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DOI: 10.1055/s-0042-1756214
Three-dimensional Printer Molds for Vaginal Agenesis: An Individualized Approach as Conservative Treatment
Moldes de impressão tridimensionais para agenesia vaginal: Uma abordagem individualizada como tratamento conservadorAbstract
Objective The aim of this study was to evaluate the use of vaginal molds, made with three-dimensional (3D) printing, for conservative treatment through vaginal dilation in patients with vaginal agenesis (VA).
Methods A total of 16 patients with a diagnosis of VA (Mayer-Rokitansky-Küster-Hauser syndrome, total androgen insensitivity syndrome, and cervicovaginal agenesis) from the Federal University of São Paulo were selected. Device production was performed in a 3D printer, and the polymeric filament of the lactic polyacid (PLA) was used as raw material. A personalized treatment was proposed and developed for each patient.
Results There were 14 patients who reached a final vaginal length of 6 cm or more. The initial total vaginal length (TVL) mean (SD) was 1.81(1.05) and the final TVL mean (SD) was 6.37 (0.94); the difference, analyzed as 95% confidence interval (95% CI) was 4.56 (5.27–3.84) and the effect size (95% CI) was 4.58 (2.88–6.28).
Conclusion The 3D printing molds for vaginal dilation were successful in 87.5% of the patients. They did not present any major adverse effects and offered an economical, accessible, and reproducible strategy for the treatment of VA.
Resumo
Objetivo O objetivo deste estudo foi avaliar o uso de moldes dilatadores vaginais, confeccionados com impressão tridimensional (3D), para tratamento conservador através da dilatação vaginal em pacientes com agenesia vaginal (AV).
Métodos Foram selecionadas 16 pacientes com diagnóstico de AV (síndrome de Mayer-Rokitansky-Küster-Hauser, síndrome de insensibilidade androgênica total e agenesia cervicovaginal), da Universidade Federal de São Paulo. A produção dos dispositivos foi realizada em uma impressora 3D e, como matéria-prima, foi utilizado o filamento polimérico do poliácido lático (PLA). Um tratamento personalizado foi proposto e desenvolvido para cada paciente.
Resultados Quatorze pacientes atingiram um comprimento vaginal final (CVF) de 6 cm ou mais. A média inicial do CVF (DP) foi de 1,81 (1,05) e a média final do CVF (DP) 6,37 (0,94); a diferença (IC 95%) foi de 4,56 (5,27–3,84) e o tamanho do efeito (IC 95%) foi de 4,58 (2,88–6,28).
Conclusão Os moldes de impressão 3D para dilatação vaginal obtiveram sucesso em 87,5% das pacientes. Como impacto secundário, não apresentaram efeitos adversos importantes e ofereceram uma estratégia econômica, acessível e reprodutível para o tratamento da AV.
Keywords
3D printing - Mayer-Rokitansky-Küster-Hauser syndrome - vaginal agenesis - vaginal dilationPalavras-chave
impressão 3D - síndrome de Mayer-Rokitansky-Küster-Hauser - agenesia vaginal - dilatação vaginalContributions
MSF contributed to project development, data collection, and writing the manuscript; CCTN contributed to project development and proofreading/editing the manuscript; TTBC and GVM proofread/ edited the manuscript; MJBCG contributed to project development and proofreading/editing the manuscript; MGFS contributed to project development and proofreading/editing the manuscript.
Publication History
Received: 22 April 2022
Accepted: 14 June 2022
Article published online:
22 September 2022
© 2022. Federação Brasileira de Ginecologia e Obstetrícia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)
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References
- 1 Fontana L, Gentilin B, Fedele L, Gervasini C, Miozzo M. Genetics of Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome. Clin Genet 2017; 91 (02) 233-246 DOI: 10.1111/cge.12883.
- 2 Sarpel U, Palmer SK, Dolgin SE. The incidence of complete androgen insensitivity in girls with inguinal hernias and assessment of screening by vaginal length measurement. J Pediatr Surg 2005; 40 (01) 133-136 , discussion 136–137 DOI: 10.1016/j.jpedsurg.2004.09.012.
- 3 McQuillan SK, Grover SR. Dilation and surgical management in vaginal agenesis: a systematic review. Int Urogynecol J Pelvic Floor Dysfunct 2014; 25 (03) 299-311 DOI: 10.1007/s00192-013-2221-9.
- 4 Frank RT. The formation of an artificial vagina without operation. Am J Obstet Gynecol 1938; 35 (06) 1053-1055 DOI: 10.1016/S0002-9378(38)90400-4.
- 5 ACOG Committee Opinion No. 728 Summary: Müllerian Agenesis: Diagnosis, Management, And Treatment. Obstet Gynecol 2018; 131 (01) 196-197 DOI: 10.1097/AOG.0000000000002452.
- 6 Chrispin TT, Fernandez MS, Novoa CC, Sartori MG. Development of personalized molds for neovagina creation by 3D printer. Rev Assoc Med Bras (1992). 2020; 66 (11) 1498-502 DOI: 10.1590/1806-9282.66.11.1498.
