Davydov Vaginoplasty in Mayer-Rokitansky-Küster-Hauser Syndrome Patient Presenting With Urethral Dilatation

Abstract

Introduction: Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome is a female congenital disorder characterized by an underdeveloped or absent vagina and uterus. The first-line treatment to create a neovagina is patient-performed vaginal dilatation. We report here the rare case of an MRKH patient who presented with urethral dilatation and was successfully treated with Davydov vaginoplasty. Case Report: Seventeen-year-old patient with known single kidney was consulted by a gynaecologist, and a diagnosis of MRKH syndrome was established. As the patient had urethral dilatation-resulting from repetitive intraurethral intercourse-neovaginal creation by means of self-performed vaginal dilatation was precluded. Rather, the Davydov vaginoplasty was successfully performed; there were no postoperative complications, and the patient was fully continent postsurgery. Conclusion: MRKH patients and healthcare providers should be educated on the damaging consequences of intraurethral intercourse. More cases need to be reported to establish the best treatment options for a normal sexual life.

Keywords: Davydov vaginoplasty; Mayer–Rokitansky–Küster–Hauser syndrome; urethral dilatation; urethral intercourse.

Figure 1

External genitalia showing normal labia majora, labia minora, and clitoris. Arrow identifies the patient's dilated urethra.

Figure 2

MRI. Sagittal view of pelvis, T2-weighted image, showing urinary bladder (UB), rectum (R), and dilated urethra and bladder neck (line).

Figure 3

Intraperitoneal view on completion of Davydov vaginoplasty. Proximal end of the newly created vagina is closed with sutures.

Figure 4

Transabdominal pelvic ultrasound, sagittal view, showing urinary bladder (UB), urethra and bladder neck (boxed area), and dilator inserted into vagina (arrow), casting a shadow. The urethra now opens at the anterior wall of the newly created vagina, and the angle precludes the possibility of accidentally penetrating it during intercourse or the dilatation process.

Figure 5

Follow-up visit, 2 months after surgery. Hegar Uterine Dilator No. 30 can be inserted approximately 8 cm deep without causing any discomfort.