Long term sexual outcomes of Mayer Rokitansky Küster Hauser Syndrome patients after Uncu-modified Davydov procedure

Abstract

Background: Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome has an incidence of 1 in 4000. The absence of the vagina and uterus results in sexual dysfunction and infertility. The first-line treatment is vaginal dilatation. There exists a number of second-line surgical options including the Uncu-modified Davydov procedure.

Objective: To determine the complication rate, anatomical outcomes, and long-term sexual outcomes of MRKH syndrome patients after Uncu-modified Davydov procedure.

Materials and methods: Patients with MRKH syndrome who underwent paramesonephric remnant-supported laparoscopic double-layer peritoneal pull-down vaginoplasty (aka Uncu-modified Davydov procedure) between January 2008 and December 2021. The procedure involves laparoscopic circular dissection of the pelvic peritoneum followed by pulling down, through the opened vaginal orifice, and suturing the vaginal cuff with the support of uterine remnants. The long-term complication rate, anatomical outcomes, and sexual function outcomes (as measured by Female Sexual Function Index (FSFI)) were ascertained.

Main outcome measures: Main Outcome Measures: The long-term complication rate, anatomical outcomes and FSFI survey results.

Results: A total of 50 patients with MRKH syndrome underwent the Uncu-modified Davydov procedure between Jan 2008- Dec 2021. There were four perioperative complications: three bladder injuries (6%) and one rectal serosa injury (2%). Four long-term postoperative complications were identified: one vesicovaginal fistula (2%), one recto-vaginal fistula (2%), and two vaginal stenoses (4%). All patients were physically examined at least one year after surgery. The mean vaginal length was 8.4 + 1.9 cm. The mean FSFI score was 31.5 + 3.9 (minimum score of 24, maximum score of 36).

Conclusion: Conclusion: The Uncu-modified Davydov procedure has been demonstrated to be a safe and effective treatment option with high female sexual function index scores for patients with MRKH syndrome.

What is new?: The long-term complication rate, anatomical and sexual outcomes of Uncu-modified laparoscopic peritoneal pull-down vaginoplasty were reported in this study. The results indicated that the surgical approach could be used in selective MRKH patients who failed first-line self-dilatation therapy.

Figure 1

A-Laparoscopic view of rudimentary uterus, B-Peritoneal incision at top of the mold, C-Insertion of the thinner mold, D-Gradually dilatation with molds, E,F,G,H-Suturing the lateral edges of the peritoneum, I-Pulling down the sutures, J-View of the vaginal opening, K-Dividing the rudimentary horn into two parts, L-Sharp dissection of the peritoneum, M-Beginning the suturation from half of the rudimentary horn, N- Purse-string suturing of the first layer, O-Beginning the suturation from the other half of the rudimentary horn for the second layer, P-Purse string suturing othe second layer.

Figure 2

Case distribution depending on the surgeon.

Figure 3

Long-Term Anatomic Outcomes; A- Healed vaginal orifice, B- The speculum can be easily inserted, C- The vaginal wall epithelium as seen during vaginoscopy.

Figure 4

The laparoscopic view of the pelvis (after seven years of neovagina creation) - the yellow arrow indicates the fibroid on the neovaginal cuff.