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Minimally invasive vaginal approach to the uterovestibular anastomosis for cervicovaginal aplasia: a case series and review of literature

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Abstract

Background

Congenital cervicovaginal agenesis (CVA) with functioning endometrium is an extremely rare mullerian anomaly. Genital tract patency and fertility preservation are the major challenges in cases of CVA. With the advances in surgical techniques, management has shifted from a radical approach-like hysterectomy towards a more conservative approach of uterine conservation.

Case presentation and review of the literature

In the present study, we report our experience in managing four cases of congenital CVA with complete vaginal atresia, which were treated with a simple minimally invasive vaginal approach for UVA without using graft for neovagina creation and studied the long-term anatomic and functional result of uterovestibular anastomosis (UVA) in patients with CVA. A literature review was performed for congenital complete vaginal atresia (≤ 2 cm blind vagina), with a functioning uterus. The experience and results of this 4-year study are in accordance with the prior studies with 97% (33/34) success rate, where vestibular mucosa was used for the UVA.

Conclusions

Findings of this study should encourage more gynaecologists to learn and recreate a complete vaginal approach, as no special surgical equipments are needed. Hysterectomy should only be reserved for cases, where repeated anastomosis attempts fail. This minimally invasive technique should be preferred over canalization procedures and graft, as it is associated with a higher success rate with least complications and recurrence. Conservative end-to-end anastomosis with a completely vaginal approach should be offered as the primary treatment option for CVA with total vaginal atresia.

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References

  1. Fujimoto VY, Miller JH, Klein NA, Soules MR (1997) Congenital cervical atresia: report of seven cases and review of the literature. Am J Obstet Gynecol 177:1419–1425. https://doi.org/10.1016/s0002-9378(97)70085-1

    Article  CAS  PubMed  Google Scholar 

  2. Rock JA, Schlaff WD, Zacur HA, Jones HW Jr (1984) The clinical management of congenital absence of the uterine cervix. Int J Gynaecol Obstet 22:231–235. https://doi.org/10.1016/0020-7292(84)90012-2

    Article  CAS  PubMed  Google Scholar 

  3. Deffarges JV, Haddad B, Musset R, Paniel BJ (2001) Utero-vaginal anastomosis in women with uterine cervix atresia: long-term follow-up and reproductive performance. A study of 18 cases. Hum Reprod 16:1722–1725. https://doi.org/10.1093/humrep/16.8.1722

    Article  CAS  PubMed  Google Scholar 

  4. Bedner R, Rzepka-Górska I, Błogowska A, Malecha J, Kośmider M (2004) Effects of a surgical treatment of congenital cervicovaginal agenesia. J Pediatr Adolesc Gynecol 17:327–330. https://doi.org/10.1016/j.jpag.2004.07.007

    Article  CAS  PubMed  Google Scholar 

  5. Jasonni VM, La Marca A, Matonti G (2007) Utero-vaginal anastomosis in the treatment of cervical atresia. Acta Obstet Gynecol Scand 86:1517–1518. https://doi.org/10.1080/00016340701698732

    Article  PubMed  Google Scholar 

  6. Fedele L, Bianchi S, Frontino G, Berlanda N, Montefusco S, Borruto F (2008) Laparoscopically assisted uterovestibular anastomosis in patients with uterine cervix atresia and vaginal aplasia. Fertil Steril 89:212–216. https://doi.org/10.1016/j.fertnstert.2007.01.168

    Article  PubMed  Google Scholar 

  7. Daraï E, Ballester M, Bazot M, Paniel BJ (2009) Laparoscopic-assisted uterovaginal anastomosis for uterine cervix atresia with partial vaginal aplasia. J Minim Invasive Gynecol 16:92–94. https://doi.org/10.1016/j.jmig.2008.09.617

    Article  PubMed  Google Scholar 

  8. Kriplani A, Kachhawa G, Awasthi D, Kulshrestha V (2012) Laparoscopic-assisted uterovaginal anastomosis in congenital atresia of uterine cervix: follow-up study. J Minim Invasive Gynecol 19:477–484. https://doi.org/10.1016/j.jmig.2012.03.017

    Article  PubMed  Google Scholar 

  9. Jeon GH, Kim SH, Chae HD, Kim CH, Kang BM (2016) Simple uterovaginal anastomosis for cervicovaginal atresia diagnosed by magnetic resonance imaging: a report of two cases. J Obstet Gynaecol Res 42:738–742. https://doi.org/10.1111/jog.12961

    Article  PubMed  Google Scholar 

  10. Paul PG, Akhila B, Aggarwal A, Paul G, Saherwala T (2020) Laparoscopy-assisted neocervicovaginal reconstruction in a rare case of müllerian anomaly: cervicovaginal aplasia with unicornuate uterus. J Minim Invasive Gynecol 27:1261–1262. https://doi.org/10.1016/j.jmig.2019.12.008

