title: Autologous in vitro cultured vaginal tissue for vaginoplasty in women with Mayer-Rokitansky-Küster-Hauser syndrome: anatomic and functional results.
abstract: OBJECTIVE
  To present the procedure and the results of a technique in which in vitro autologous cell cultures were used for the canal lining in patients with Mayer-Rokitansky-Küster-Hauser syndrome (MRKHS) subjected to vaginoplasty with a modified Abbè-McIndoe technique. MRKHS is a rare anomaly characterized by vaginal agenesis with variable müllerian duct abnormalities. The Abbè-McIndoe procedure is 1 of the most frequent surgical treatments adopted in these women. In the last decades, several modifications have been introduced by different authors, mostly changing the lining material, but no consensus has been reached on what material should be used for the neovagina canal wall lining.
  
  
  METHODS
  A pilot study (Canadian Task Force classification II-1).
  
  
  METHODS
  Policlinico Umberto I, "Sapienza" University of Rome.
  
  
  METHODS
  A consecutive series of 23 women with MRKHS underwent neovaginoplasty with autologous vaginal tissue as the graft material between 2006 and 2013.
  
  
  METHODS
  Each patient with MRKHS was subjected to a full-thickness mucosal biopsy from the vaginal vestibule. After enzymatic dissociation, cells were inoculated onto collagen IV-coated plates and cultured for 2 to 3 weeks. The patients were subjected to vaginoplasty with a modified Abbè-McIndoe technique with autologous in vitro cultured vaginal tissue. Patients underwent clinical follow-up visits at 1, 3, 6, and 12 months after surgery and every year thereafter. Anatomic, functional, and sexual results were assessed.
  
  
  RESULTS
  In all cases, the vagina appeared normal in length and depth. A vaginal cytology and a vaginal biopsy obtained at the 3-month follow-up visit revealed physiological vaginal tissue. All 23 patients completed the Female Sexual Function Index questionnaire at 12 months after surgery. The results showed a total score of 27.2. These results indicate a satisfactory quality of sexual life.
  
  
  CONCLUSIONS
  The modified Abbè-McIndoe technique with autologous vaginal tissue appears to be safe and feasible. This technique allows normal and satisfying sexual intercourse. Larger series with longer follow-ups will be necessary to confirm if this technique represents the ideal procedure for vaginal agenesis.
authors.affiliation: Department of Gynecologic-Obstetrical and Urologic Sciences, "Sapienza" University of Rome, Rome, Italy.
authors.forename: Pierluigi
authors.initials: P
authors.lastname: Benedetti Panici
authors.affiliation: Department of Gynecologic-Obstetrical and Urologic Sciences, "Sapienza" University of Rome, Rome, Italy. Electronic address: dianamaffucci@tiscali.it.
authors.forename: Diana
authors.initials: D
authors.lastname: Maffucci
authors.affiliation: Department of Experimental Medicine, Unit of Regenerative Medicine, "Sapienza" University of Rome, Rome, Italy.
authors.forename: Simona
authors.initials: S
authors.lastname: Ceccarelli
authors.affiliation: Department of Experimental Medicine, Unit of Regenerative Medicine, "Sapienza" University of Rome, Rome, Italy.
authors.forename: Enrica
authors.initials: E
authors.lastname: Vescarelli
authors.affiliation: Department of Gynecologic-Obstetrical and Urologic Sciences, "Sapienza" University of Rome, Rome, Italy.
authors.forename: Giorgia
authors.initials: G
authors.lastname: Perniola
authors.affiliation: Department of Gynecologic-Obstetrical and Urologic Sciences, "Sapienza" University of Rome, Rome, Italy.
authors.forename: Ludovico
authors.initials: L
authors.lastname: Muzii
authors.affiliation: Department of Experimental Medicine, Unit of Regenerative Medicine, "Sapienza" University of Rome, Rome, Italy.
authors.forename: Cinzia
authors.initials: C
authors.lastname: Marchese
mesh_terms: D058489:46, XX Disorders of Sex Development / Q000503:physiopathology / Q000601:surgery*; D000328:Adult; D003075:Coitus; D000013:Congenital Abnormalities / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D006801:Humans; D066298:In Vitro Techniques; D007558:Italy; D008875:Middle Aged; D009092:Mucous Membrane; D009095:Mullerian Ducts / Q000002:abnormalities* / Q000503:physiopathology / Q000601:surgery; D017060:Patient Satisfaction; D010865:Pilot Projects; D019651:Plastic Surgery Procedures / Q000379:methods; D019738:Surgically-Created Structures / Q000473:pathology; D011795:Surveys and Questionnaires; D014182:Transplantation, Autologous; D016896:Treatment Outcome; D014621:Vagina / Q000002:abnormalities / Q000254:growth & development / Q000473:pathology*
keywords: Abbè-McIndoe; Autologous tissue; Mayer-Rokitansky-Küster-Hauser syndrome; Vaginal agenesis; Vaginoplasty