Vaginal Surgery for Congenital Anomalies

Abstract

Congenital anomalies of the vagina may be isolated to the vagina or be part of a more complex Mullerian tract anomaly with possible fertility concerns. Patient age, complete assessment of the anomaly before surgery, and the psychologic implications for the patient are important components of the initial evaluation and treatment planning. Imaging, including magnetic resonance imaging, should be used to assess the extent of the anomaly and possibly other organ systems involved. Surgeries for imperforate hymen, longitudinal septum, and low thin transverse septum are relatively straightforward. More complicated surgeries should be performed by a specialized surgical team.

A New Technique For the Treatment of Transverse Vaginal Septum by Foley Catheter

“…5 The various congenital anomalies of the female reproductive tract occur as a result of disruption of normal embryologic processes of the M € ullerian ducts. 8 These obstructing anomalies are either longitudinal or transverse in origin.…”

“…Placement of a Foley catheter to drain the bladder is recommended because injuries to bladder and bowels are the most common intraoperative complications. 5 A common complication of resection of thick septa is scar contracture and vaginal stenosis. 9 In our case, the vaginal septum was thin; it was only perforated in the middle, not completely excised but widened.…”

“…4 Transverse vaginal septum may present as primary amenorrhea or dysmenorrhea or be more urgent with acute pain and a pelvic mass due to obstruction. 5 Ultrasound may be helpful to visualize hematocolpos and the presence or absence of a uterus and/or septum, the MRI can be helpful for planning surgical treatment, and should be planned for more complex cases. 6,7 Surgical evaluation and treatment, including laparoscopy, hysteroscopy, and excision of septum, may be followed by repeated surgery as deemed necessary.…”

Pregnancy following re-stenosis of complete transverse vaginal septum

“…However, if stenosis occurs it may be treated with dilatation or surgery. 4 Bautista et al reported a case of term pregnancy with complete transverse vaginal septum in which surgical correction was done in puerperium with no post-operative vaginal stenosis. 5 Our patient developed restenosis but was asymptomatic with satisfactory coital functions.…”

“…3 However, restenosis is the most common post-operative complication. 4 To prevent restenosis patient must wear a stent continuously for first 2 months after the surgery and at night for next 4 months. However, if stenosis occurs it may be treated with dilatation or surgery.…”