    Article  PubMed  Google Scholar 

  11. Khoiwal K, Agarwal A, Ravi AK, Chaturvedi J (2021) Unique minimally invasive management of cervicovaginal agenesis. BMJ Case Rep 14:e242862. https://doi.org/10.1136/bcr-2021-242862

    Article  PubMed  PubMed Central  Google Scholar 

  12. Chakravarty B, Konar H, Chowdhury NN (2000) Pregnancies after reconstructive surgery for congenital cervicovaginal atresia. Am J Obstet Gynecol 183:421–423. https://doi.org/10.1067/mob.2000.105740

    Article  CAS  PubMed  Google Scholar 

  13. Bugmann P, Amaudruz M, Hanquinet S, La Scala G, Birraux J, Le Coultre C (2002) Uterocervicoplasty with a bladder mucosa layer for the treatment of complete cervical agenesis. Fertil Steril 77:831–835. https://doi.org/10.1016/s0015-0282(01)03269-1

    Article  PubMed  Google Scholar 

  14. Acien P, Acien MI, Quereda F, Santoyo T (2008) Cervicovaginal agenesis: spontaneous gestation at term after previous reimplantation of the uterine corpus in a neovagina: case report. Hum Reprod 23:548–553

    Article  CAS  PubMed  Google Scholar 

  15. Ding JX, Chen XJ, Zhang XY, Zhang Y, Hua KQ (2014) Acellular porcine small intestinal submucosa graft for cervicovaginal reconstruction in eight patients with malformation of the uterine cervix. Hum Reprod 29:677–682. https://doi.org/10.1093/humrep/det470

    Article  PubMed  Google Scholar 

  16. Kisku S, Varghese L, Kekre A, Sen S, Karl S, Mathai J, Thomas RJ, Barla RK (2014) Cervicovaginal atresia with hematometra: restoring menstrual and sexual function by utero-coloneovaginoplasty. Pediatr Surg Int 30:1051–1060. https://doi.org/10.1007/s00383-014-3550-6

    Article  PubMed  Google Scholar 

  17. Minami C, Tsunematsu R, Hiasa K, Egashira K, Kato K (2019) Successful surgical treatment for congenital vaginal agenesis accompanied by functional uterus: a report of two cases. Gynecol Minim Invasive Ther 8:76–79. https://doi.org/10.4103/GMIT.GMIT_124_18 (Epub 2019 Apr 29)

    Article  PubMed  PubMed Central  Google Scholar 

  18. Creighton SM, Davies MC, Cutner A (2006) Laparoscopic management of cervical agenesis. Fertil Steril 85(1510):e13–e15. https://doi.org/10.1016/j.fertnstert.2005.10.067

    Article  Google Scholar 

  19. Grimbizis GF, Gordts S, Di Spiezio SA, Brucker S, De Angelis C, Gergolet M, Li TC, Tanos V, Brölmann H, Gianaroli L, Campo R (2013) The ESHRE/ESGE consensus on the classification of female genital tract congenital anomalies. Hum Reprod 28:2032–2044. https://doi.org/10.1093/humrep/det098

    Article  CAS  PubMed  PubMed Central  Google Scholar 

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Funding

The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.

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Author notes

  1. Niraj N. Mahajan and Arundhati Tilve contributed equally.

Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Topiwala National Medical College and BYL Nair Charitable Hospital, Mumbai, 400008, India

    Niraj N. Mahajan, Arundhati Tilve, Ganesh Shinde, Bhargavi Jnanananda, Vartika Srivastava, Shubhada Bahirat, Shayla Srivastava & Madhura Pophalkar

  2. Department of Radiology, Topiwala National Medical College and BYL Nair Charitable Hospital, Mumbai, 400008, India

    Shenaz Saifi

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  1. Niraj N. Mahajan
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Contributions

NNM: contributed to the study conception and design. Material preparation was done by NNM and AT. Data collection was done by all authors. Analysis was performed by NNM and AT. The first draft of the manuscript was written by NNM and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Niraj N. Mahajan.

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Conflict of interest

The authors have no relevant financial or non-financial interests to disclose.

Ethics approval

This is an observational study. No objection certificate was granted for anonymous publication by the Ethics Committees of TNMC (No. ECARP/71/2021 dated 03 December 2021).

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Informed consent was obtained from all individual participants included in the study and written informed consent was obtained from the parents. A copy of the written consent is available for review by the Editor of this journal.

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404_2022_6708_MOESM1_ESM.jpg

Fig. S1: Case #3—a, complete vaginal atresia with only vestibular mucosa; b, caudal end of hematometra with dissection in the vesicouterine and rectouterine spaces; c, intraoperative image showing incised hematometra and cervix pulled down till the vestibular mucosa; d, completed utero-vestibular anastomosis procedure before the insertion of indwelling Foley’s catheter (JPG 159 KB)

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Mahajan, N.N., Tilve, A., Shinde, G. et al. Minimally invasive vaginal approach to the uterovestibular anastomosis for cervicovaginal aplasia: a case series and review of literature. Arch Gynecol Obstet 308, 25–34 (2023). https://doi.org/10.1007/s00404-022-06708-9

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