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Laparoscopic reconstruction of an iatrogenic perforation of the neovagina and urinary bladder by a neovaginal dilator in a patient with Mayer–Rokitansky–Küster–Hauser syndrome

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Abstract

Introduction and hypothesis

Mayer–Rokitansky–Küster–Hauser syndrome (MRKH) is a rare genital aplasia syndrome. Patients with MRKH regularly dilate their neovagina with vaginal dilatators.

Methods

A 23-year-old MRKH syndrome patient came to our department complaining of a lost vaginal dilator, which she had inserted 2 days previously. She had no bleeding or abdominal pain, but did have occasional urine loss. She had a history of abdominal exploration for an acute abdomen and the creation of a neovagina at the age of 16. An abdominal CT scan located the dislocated dilator intravesically. After diagnostic laparoscopy, the dilator was removed through the vesico-neovaginal perforation. The vagina was closed and covered by a pedicled peritoneal flap, followed by closure of the urinary bladder. An omental J-flap was then fixed between the vagina and bladder.

Results

The operative time was 185 min, with no significant blood loss, injuries or need for conversion/revision. The indwelling catheter was removed 7 days later after cystography, followed by normal micturition and an adequate bladder capacity. Vaginal dilation and sexual activity was resumed 1 month postoperatively. Follow-up was uneventful.

Conclusions

Laparoscopic vaginal dilator removal with immediate repair of the perforation of the neovagina and the urinary bladder directly after an acute trauma in a patient with MRKH syndrome may be a management option. It is a feasible, safe and viable operation in the hands of experienced laparoscopists.

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Written informed consent was obtained from the patient for publication of this video article and any accompanying images.

Conflicts of interest

We disclose any commercial association that might pose a conflict in connection with the submitted article.

Author information

Correspondence to Wael Y. Khoder.

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Khoder, W.Y., Stief, C.G., Burgmann, M. et al. Laparoscopic reconstruction of an iatrogenic perforation of the neovagina and urinary bladder by a neovaginal dilator in a patient with Mayer–Rokitansky–Küster–Hauser syndrome. Int Urogynecol J 26, 1083–1087 (2015). https://doi.org/10.1007/s00192-014-2609-1

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Keywords

  • Laparoscopic reconstructive surgery
  • Mayer–Rokitansky–Küster–Hauser syndrome
  • Vesico-vaginal fistula
  • Traumatic urinary bladder injuries