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The purpose of this study is to describe practices to prevent vaginal stenosis in pediatric and adolescent patients and to evaluate the strengths and weaknesses of available vaginal stents. An online survey was distributed to North American Society for Pediatric and Adolescent Gynecology (NASPAG) members with an optional follow-up focus group. Quantitative and qualitative data were synthesized to highlight physician practices and preferences using vaginal stents, strengths and weakness of stents, and ideal stent properties. Twenty physicians completed at least 50% of the survey, and 4 participated in the focus group. Most were pediatric and adolescent gynecology specialists (95%) with fellowship training (60%) and experience in managing Müllerian anomalies (80%). Physicians reported they "always" used a vaginal stent when performing vaginoplasty for distal vaginal agenesis with a graft (62.5%) or without a graft (37.5%) and for transverse vaginal septa (57.1%). The most common type of stents used were packed condoms (60%), tracheobronchial stents (40%), Foley catheters (35%), and custom stents (35%). Participants described an ideal vaginal stent as something that would stay in place, cause little discomfort, expand, and come in a variety of lengths. There are limited vaginal stent options for the pediatric and adolescent gynecology population. Participants reported variability in stents used to prevent vaginal stenosis, with commonly used vaginal stents having significant weaknesses. Future efforts are needed to identify and develop postoperative clinical guidelines to prevent vaginal stenosis. [ABSTRACT FROM AUTHOR]

Vaginal agenesis is the most common condition affecting women known as Mayer-Rokitansky-Kã¼Ster-Hauser syndrome (MRKH). After surgery, vaginal stents are prosthetic devices that are utilized to keep the vagina that was rebuilt from potentially contracting. They ensure that the neovagina keeps its shape by assisting in maintaining the width, depth, and preventing stenosis. But there are some potential problems associated with the use of vaginal stent which needs to be addressed for better functioning and in improving overall quality of life for women. This review article deals with the potential problems associated with the vaginal stent. [ABSTRACT FROM AUTHOR]

Objective. The objective is to determine the possible improvement in outlet obstructive constipation symptoms after vaginal stent treatment for rectocele. Methods. Female patients with rectocele (n = 156) accompanied with outlet obstructive constipation were selected in this study. Longo's obstructed defecation syndrome (ODS) questionnaire, rectoanal pressures, and rectal balloon expulsion (BET) were evaluated at baseline, 1 month follow-up, and 6 months follow-up. Moreover, the side effects and the potential reasons for giving up treatment were also detected. Results. Vaginal stent significantly decreased the straining intensity, shortened the straining extensity time, decreased the use of laxatives, and alleviated the symptoms of incomplete evacuation (P <.05). The vaginal stent also increased the rectal pressure and shortened the balloon expulsion time (P <.05). Conclusions. As an effective, feasible, and safe procedure, the vaginal stent can be recommended as a treatment of choice for rectocele combined with outlet obstructive constipation. [ABSTRACT FROM AUTHOR]

Vaginal agenesis is a common congenital anomaly in females and is most commonly associated with Mayer–Rokitansky–Kuster–Hauser (MRKH) syndrome. These patients can be treated with both surgical and nonsurgical procedures. Prefabricated as well as customized vaginal stents are used for the reconstruction and maintenance of neovagina. This case report explains the fabrication of customized tissue conditioner-reinforced acrylic vaginal stent for the treatment of a 20-year-old female having vaginal agenesis associated with MRKH syndrome. This vaginal stent with resilient surface provides a relatively easy, simple, and cost-effective alternative for the treatment of vaginal agenesis. It is also associated with increased compliance and comfort to the patient.

Congenital vaginal agenesis is a common condition with an instance of 1 in 5000 females. It is usually associated with Mayer-Rokitansky-Kuster Hauser syndrome. Such anomalies have a high impact on the physiology and psychology of patients. A simple approach for the hollowing of the customized vaginal stent prosthesis has been described for the case of Mayer-Rokitansky-Kuster-Hauser syndrome.

