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.
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.
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.
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.
This is a preview of subscription content, log in to check access.
Buy single article
Instant unlimited access to the full article PDF.
Price includes VAT for USA
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
This is the net price. Taxes to be calculated in checkout.
Pavanello Rde C, Eigier A, Otto PA (1988) Relationship between Mayer–Rokitansky–Küster (MRK) anomaly and hereditary renal adysplasia (HRA). Am J Med Genet 29:845–849
Simpson JL (1999) Genetics of the female reproductive ducts. Am J Med Genet 89:224–239
Morcel K, Camborieux L, Guerrier D (2007) Mayer–Rokitansky–Küster–Hauser (MRKH) syndrome. Orphanet J Rare Dis 2:13
McQuillan SK, Grover SR (2014) Dilation and surgical management in vaginal agenesis: a systematic review. Int Urogynecol J 25:299–311
Angioli R, Penalver M, Muzii L, Mendez L, Mirhashemi R, Bellati F, Crocè C, Panici PB (2003) Guidelines of how to manage vesicovaginal fistula. Crit Rev Oncol Hematol 48:295–304
Sotelo R, Moros V, Clavijo R, Poulakis V (2012) Robotic repair of vesicovaginal fistula (VVF). BJU Int 109:1416–1434
Miklos JR, Soboluwski C, Lucente V (1999) Laparoscopic management of recurrent vesicovaginal fistula. Int Urogynaecol J 10:116–117
Michala L, Cutner A, Creighton SM (2007) Surgical approaches to treating vaginal agenesis. Br J Obstet Gynecol 114:1455–1459
Miyahara Y, Yoshida S, Shirakawa T et al (2013) Less invasive new vaginoplasty using laparoscopy, atelocollagen sponge, and hand-made mould. Kobe J Med Sci 58:138–144
Carr LK, Webster GD (1996) Abdominal repair of vesicovaginal fistula. Urology 48:10–11
Fedele L, Bianchi S, Frontino G, Fontana E, Restelli E, Bruni V (2008) The laparoscopic Vecchietti’s modified technique in Rokitansky syndrome: anatomic, functional, and sexual long-term results. Am J Obstet Gynecol 198(377):1–6
Romics I, Kelemen Z, Fazakas Z (2002) The diagnosis and management of vesicovaginal fistulae. BJU Int 89:764–766
Sotelo R, Mariano MB, Garcia-Segui A et al (2005) Laparoscopic repair of vesicovaginal fistula. J Urol 173:1615–1618
Hemal AK, Kolla SB, Wadhwa P (2008) Robotic reconstruction for recurrent supratrigonal vesicovaginal fistulas. J Urol 180:981–985
Grody MHT, Nyirjesy P, Chatwani A (1999) Intravesical foreign body and vesicovaginal fistula: a rare complication of a neglected pessary. Int Urogynecol J 10:407–408
Penrose KJ, Ma Yin J, Tsokos N (2013) Delayed vesicovaginal fistula after ring pessary usage. Int Urogynecol J 25:291–293
Arias BE, Ridgeway B, Barber MD (2008) Complications of neglected vaginal pessaries: case presentation and literature review. Int Urogynecol J Pelvic Floor Dysfunct 19:1173–1178
Staskin D, Malloy T, Carpiniello V et al (1985) Urological complications secondary to a contraceptive diaphragm. J Urol 134:142–143
Yong PJ, Garrey MM, Geoffrion R (2011) Transvaginal repair and graft interposition for rectovaginal fistula due to a neglected pessary: case report and review of the literature. Female Pelvic Med Reconstr Surg 17:195–197
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.
Electronic supplementary material
Below is the link to the electronic supplementary material.
(MP4 99518 kb)
About this article
Cite this article
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
- Laparoscopic reconstructive surgery
- Mayer–Rokitansky–Küster–Hauser syndrome
- Vesico-vaginal fistula
- Traumatic urinary bladder injuries