title: Laparoscopically assisted neovaginoplasty in vaginal agenesis: a long-term outcome study in 240 patients.
abstract: OBJECTIVE
  To assess the long-term outcome of an optimized minimally invasive neovaginoplasty technique in vaginal agenesis.
  
  
  METHODS
  Combined retrospective and prospective study.
  
  
  METHODS
  University hospital.
  
  
  METHODS
  240 patients with congenital vaginal agenesis.
  
  
  METHODS
  Patients with an indication for neovagina creation underwent laparoscopically assisted neovaginoplasty involving vaginoabdominal blunt perforation and intracorporeal traction using tension threads and an abdominally positioned extracorporeal traction device.
  
  
  METHODS
  Long-term anatomic success, functional success compared with similar-aged controls, long-term complications, and incidence of human papilloma virus (HPV) infections.
  
  
  RESULTS
  During median follow-up for 16 (range 11-141) months, mean functional neovaginal length remained stable at 9.5 cm in all patients, including those who had no sexual intercourse and had stopped wearing the vaginal dummy. Median dummy wearing time was 8.6 months. Time to epithelialization depended on the time of onset and frequency of sexual intercourse. At long-term follow-up, median total Female Sexual Function Index score was 30.0, comparable with similar-aged controls. No common long-term complications occurred. Four patients required cauterization of granulation tissue. 7/240 (2.9%) patients were HPV-positive with low- to high-grade squamous intraepithelial lesions, 3 patients reverting to HPV-negative status at long-term follow-up.
  
  
  CONCLUSIONS
  Our technique creates a neovagina of adequate size and secretory capacity for normal coitus, requiring no prolonged dilation postoperatively, even in the absence of sexual intercourse. The procedure is fast, effective and minimally traumatic, has a very low long-term complication rate and provides very satisfactory long-term functional results.
authors.affiliation: Department of Obstetrics and Gynecology, Tübingen University Hospital, Calwerstr. 7, 72076 Tübingen, Germany.
authors.forename: Katharina
authors.initials: K
authors.lastname: Rall
authors.affiliation: Department of Obstetrics and Gynecology, Tübingen University Hospital, Calwerstr. 7, 72076 Tübingen, Germany.
authors.forename: Melanie C
authors.initials: MC
authors.lastname: Schickner
authors.affiliation: Department of Obstetrics and Gynecology, Tübingen University Hospital, Calwerstr. 7, 72076 Tübingen, Germany.
authors.forename: Gianmaria
authors.initials: G
authors.lastname: Barresi
authors.affiliation: Department of Obstetrics and Gynecology, Tübingen University Hospital, Calwerstr. 7, 72076 Tübingen, Germany.
authors.forename: Birgitt
authors.initials: B
authors.lastname: Schönfisch
authors.affiliation: Department of Obstetrics and Gynecology, Heidelberg University Hospital, Im Neuenheimer Feld 440, 69120 Heidelberg, Germany.
authors.forename: Markus
authors.initials: M
authors.lastname: Wallwiener
authors.affiliation: Department of Obstetrics and Gynecology, Tübingen University Hospital, Calwerstr. 7, 72076 Tübingen, Germany.
authors.forename: Christian W
authors.initials: CW
authors.lastname: Wallwiener
authors.affiliation: Department of Obstetrics and Gynecology, Tübingen University Hospital, Calwerstr. 7, 72076 Tübingen, Germany.
authors.forename: Diethelm
authors.initials: D
authors.lastname: Wallwiener
authors.affiliation: Department of Obstetrics and Gynecology, Tübingen University Hospital, Calwerstr. 7, 72076 Tübingen, Germany. Electronic address: sara.brucker@med.uni-tuebingen.de.
authors.forename: Sara Y
authors.initials: SY
authors.lastname: Brucker
mesh_terms: D058489:46, XX Disorders of Sex Development / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D003075:Coitus; D000013:Congenital Abnormalities / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy; D008875:Middle Aged; D009095:Mullerian Ducts / Q000002:abnormalities* / Q000601:surgery; D011446:Prospective Studies; D012189:Retrospective Studies; D019738:Surgically-Created Structures / Q000009:adverse effects; D013997:Time Factors; D016896:Treatment Outcome; D014621:Vagina / Q000002:abnormalities* / Q000033:anatomy & histology / Q000601:surgery*; D055815:Young Adult
keywords: Laparoscopic creation of neovagina; Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome; Müllerian aplasia; Uterovaginal agenesis; Vaginal aplasia