title: Long-term results of vaginal construction with the use of Frank dilation and a peritoneal graft (Davydov procedure) in patients with Mayer-Rokitansky-Küster syndrome.
abstract: OBJECTIVE
  To describe long-term outcomes after nonsurgical and surgical treatment of vaginal agenesis in a cohort of girls and women with Mayer-Rokitansky-Küster (MRK) syndrome.
  
  
  METHODS
  Retrospective cohort study using a standardized case record form.
  
  
  METHODS
  University hospital.
  
  
  METHODS
  All girls and women with vaginal agenesis due to MRK syndrome, presenting during a 40-year period (1962-2012).
  
  
  METHODS
  Frank dilation and surgical treatment (with the use of a peritoneal graft, i.e., the Davydov method) for vaginal agenesis.
  
  
  METHODS
  Functional vaginal depth and complications.
  
  
  RESULTS
  Two hundred fifty-four women with MRK visited the department. Urinary tract anomalies were found in 72 patients (31%), and other congenital anomalies in 59 (32%) of the patients with available data. One hundred sixty women were treated for vaginal agenesis. The mean follow-up time was 90 months (range 0-560 months). Sixty-eight patients had surgical treatment for vaginal agenesis with the use of a peritoneal graft (Davydov method) and reached a functional depth of the vagina of 7.8 cm (range 1-13 cm) Surgical therapy preceded by nonsurgical Frank dilation and/or attempted sexual intercourse did not result in more functional depth of the neovagina. The formation of granulation tissue (23%) and the tendency to obliterate (12%) were the major problems when using a peritoneal graft.
  
  
  CONCLUSIONS
  Long-term results of both Frank dilation and Davydov neovagina procedure in experienced hands were good. The use of a peritoneal graft may be regarded as a good alternative to other widely used neovagina techniques using a graft, such as split-thickness skin graft or sigmoid neovagina.
authors.affiliation: Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, the Netherlands. Electronic address: wimwillemsen1947@gmail.com.
authors.forename: Wim N P
authors.initials: WN
authors.lastname: Willemsen
authors.affiliation: Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, the Netherlands.
authors.forename: Kirsten B
authors.initials: KB
authors.lastname: Kluivers
mesh_terms: D058489:46, XX Disorders of Sex Development / Q000175:diagnosis* / Q000628:therapy*; D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003131:Combined Modality Therapy / Q000379:methods; D000013:Congenital Abnormalities / Q000175:diagnosis* / Q000628:therapy*; D004106:Dilatation / Q000379:methods*; D005260:Female; D006084:Graft Rejection / Q000209:etiology / Q000517:prevention & control; D006801:Humans; D008137:Longitudinal Studies; D009095:Mullerian Ducts / Q000002:abnormalities*; D010537:Peritoneum / Q000637:transplantation*; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014621:Vagina / Q000601:surgery*; D055815:Young Adult
keywords: Davydov; Frank nonsurgical method; Mayer-Rokitansky-Küster; neovaginoplasty; peritoneal graft