Abstract
Introduction and hypothesis
Mayer–Rokitansky–Küster–Hauser (MRKH) syndrome is a condition with an underdeveloped or absent vagina and uterus due to embryological growth failure of the Müllerian ducts. Many techniques have been described to construct a neovagina with an acceptable depth that allows penetrative intercourse. This is a step-by-step video tutorial on the Wharton–Sheares–George surgical technique for vaginoplasty in patients with MRKH syndrome.
Method
With Wharton–Sheares–George vaginoplasty, the rudimentary Müllerian ducts are incrementally dilated by pushing Hegar dilators in the direction of the pelvic axis, and the resulting median raphe is then intersected using diathermy. As a result, a neovagina is created and an estriol-coated vaginal mold is inserted for 3 days. The patient receives comprehensive discharge instructions, a self-dilation program three times a day, and a monthly follow-up.
Results
A 3-month follow-up showed a high subjective degree of satisfaction with surgery and sexual satisfaction in both patients.
Conclusion
Wharton–Sheares–George vaginoplasty is a safe and efficient technique for creating a neovagina for patients with MRKH syndrome.
References
Chen N, Song S, Bao X, Zhu L. Update on Mayer–Rokitansky–Küster–Hauser syndrome. Front Med. 2022;16(6):859–72. https://doi.org/10.1007/s11684-022-0969-3.
Lee MH. Non-surgical treatment of vaginal agenesis using a simplified version of Ingram’s method. Yonsei Med J. 2006;47(6):892–5. https://doi.org/10.3349/ymj.2006.47.6.892.
Wang YY, Duan H, Zhang XN, Wang S. Neovagina creation: a novel improved laparoscopic Vecchietti procedure in patients with Mayer–Rokitansky–Küster–Hauser syndrome. J Minim Invasive Gynecol. 2021;28(1):82–92. https://doi.org/10.1016/j.jmig.2020.04.006.
Piro C, Asensio M, Martín JA, Giné C, Ormaetxea E, Chicaiza E. Vaginoplastia con sigma: a propósito de 5 casos [Sigmoid colon vaginoplasty: experience with five cases]. Cir Pediatr. 2006;19(1):19–22.
Navarro V, Acién MI, Acién P. Classical McIndoe technique versus the McIndoe technique with a neovaginal PACIENA Prosthesis® and no skin graft. J Clin Med. 2020;9(11):3648. https://doi.org/10.3390/jcm9113648.
Samantray SR, Mohapatra I, Harshini N. Laparoscopic Davydov’s colpopoiesis for a case of Mayer–Rokitansky–Kuster–Hauser (MRKH) syndrome. Cureus. 2021;13(3):e13974. https://doi.org/10.7759/cureus.13974.
Kuessel L, Wenzl R, Marschalek ML, Slavka G, Doerfler D, Husslein H. Using the Wharton–Sheares–George method to create a neovagina in patients with Mayer–Rokitansky–Küster–Hauser syndrome: a step-by-step video tutorial. Fertil Steril. 2016;106(7):e20–1. https://doi.org/10.1016/j.fertnstert.2016.08.030.
Schätz T, Huber J, Wenzl R. Creation of a neovagina according to Wharton–Sheares–George in patients with Mayer–Rokitansky–Küster–Hauser syndrome. Fertil Steril. 2005;83(2):437–41. https://doi.org/10.1016/j.fertnstert.2004.06.079.
Zhou J-H, Sun J, Yang C-B, Xie Z-W, Shao W-Q, Jin H-M. Long-term outcomes of transvestibular vaginoplasty with pelvic peritoneum in 182 patients with Rokitansky’s syndrome. Fertil Steril. 2010;94(6):2281–5.
Kölle A, Taran FA, Rall K, Schöller D, Wallwiener D, Brucker SY. Neovagina creation methods and their potential impact on subsequent uterus transplantation: a review. BJOG. 2019;126(11):1328–35. https://doi.org/10.1111/1471-0528.15888.
Acknowledgements
Thanks to Ervin Kocjancic, MD, PhD (Department of Surgery–Urology, University of Chicago) for review of the manuscript and Donald Reindl for copyediting assistance with this manuscript.
Funding
This research received no external funding.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflicts of interest
All the authors completed the ICMJE uniform disclosure form. The authors have no conflicts of interest to declare.
Consent
Written informed consent was obtained from the patient for publication of this video article and any accompanying images.
Additional information
Publisher's note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Brief summary
Wharton–Sheares–George vaginoplasty is a safe and efficient technique for creating a neovagina for patients with MRKH syndrome.
Supplementary information
Below is the link to the electronic supplementary material.
Supplementary file1 (MP4 68059 KB)
Rights and permissions
About this article
Cite this article
Rhazi, I., Lukanović, D., Blaganje, M. et al. Wharton–Sheares–George vaginoplasty: a safe and efficient technique in patients with Mayer–Rokitansky–Küster–Hauser syndrome. Int Urogynecol J 35, 467–470 (2024). https://doi.org/10.1007/s00192-023-05632-z
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00192-023-05632-z