Functional endometrial preservation in cervicovaginal or vaginal agenesis: A medical versus cultural perspective in a developing country

4^th Global Surgery and Transplantation Congress

October 03-04, 2016 Atlanta, USA

Vijaya Kumar

Kasturba Medical College, India

Posters & Accepted Abstracts: J Transplant Technol Res

Abstract :

Aim: Congenital agenesis of the uterine cervix and vagina in the presence of a functional endometrium is an extremely rare Mullerian anomaly presenting with painful cryptomenorrhea. Our subset of women in this group wishes to conserve their uterus for social and cultural reason of the region. We report 15 cases of functional endometrial preservation with restoration utero-vaginal continuity for menstrual function. Material & Methods: All the girls (13-26 years) presented with cyclical painful cryptomenorrhea. Magnetic resonance imaging (MRI) confirmed hematometra and distal cervicovaginal or vaginal agenesis. The patient counselling revealed that girls were very keen to conserve their uterus for social and cultural reasons but want to get relieved of painful cyclical cryptomenorrhea. A sigmoid colon conduit was planned as neo-vagina and anastomosed to the uterus through posterior uterine wall in 12 girls with cervicovaginal agenesis. It was anastomosed to upper vaginal pouch in three girls with vaginal agenesis. Three patients also underwent anterior sagittal anorectoplasty as there was no space available between the urethra and anal opening to accommodate the neo-vagina because of the anterior ectopic anal opening. A circular portion of the posterior uterine wall needs to be excised for wide colo-uterine anastomoses. Results: Recovery of painless menstrual activity was possible in all the cases. Two patients had stenosis of perineal neo-vaginal orifice, out of which one responded for dilatation and the other for Y-V plasty of the orifice. One patient developed obstruction at colo-uterine anastomosis and managed by redoing the anastomosis. Neo vaginal prolapse seen in one patient underwent excision of prolapsed portion of the neo vagina. Four girls got married and reports satisfactory intercourse. Conclusion: The surgical technique described herein creates a conduit for sexual function and also allows an egress for regular painless menstruation. We believe that this is an important achievement in a young woman, helping her to acquire psychological fulfillment as a woman. However, they should be cautioned against pregnancy in cases of cervicovaginal agenesis and against vaginal delivery if they have vaginal agenesis.

Biography :

Vijaya Kumar is a Professor and Head in Department of Pediatric Surgery, Kasturba Medical College, Manipal, India. His area of interest includes Pediatric Urology and Pediatric Gynecology. He has attended more than 40 national and international conferences, workshops and presented more than 60 scientific papers. He has published 49 publications in both national and international journals. He is actively involved with the research activities at the university level and completed three international funded projects.

Email: vijaykumar5566@yahoo.com