Congenital vaginal agenesis is a common condition with an instance of 1 in 5000 females. It is usually associated with Mayer-Rokitansky-Kuster Hauser syndrome. Such anomalies have a high impact on the physiology and psychology of patients. A simple approach for the hollowing of the customized vaginal stent prosthesis has been described for the case of Mayer-Rokitansky-Kuster-Hauser syndrome. [ABSTRACT FROM AUTHOR]

Objective: To describe how to create an inflatable vaginal stent for use in McIndoe vaginoplasty that can be constructed using standard operating room supplies.Design: Step-by-step video instructions that demonstrate how to construct and use an inflatable vaginal stent. (This video article was exempt from institutional review board approval.) SETTING: Academic hospital.Patient(s): A woman presenting with vaginal agenesis requiring a McIndoe vaginoplasty for the creation of a neovagina.Intervention(s): A novel inflatable vaginal stent compliant with operating room procedures that is radio-opaque, functional, and can be used for patients with or without a functional uterus. The device is modeled after the effective inflatable vaginal stent that was previously commercially available but is no longer produced. Although a vaginal stent may be created in the operating room by placing surgical sponges inside a sterilized condom, many operating rooms have restrictions on equipment that can be brought into the operating room and special criteria for how to sterilize this equipment, and there are also restrictions against leaving non-radio-opaque objects "inside" the patient. The novel inflatable vaginal stent we have developed has multiple advantages compared with a rigid dilator: it is deflatable, so it does not cause trauma or interrupt the delicate tissue graft during insertion, removal, or repositioning; it is firm enough to conform and circumferentially press the tissue graft against the dissected vaginal space but is soft enough to decrease the risk of pressure necrosis or damage to the urethra; and it has a drainage port to prevent the buildup of a fluid pocket that could interfere with graft adherence. Our stent incorporates all these unique properties and can be easily constructed using sterile operating room supplies. The construction of this device requires a silicone Foley catheter, sterile foam sponges from a vaginal prep kit, a sterile radio-opaque sponge, a sterile vaginal ultrasound probe cover, a long Kelly, a 60-cc catheter tip syringe, a ruler, scissors, 0-vicryl suture, and sterile gloves.Main Outcome Measure(s): Effectiveness of a self-made inflatable vaginal stent using standard operating room supplies that meets operating room protocol standards.Result(s): A standard dose of prophylactic antibiotics should be administered preoperatively to prevent surgical site infection. After placement of the tissue graft in the dissected neovagina cavity, the vaginal stent is placed and slowly inflated to circumferentially apply the tissue graft against the dissected vaginal space. The stent remains in place for 7 days and then should be removed in the operating room to allow for an examination under anesthesia, which provides the ideal setting to best evaluate the initial graft adherence. After careful inspection of the neovagina and tissue graft, a standard silicone vaginal mold is placed to maintain vaginal patency and prevent stricture of the tissue graft. The silicone mold should remain in place continuously until complete graft adherence occurs (approximately 4 to 6 weeks), and then it can be worn nightly until the patient is regularly sexually active. If at any point the patient discontinues nightly use of the silicone mold before regular sexual activity, vaginal stricture and a decrease in vaginal caliber will occur.Conclusion(s): Our novel inflatable vaginal stent is useful to surgeons performing a McIndoe vaginoplasty for vaginal agenesis with or without a uterus. It is compliant with operating room protocols and restrictions, as it is constructed from operating room supplies and is radio-opaque. Moreover, it is adjustable in size and effective in applying circumferential pressure for graft adherence. When used for segmental vaginal agenesis, the Foley catheter may be advanced through the cervix, then the balloon can be inflated, to stabilize the position of the stent during the first week postoperatively. The main limitation of this device is that it must be constructed by the surgeon, but the advantage of self-constructing the stent is that the size and shape can be tailored to conform to each individual patient. We prefer this inflatable vaginal stent to a rigid vaginal dilator in the first week of tissue healing to allow for easy insertion and removal of the stent without disrupting the tissue graft, to help prevent tissue necrosis, and to provide a fluid drainage port during graft adherence. We recommend this device as an ideal option for surgeons to consider when performing a McIndoe vaginoplasty. [ABSTRACT FROM AUTHOR]

Vaginal agenesis is one of the major congenital anomalies of the female genital tract. It may present either as an isolated developmental defect or within a complex of more extensive anomalies. Most commonly it is associated with Mayer-Rokitansky-Kόster-Hauser (MRKH) syndrome. The correction of vaginal agenesis requires the creation of a neovaginal cavity that is dissected between the bladder and the rectum. After reconstruction of space for vagina surgically, a long-term vaginal stent use is required to maintain vaginal width and depth and to prevent contraction. In this article is presented a case of nonsyndromic agenesis of vagina in a 14-year-old girl and its surgical management using custom fabricated acrylic vaginal stent.