- 7 Cohen J. Statistical power analysis for the behavioral sciences. 2nd ed.. New York: Routledge; 1988
- 8 Edmonds DK, Rose GL, Lipton MG, Quek J. Mayer-Rokitansky-Küster-Hauser syndrome: a review of 245 consecutive cases managed by a multidisciplinary approach with vaginal dilators. Fertil Steril 2012; 97 (03) 686-690 DOI: 10.1016/j.fertnstert.2011.12.038.
- 9 Costa EM, Mendonca BB, Inácio M, Arnhold IJ, Silva FA, Lodovici O. Management of ambiguous genitalia in pseudohermaphrodites: new perspectives on vaginal dilation. Fertil Steril 1997; 67 (02) 229-232 DOI: 10.1016/s0015-0282(97)81902-4.
- 10 Robson S, Oliver GD. Management of vaginal agenesis: review of 10 years practice at a tertiary referral centre. Aust N Z J Obstet Gynaecol 2000; 40 (04) 430-433 DOI: 10.1111/j.1479-828x.2000.tb01175.x.
- 11 Lappöhn RE. Congenital absence of the vagina–results of conservative treatment. Eur J Obstet Gynecol Reprod Biol 1995; 59 (02) 183-186 DOI: 10.1016/0028-2243(94)02037-f.
- 12 Ingram JM. The bicycle seat stool in the treatment of vaginal agenesis and stenosis: a preliminary report. Am J Obstet Gynecol 1981; 140 (08) 867-873 DOI: 10.1016/0002-9378(81)90076-4.
- 13 Roberts CP, Haber MJ, Rock JA. Vaginal creation for müllerian agenesis. Am J Obstet Gynecol 2001; 185 (06) 1349-1352 , discussion 1352–1353 DOI: 10.1067/mob.2001.119075.
- 14 Apfel VR, Takano CC, Marquini GV, de Jarmy di Bella ZIK, Girão MJBC, Sartori MGF. Treatment for vaginal agenesis: A prospective and comparative study between vaginal dilation and surgical neovaginoplasty. Int J Gynaecol Obstet 2022; 157 (03) 574-581 DOI: 10.1002/ijgo.13931.
- 15 Baldwin JF. XIV. The formation of an artificial vagina by intestinal transplantation. Ann Surg 1904; 40 (03) 398-403
- 16 Vecchietti G. [Creation of an artificial vagina in Rokitansky-Küster-Hauser syndrome]. Attual Ostet Ginecol 1965; 11 (02) 131-147 Italian.
- 17 Davydov SN, Zhvitiashvili OD. Formation of vagina (colpopoiesis) from peritoneum of Douglas pouch. Acta Chir Plast 1974; 16 (01) 35-41
- 18 McIndoe AH, Banister JB. An operation for the cure of congenital absence of the vagina. J Obstet Gynaecol Br Emp 1938; 45: 490-494
- 19 McIndoe AH. The treatment of vaginal atresia by free grafts. In: Skoog T, Ivy RH. editors. Transactions of the international society of plastic surgeons first congress Stockholm and Uppsala 1955. Baltimore: Williams & Wilkins; 1957: 414-7
- 20 Crema LC. Neovaginoplastia com celulose oxidada aspectos clínicos e morfológicos [dissertação]. São Paulo: Universidade Federal de São Paulo; 2008
- 21 Dornelas J, Jármy-Di Bella ZI, Heinke T, Kajikawa MM, Takano CC, Zucchi EV. et al. Vaginoplasty with oxidized cellulose: anatomical, functional and histological evaluation. Eur J Obstet Gynecol Reprod Biol 2012; 163 (02) 204-209 DOI: 10.1016/j.ejogrb.2012.04.018.
- 22 Kajikawa MM, Jármy-Di Bella ZI, Focchi GR, Dornelas J, Girão MJ, Sartori MG. Role of estrogen receptor alpha on vaginal epithelialization of patients with Mayer-Rokitansky-Kuster-Hauser syndrome submitted to neovaginoplasty using oxidized regenerated cellulose. Int Urogynecol J Pelvic Floor Dysfunct 2012; 23 (04) 467-472 DOI: 10.1007/s00192-011-1604-z.
- 23 National Inventors Hall of Fame. Charles Hull: Stereolithography (3D Printing): Patent No. 4,575,330 [Internet]. 2014 [cited 2021 Oct 18]. Available from: https://web.archive.org/web/20140312010450/http://invent.org/inductees/hull-charles/
- 24 Pugliese L, Marconi S, Negrello E, Mauri V, Peri A, Gallo V. et al. The clinical use of 3D printing in surgery. Updates Surg 2018; 70 (03) 381-388 DOI: 10.1007/s13304-018-0586-5.
- 25 Barbosa MZ, Zylbersztejn DS, de Mattos LA, Carvalho LF. Three-dimensionally-printed models in reproductive surgery: systematic review and clinical applications. Minerva Ginecol 2019; 71 (03) 235-244 DOI: 10.23736/S0026-4784.19.04319-3.