BACKGROUND: Vaginal aplasia occurs in 1 in 5,000–
10,000 female live births. In this report, we evaluated
a novel dual-force vaginoplasty technique for treatment
of 11 patients with segmental vaginal aplasia.
TECHNIQUE: The principle of the approach is to thin the
atretic part between two counteracting forces. The
instrument was inserted laparoscopically into the proximal
hematocolpos. Two balloon catheters, one for drainage
and one for traction, were threaded over the inserter.
The traction catheter was then threaded over a silicon
tube, leaving the balloon in the proximal portion of the
vagina and connecting across the vaginal septum to
a fenestrated Teflon olive, which was positioned against
the distal surface of the vaginal septum. This created
a dual “pushing and pulling” force across the septum,
which, over 3–4 days, pulls the upper vaginal pouch down
while the vaginal dimple is pushed up. The aplastic segment
becomes thin and easy to dilate and permits
achievement of vaginal patency. The drainage of the hematocolpos
is predominantly through the balloon catheter
so postoperative wound management is facilitated.
EXPERIENCE: Eleven menarchal girls were diagnosed
with segmental vaginal aplasia. The dual-force vaginoplasty
was performed on each and was tolerated well
with no operative complications. They all reported
establishment of the menstrual cycle and significant
improvement of pain during follow-up.
CONCLUSION: Creation of a dual pushing–pulling force
on the atretic vaginal segment is a feasible short procedure
for management of segmental vaginal aplasia.
(Obstet Gynecol 2017;129:854–9)