Vaginal agenesis is one of the major congenital anomalies of the female genital tract. It may present either as an isolated developmental defect or within a complex of more extensive anomalies. Most commonly it is associated with Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome. The correction of vaginal agenesis requires the creation of a neovaginal cavity that is dissected between the bladder and the rectum. After reconstruction of space for vagina surgically, a long-term vaginal stent use is required to maintain vaginal width and depth and to prevent contraction. In this article is presented a case of nonsyndromic agenesis of vagina in a 14-year-old girl and its surgical management using custom fabricated acrylic vaginal stent. [ABSTRACT FROM AUTHOR]

Introduction and Objectives: To describe the development and characteristics living donor uterine transplantation program of the Hospital Clínic (Barcelona, Spain) and to report the first successful procedure in Southern Europe., Patients and Methods: A 31-year-old female suffering of Rokitansky Syndrome underwent uterus transplant from her living sister, as a part of our research protocol. Before the transplant, the patient underwent an in vitro fertilization procedure and twelve embryos were obtained and cryopreserved. The uterus obtention procedure was performed entirely by robotic surgery and lasted 10h, being the main objective to obtain arterial and venous pedicles of good quality in order to ensure the vitality of the graft. The surgical procedure in the recipient was performed by laparotomy and the vascular anastomoses were performed in a terminolateral fashion, with polypropylene 8-0, the vaginal cuff of the graft was sutured to the recipient vaginal vault and the round and utero-sacral ligaments were fixed to the remaining recipient ligaments. Immunosuppressive treatment was prescribed following the protocols from other groups modified according to the solid organ transplantation protocols from our center., Results: The donor and recipient were discharged without any major complications. The recipient ultrasound scan showed a normal flow in both uterine arteries and veins. A grade II rejection was treated with high dose corticoids with subsequent normal biopsies and a vaginal stricture was treated with the placement of an esophageal stent for 4 weeks. The patient had her first menstrual period 47 days after the surgery., Conclusions: The case reported here open new options in Spain for a wide group of patients that had no medical solution for a disease that deeply impairs their quality of life., (Copyright © 2020 Elsevier España, S.L.U. All rights reserved.)

Meyer -Rokitansky- Kuster -Hauser syndrome is associated with the congenital absence of uterus and vagina. In this condition a neovagina is created with modified Mc Indoe's method. The tissues surrounding the neovagina are pushed aside during dissection and these tissues will attempt to move back to the original position.Inorder to prevent this and to maintain the patency of the neovagina, a stent has to be placed.An acrylic vaginal stent prevents vaginal contracture and stenosis. [ABSTRACT FROM AUTHOR]

Introduction: Appropriate postoperative care and prolonged use of the mold are prerequisites for achieving successful results in McIndoe-style vaginoplasty., Objective: We introduce a specially designed pored polyacetal mold to maintain the reconstructed vagina, with favorable long-term results allowing drainage of the serous and bloody discharge without removal of the mold, and reduction of infection rate and the chance of skin graft shearing in McIndoe vaginoplasty., Methods: We retrospectively reviewed data of 10 consecutive patients with Mayer-Rokitansky-Kuster-Hauser syndrome who underwent McIndoe vaginoplasty between March 2010 and January 2014. We used a specially designed pored polyacetal mold (Figure) in all reconstructed vaginal wounds. The anatomical surgical success was evaluated by physical examination and functional success, which was defined as satisfaction with sex evaluated by patient self-assessed questionnaire., Results: The follow-up period ranged from 1 to 3.5 years. The postoperative mean vaginal length was 9.5 cm in nine patients who used the mold regularly. In all cases in which a pored polyacetal mold was used, skin engraftment was successfully maintained without partial skin graft loss or infection. The subjective patient self-assessed satisfaction evaluation reported a high satisfaction rate., Discussion: The multi-holed polyacetal vaginal mold was designed to perform vaginal irrigation without removal of the mold, allowing drainage of the serous and bloody discharge. This makes it possible to reduce infection rate and maintain successful skin engraftment by reducing the chance of skin graft shearing. The characteristics of polyacetal make it useful as a vaginal mold material as it is lightweight to use, easy to manufacture in accordance with the dimensions of the neovaginal space, and cost-effective. Although a constant follow-up evaluation is required, the pored polyacetal mold is an attractive vaginal mold dressing material to maximize the initial graft uptake, and it can be individually tailored in patients undergoing McIndoe-style vaginoplasty., Conclusions: The specially designed vaginal mold made up of pored polyacetal is a proper vaginal mold, which could maximize the initial graft uptake, decrease the risk of wound infection, and, therefore, decrease contracture of the neovagina in patients undergoing McIndoe vaginoplasty., (Copyright © 2017 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.)