage of a mould in the neovagina are essential for the success of this surgery. Various graft materials as well as various types of moulds have been used by various workers. We have used a different type of mould for this surgery.
Aim: To evaluate the success of vaginoplasty in vaginal agenesis and to assess the acceptability and final outcome by the use of the soft mould in the postoperative period
Materials and Methods: In a prospective study, nine patients aged between 14 to 29 years underwent vaginoplasty in our institution from 2013 to 2016. A team of gynaecologists, reconstructive and plastic surgeons were involved in management of all the cases. McIndoe technique was adopted for creating the neovaginal space and a split thickness skin graft was used on a specially made mould. The subsequent moulds on removal of the first one with skin graft, we used a soft mould instead of the hard acrylic mould which is generally uncomfortable to the patients.
Results: All the nine cases presented were with primary amenorrhoea. Four of them had associated anomalies of kidney besides having hypoplastic uterus. Surgical procedures remained uneventful in immediate and late postoperative period. Skin grafts were well taken in all the cases. Two cases developed vaginal stenosis due to failure to use dilator regularly. However, they improved following resumption of regular use of dilator. Satisfactory intercourse is experienced by the married couple and those who got married subsequently.
Conclusion: McIndoe technique of vaginoplasty is simple, minimally invasive and without any significant complications and gives satisfactory coital function. Use of soft mould in the immediate postoperative period is a useful option.