Acute Kidney Injury After Sigmoid Vaginoplasty Procedure In Mullerian Duct Anomalies: A Case Report

Background: Development of female genital tract is a complex process and dependent upon a series of events involving cellular differentiation, migration, fusion, and canalization. Mullerian Duct Anomalies (MDA) are uncommon congenital anomalies, but can vary widely and treatable with surgical procedure. Classification system that have been used are classification from American Society for Reproductive Medicine (ASRM) and European Society of Human Reproduction and Embriology (ESHRE) and European Society for Gynaecological Endoscopy (ESGE). Surgical procedure in MDA patient had a high successful rate, but postoperative complication can arise in form of the need for further surgical requirement and acute kidney injury. Case report: A 20 year old girl admitted to obstetric gynecologic clinic with complaints of abdominal pain, amenorrhea, and redness voiding. She experienced abdominal pain since 6 years ago. Previously, patient had history of vaginal drainage procedure when she was 14 years old but she did not felt improvement in complaint and symptom. Cystoscopy and radiology imaging showed vaginal agenesis and renal dekstra agenesis, subsequently patient was planned for a sigmoid vaginoplasty procedure. Identification and exploration during surgery revealed vaginal agenesis, renal dekstra agenesis, hematometra from hemiuterus dekstra, hemiuterus sinistra with asesorius or hipoplasia uterine and hematosalping dekstra. In 5 days post operative, patient suffer anuria and acute kidney injury complication. Acute kidney injury after major surgery involving gastrointestinal was common because of surgical stress response, and agenesis renal condition aggravates this complication.

Komplikasi Bedah, Luaran Fungsi Seksual dan Menstruasi dari Prosedur Vaginoplasti Sigmoid pada Pasien dengan Agenesis Vagina

Background: Vaginal agenesis is one form of abnormality found in the uroginecology with a prevalence of 1: 4000 births. Various reconstruction techniques, both non-surgical and surgical, have been introduced, one of which is sigmoid vaginoplasty. Research on the complications and outcomes of sigmoid vaginoplasty procedure is still limited.Objective: To assess surgical complications, sexual and menstrual function outcomes of sigmoid vaginoplasty procedure.Method: This is a prospective study. A total 11 patients with a variety of genital tract malformations have been performed for sigmoid vaginoplasty during January 2017 to January 2019. Data are described descriptively-analytically. All patients were assessed for surgical complications, menstrual and sexual function after surgery.Results and Discussion: A total of 10 cases (90.9%) were diagnosed with vaginal agenesis and 1 case (9.1%) was diagnosed with Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome. Durante surgery complications are severe bleeding and rectum injury, occurred in 2 cases (18.2%). Postoperative complication is surgical wound dehiscence, occurred in 2 cases (18.2%). All patients who have uterus (100%) showed good menstrual function outcomes. Of the 3 married patients, all patients (100%) showed good postoperative sexual function outcomes (FSFI score 27-30.4). Conclusion: The sigmoid vaginoplasty procedure is an effective procedure for patients with agenesis vaginal. This procedure has low surgical complications with good outcomes of menstrual and sexual function. Keywords: Sigmoid vaginoplasty; vaginal agenesis; menstrual function; sexual function.

Double Pedicle Artery Rotation Sigmoid Vaginoplasty for Vaginal Aplasia Management

Sigmoid vaginoplasty has been popular for neovagina reconstruction in vaginal aplasia. The most common surgical complication was vaginal stenosis caused by inadequate vascularization and tension because of graft length. Therefore, ischemia ensued and disrupted wound healing. The selection of double pedicle artery rotation sigmoid vaginoplasty is expected to reduce this problem. Five patients from April to December 2016 were diagnosed with vaginal aplasia; 4 had history of neovagina stenosis. These patients underwent sigmoid vaginoplasty with double pedicle artery rotation. No complications occurred during or after the procedure. Assessment postsurgery was conducted at 1 year. These results suggest that double pedicle artery rotation sigmoid vaginoplasty is a safe and acceptable technique for management of vaginal aplasia. The procedure decreased tension inside vascular pedicles as a result of maintaining abundant vascularization supply. Consequently, this procedure could avert graft necrosis, leakage, and severe stenosis. All of the patients exhibited regular menstrual cycle and satisfactory sexual activity. The outcomes were excellent with remarkable anatomical and functional results.

Laparoscopic sigmoid vaginoplasty: a salvage option for genitourinary fistula after failed McIndoe’s repair

A 30-year-old woman presented with vesicovaginal fistula after a forceful intercourse. She was diagnosed as a case of Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome 14 years ago and had underwent McIndoe’s vaginoplasty using amniotic membrane. Similarly, another 14-year-old girl presented with an iatrogenic urethral and bladder neck injury during an attempt at McIndoe’s vaginoplasty 4 months ago at another centre leading to urinary fistula with absent vagina. A laparoscopic salvage was done for both the cases along with repair of genitourinary fistula using sigmoid colon. There was no further requirement of vaginal dilation. Both patients remain fully continent at 1 year follow-up. Laparoscopic sigmoid vaginoplasty is a worthy minimally invasive salvage method for the patients of MRKH who develop fistulous complication after a previous attempt at neovagina creation. The bowel wall provides a structurally strong layer to withstand the repeated sexual trauma of the vagina.