A novel approach to recurrent vaginal vault prolapse in a patient with müllerian agenesis.
BACKGROUND
Vaginal agenesis is a congenital disorder affecting 1 in 4000 to 1 in 10,000 females. Lack of normal vaginal support structures may lead these patients to develop prolapse of the distal rudimentary vagina. Presently, there is no consensus regarding the best surgical option. However, the goal of surgery is to restore normal anatomy and establish normal sexual function.


METHODS
We report the case of a 28-year-old woman with müllerian agenesis, diagnosed at age 19 years, who presented with complaints of dyspareunia and vaginal eversion. One year before presentation to our practice, the patient underwent an anterior and posterior repair with mesh and a transobturator sling. After careful evaluation, the patient underwent excision of mesh and a second procedure to elongate and suspend her vagina. Her vaginal length was extended from 4 to 8 cm.


CONCLUSIONS
Prolapse of the neovagina in müllerian agenesis is a rare event; it can occur after nonsurgical or surgical treatments. Although there have been reported cases of abdominal or laparoscopic sacrocolpopexy to correct vaginal vault prolapse in these patients, there is a scarcity of information addressing the vault suspension in cases lacking healthy vaginal tissue. Our case shows how successful anatomical functional correction can be achieved with a simpler technique using an allograft to achieve a normal vaginal length in combination with a sacrocolpopexy.
From the University Urogynecology, Cooper Medical School at Rowan University, Camden, NJ.
Tamara V
TV
Toidze
Karolynn T
KT
Echols
Ricardo
R
Caraballo
D058489:46, XX Disorders of Sex Development / Q000150:complications*; D000328:Adult; D000013:Congenital Abnormalities; D005260:Female; D006801:Humans; D009095:Mullerian Ducts / Q000002:abnormalities*; D056887:Pelvic Organ Prolapse / Q000150:complications / Q000601:surgery*; D012008:Recurrence; D053825:Suburethral Slings; D013526:Surgical Mesh; D019738:Surgically-Created Structures; D014621:Vagina / Q000002:abnormalities / Q000601:surgery