New method of vaginoplasty in vaginal agenesis, shamdeen's vaginoplasty

Aim: To present a new technique of vaginoplasty in Mayer-Rokitansky-Kuster-Hause (MRKH) syndrome. Methods and interventions: A case series study of 145 females presented with primary amenorrhea due to vaginal agenesis, on which the new procedure of Vaginoplasty was conducted on those suffering from MRKH syndrome. Evaluation of cases was conducted through clinical, laboratory, sonography and laparoscopy, to confirm the diagnosis of MRKH syndrome. Shamdeen`s Vaginoplasty; creating a new vagina by two-skin flap from labia minora and majora. The first step was to excise two skin flaps, one from each side of labia, keeping the insertion of one flap anterior and the other posterior, separate the two layer of the skin flap. The second step was by creating a space between the bladder and rectum by blunt dissection, creating a pouch extended to the pouch of Douglas .The third step was to sutures the two flaps as a tube, three bites of the top stitches sutured with the highest point in the created pouch but left un tightened, inverting this tube, and then tighten the sutures on the top to keep it in place, betadiene socked pack left for 7 days. Regular dilatation weekly and sexual practice after 8 weeks. All were folled up for three years. Results: one hundred forty five cases of primary amenorrhea, in which 29 cases (20%) found to have MRKH syndrome, 23 married women underwent Shamdeen`s vaginoplasty. Most of the patients were satisfied post operatively; functionally and psychologically, only one case had severe post operative infection and moderate vaginal stricture. Conclusion: the created vagina got normal anatomical position, covered with normal skin, took shorter operative duration, convenient for patients, had good results, not that invasive, and relatively inexpensive.