Cervicovaginal agenesis treated with modified Yang-Monti technique in two steps: Case report and literature review.
BACKGROUND
Müllerian duct anomalies are rare with less than 200 cases published in the literature. Recently, the implementation of the Yang-Monti principle for the creation of the neovagina has been used in 10 previous published cases. Here, we report the first case of cervicovaginal agenesis treated with the modified Yang-Monti technique in two steps in México.


METHODS
A 14-year-old female presented to the pediatric consult with a history of primary amenorrhea and a chronic-cyclic pelvic pain. She had normal external genitalia and secondary sexual characteristics, with a small vaginal pouch. Pelvic ultrasonography and magnetic resonance showed the absence of cervix and proximal vagina. The surgical approach was carried out in two steps. In the first, a neovagina was created with the modified Yang-Monti technique. On a second step one year after, the neovaginal dome was anastomosed with the uterus in a diamond shape, using Gore-tex®in the cervicovaginal anastomosis, and a Foley catheter to prevent stenosis. After an 18-month follow-up, no complications have been observed. She has been taking Drospirenone and Ethinyl Estradiol with regular menstrual cycles.


CONCLUSIONS
The surgical treatment of cervicovaginal agenesis has evolved. The advantages of the modified Yang-Monti technique lie in the possible diminution of the tension on the vascular pedicle, and the gained length of the neovagina. To perform this procedure in two steps, likely diminishes the risk of neovaginal ischemia and leakage of the anastomosis.


CONCLUSIONS
The two-steps modified Yang-Monti technique represents a safe alternative for the management of cervicovaginal agenesis.
Department of Pediatric Urology, Hospital Civil de Guadalajara "Dr. Juan I. Menchaca", Mexico. Electronic address: jacostaleo@yahoo.com.
J
J
Acosta-León
Department of Gynecology and Obstetrics, Hospital Civil de Guadalajara "Dr. Juan I. Menchaca", Mexico.
A
A
Pantoja-Rojas
Department of Genetics, Hospital Civil de Guadalajara "Dr. Juan I. Menchaca", Mexico.
J R
JR
Corona-Rivera
Department of Radiology, Hospital Civil de Guadalajara "Dr. Juan I. Menchaca", Mexico.
E
E
López-Marure
Department of General Surgery, Hospital Civil de Guadalajara "Dr. Juan I. Menchaca", Mexico. Electronic address: plonecef@gmail.com.
C F
CF
Ploneda-Valencia
Cervicovaginal agenesis; Müllerian duct anomalies; Yang-Monti technique