title: 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.
abstract: OBJECTIVE
  Mayer-Rokitansky-Küster-Hauser syndrome (MRKH) is a rare genital aplasia syndrome. Patients with MRKH regularly dilate their neovagina with vaginal dilatators.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Urology, University Hospital Munich-Grosshadern, Ludwig-Maximilians-University Munich, Marchioninistrasse 15, 81377, Munich, Germany, wael.khoder@med.uni-muenchen.de.
authors.forename: Wael Y
authors.initials: WY
authors.lastname: Khoder
authors.forename: Christian G
authors.initials: CG
authors.lastname: Stief
authors.forename: Maximiliane
authors.initials: M
authors.lastname: Burgmann
authors.forename: Alexander
authors.initials: A
authors.lastname: Burges
mesh_terms: D058489:46, XX Disorders of Sex Development; D000013:Congenital Abnormalities; D005260:Female; D013509:Gynecologic Surgical Procedures; D006801:Humans; D007049:Iatrogenic Disease; D010535:Laparoscopy; D009095:Mullerian Ducts / Q000002:abnormalities*; D019738:Surgically-Created Structures; D001743:Urinary Bladder / Q000293:injuries* / Q000601:surgery; D055815:Young Adult