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Using the Wharton-Sheares-George method to create a neovagina in patients with Mayer-Rokitansky-Küster-Hauser syndrome: a step-by-step video tutorial.

Abstract To provide a review of the literature regarding this technique as well as a step-by-step description with the goal of increasing its use as a safe surgical option. Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome is characterized by vaginal agenesis and a variety of mullerian duct anomalies. To date, a variety of procedures have been described for creating a neovagina, but the best treatment remains debated. The Wharton-Sheares-George method, a minimally invasive surgical approach for the creation of a neovagina, is remarkably simple to perform.
PMID
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Functional and anatomic results after creation of a neovagina according to Wharton-Sheares-George in patients with Mayer-Rokitansky-Küster-Hauser syndrome-long-term follow-up.

Authors

Mayor MeshTerms

Surgically-Created Structures

Keywords

MRKH

Mayer-Rokitansky-Küster-Hauser syndrome

Wharton-Sheares-George

neovagina

neovaginoplasty

Journal Title fertility and sterility
Publication Year Start




PMID- 27678038
OWN - NLM
STAT- MEDLINE
DCOM- 20170607
LR  - 20170607
IS  - 1556-5653 (Electronic)
IS  - 0015-0282 (Linking)
VI  - 106
IP  - 7
DP  - 2016 Dec
TI  - Using the Wharton-Sheares-George method to create a neovagina in patients with
      Mayer-Rokitansky-Kuster-Hauser syndrome: a step-by-step video tutorial.
PG  - e20-e21
LID - S0015-0282(16)62727-9 [pii]
LID - 10.1016/j.fertnstert.2016.08.030 [doi]
AB  - OBJECTIVE: To provide a review of the literature regarding this technique as well
      as a step-by-step description with the goal of increasing its use as a safe
      surgical option. Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome is characterized 
      by vaginal agenesis and a variety of mullerian duct anomalies. To date, a variety
      of procedures have been described for creating a neovagina, but the best
      treatment remains debated. The Wharton-Sheares-George method, a minimally
      invasive surgical approach for the creation of a neovagina, is remarkably simple 
      to perform. DESIGN: Surgical video tutorial. SETTING: University hospital and
      referral center for pediatric and adolescent gynecology. PATIENT(S): A
      20-year-old woman with MRKH syndrome who underwent Wharton-Sheares-George
      neovaginoplasty. INTERVENTION(S): With the Wharton-Sheares-George neovaginoplasty
      the rudimentary mullerian ducts are dilated incrementally by pushing Hegar
      dilators in the direction of the pelvic axis, and the resulting median raphe is
      then intersected using diathermy. Subsequently a vaginal mold is inserted into
      the newly created cavity and held in position by two sutures. MAIN OUTCOME
      MEASURE(S): Discussion of the surgical steps according to the
      Wharton-Sheares-George method and review of the anatomic and functional results. 
      RESULTS: Reviewing the existing literature shows that a mean vaginal length and
      width of 8.3 and 3.3 cm, respectively, can be achieved, and so far no major
      intraoperative or postoperative complications or prolapse of the neovagina has
      been reported. Patients can achieve a high degree of general well-being as well
      as sexual and psychosocial functioning. However, as with most other methods, the 
      presented method requires diligent patient compliance due to the lifelong need to
      actively avoid contraction of the neovagina. Also, as revealed by vaginal
      cultures and biopsies, the neovaginas remarkably resemble natural vaginas with
      regard to type of bacterial colonization and structure of epithelium. The process
      of spontaneous epithelialization of the neovagina is not fully understood, but
      has been observed to begin at the vaginal orifice and take several months to
      reach the apex. This leads to the assumption that the nonkeratinizing, stratified
      squamous epithelium originates from the preexisting vaginal epithelium of the
      vaginal dimple and migrates in a cranial direction. Alternatively,
      epithelialization might arise from pluripotent stem cells located in the
      obliterated mullerian ducts. CONCLUSION(S): The creation of a neovagina using the
      Wharton-Sheares-George method does not require allogenic or autologous
      transplants, nor does it require traction devices or specialized surgical
      equipment. Furthermore, the procedure is comparatively simple to perform and easy
      to learn. By following our step-by-step description of this technique, surgeons
      can offer a minimally invasive, quick, and safe surgical option that provides
      long-term results that are both functionally and anatomically satisfying. We
      believe that this technique represents a valuable alternative for the creation of
      a neovagina in patients with MRKH syndrome and thus should be investigated on a
      broader scale in the future.
CI  - Copyright (c) 2016 American Society for Reproductive Medicine. Published by
      Elsevier Inc. All rights reserved.
FAU - Kuessel, Lorenz
AU  - Kuessel L
AD  - Department of Gynecology and Obstetrics, Medical University of Vienna, Vienna,
      Austria.
FAU - Wenzl, Rene
AU  - Wenzl R
AD  - Department of Gynecology and Obstetrics, Medical University of Vienna, Vienna,
      Austria. Electronic address: [email protected]
FAU - Marschalek, Marie-Louise
AU  - Marschalek ML
AD  - Department of Gynecology and Obstetrics, Medical University of Vienna, Vienna,
      Austria.
FAU - Slavka, Georg
AU  - Slavka G
AD  - Department of Laboratory Medicine, Wilhelminen Hospital, Vienna, Austria.
FAU - Doerfler, Daniela
AU  - Doerfler D
AD  - Department of Gynecology and Obstetrics, Medical University of Vienna, Vienna,
      Austria.
FAU - Husslein, Heinrich
AU  - Husslein H
AD  - Department of Gynecology and Obstetrics, Medical University of Vienna, Vienna,
      Austria.
LA  - eng
PT  - Case Reports
PT  - Journal Article
PT  - Review
PT  - Video-Audio Media
DEP - 20160924
PL  - United States
TA  - Fertil Steril
JT  - Fertility and sterility
JID - 0372772
RN  - Mullerian aplasia
SB  - IM
MH  - 46, XX Disorders of Sex Development/diagnosis/*surgery
MH  - Congenital Abnormalities/diagnosis/*surgery
MH  - Female
MH  - Gynecologic Surgical Procedures/*methods
MH  - Humans
MH  - Mullerian Ducts/*abnormalities/surgery
MH  - Reconstructive Surgical Procedures/*methods
MH  - *Surgically-Created Structures
MH  - Treatment Outcome
MH  - Vagina/*surgery
MH  - Young Adult
OTO - NOTNLM
OT  - *MRKH
OT  - *Mayer-Rokitansky-Kuster-Hauser syndrome
OT  - *Wharton-Sheares-George
OT  - *neovagina
OT  - *neovaginoplasty
EDAT- 2016/09/30 06:00
MHDA- 2017/06/08 06:00
CRDT- 2016/09/29 06:00
PHST- 2016/06/22 00:00 [received]
PHST- 2016/08/12 00:00 [revised]
PHST- 2016/08/12 00:00 [accepted]
PHST- 2016/09/30 06:00 [pubmed]
PHST- 2017/06/08 06:00 [medline]
PHST- 2016/09/29 06:00 [entrez]
AID - S0015-0282(16)62727-9 [pii]
AID - 10.1016/j.fertnstert.2016.08.030 [doi]
PST - ppublish
SO  - Fertil Steril. 2016 Dec;106(7):e20-e21. doi: 10.1016/j.fertnstert.2016.08.030.
      Epub 2016 Sep 24.