Urogynecological and Sexual Functions after Vecchietti Reconstructive Surgery

Aneta Adamiak-Godlewska, Katarzyna Skorupska, Tomasz Rechberger, Katarzyna Romanek-Piva, Paweł Miotła, Aneta Adamiak-Godlewska, Katarzyna Skorupska, Tomasz Rechberger, Katarzyna Romanek-Piva, Paweł Miotła

Abstract

Hypothesis/aims of study: Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome is the second most common cause of primary amenorrhea. The ESHRE/ESGE categorizes this disorder within the class 5 uterine malformation of the female genital tract anomalies. It is characterized by congenital absence of the uterus, cervix, and upper part of the vagina in otherwise phenotypically normal 46XX females. These patients have normal ovaries, biphasic ovarian cycle, and female psychosexual identification. Laparoscopic Vecchietti's operation-surgical method in which the vagina increases in size by gradually applying traction to the vaginal vault-is one of the methods used to treat MRKH. The aim of this study was to establish the urogynecological and sexual functions after Vecchietti's operation.

Study design materials and methods: Fifteen patients with MRKHS who underwent laparoscopic Vecchietti's operation were included. A control group of 15 age-matched, childless, sexually active women were examined during the same period. All patients underwent the basic evaluation of anatomical outcomes. Sexual outcomes were established by the Polish validated Female Sexual Function Index (FSFI) questionnaire. Continence status was assessed by Polish validated Urinary Distress Inventory (UDI-6) and the Incontinence Impact Questionnaire (IIQ-7).

Results: Mean age of MRKH group was 22.06±5.13 yrs. Mean follow-up after surgery was 8.02±3.43 yrs. Mean age of women from control group was 22.4±4.35. Mean FSFI scores show good quality of sexual life in both groups. UDI-6 scores showed that patients after Vecchietti surgery have urogynecological problems significantly more often than healthy women do. Based on the IIQ-7, it is evident that one patient from the MRKH group (6,6%) suffers from stress urinary incontinence and the rest (20%) have rather irritative problems with the functioning of the lower urinary tract.

Conclusion: Quality of sexual life after the Vecchietti's operation in long-term follow-up does not differ from that of healthy women, but these patients suffer more frequent from urogynecological complaints. The trial is registered with NCT03809819.

References

    1. Grimbizis G. F., Gordts S., Di Spiezio Sardo A., et al. The ESHRE/ESGE consensus on the classification of female genital tract congenital anomalies. Human Reproduction. 2013;28(8):2032–2044. doi: 10.1093/humrep/det098.
    1. D'Alberton A., Reschini E., Ferrari N., Candiani P. Prevalence of urinary tract abnormalities in a large series of patients with uterovaginal atresia. The Journal of Urology. 1981;126(5):623–624. doi: 10.1016/S0022-5347(17)54658-3.
    1. Labus L. D., Djordjevic M. L., Stanojevic D. S., Bizic M. R., Stojanovic B. Z., Cavic T. M. Rectosigmoid vaginoplasty in patients with vaginal agenesis: sexual and psychosocial outcomes. Sexual Health. 2011;8(3):427–430. doi: 10.1071/SH10105.
    1. Borruto F., Camoglio F. S., Zampieri N., Fedele L. The laparoscopic Vecchietti technique for vaginal agenesis. International Journal of Gynecology and Obstetrics. 2007;98(1):15–19. doi: 10.1016/j.ijgo.2007.03.012.
    1. Edmonds D. K., Rose G. L., Lipton M. G., Quek J. Mayer-Rokitansky-Küster-Hauser syndrome: a review of 245 consecutive cases managed by a multidisciplinary approach with vaginal dilators. Fertility and Sterility. 2012;97(3):686–690. doi: 10.1016/j.fertnstert.2011.12.038.
    1. Oppelt P. G., Lermann J., Strick R., et al. Malformations in a cohort of 284 women with Mayer-Rokitansky-Küster-Hauser syndrome (MRKH) Reproductive Biology and Endocrinology. 2012;10(1):p. 57. doi: 10.1186/1477-7827-10-57.
    1. Guralnick M. L., Fritel X., Tarcan T., Espuna-Pons M., Rosier P. F. W. M. ICS Educational Module: Cough stress test in the evaluation of female urinary incontinence: introducing the ICS-Uniform Cough Stress Test. Neurourology and Urodynamics. 2018;37(5):1849–1855. doi: 10.1002/nau.23519.
    1. Nowosielski K., Wróbel B., Sioma-Markowska U., Poreba R. Development and validation of the polish version of the female sexual function index in the polish population of females. The Journal of Sexual Medicine. 2013;10(2):386–395. doi: 10.1111/jsm.12012.
    1. Uebersax J. S., Wyman J. F., Shumaker S. A., et al. Short forms to assess life quality and symptom distress for urinary incontinence in women: the incontinence impact questionnaire and the urogenital distress inventory. Neurourology and Urodynamics. 1995;14(2):131–139. doi: 10.1002/nau.1930140206.
    1. Uçar M. G., Ilhan T. T., Kebapçilar A. G., Tosun Z., Çelik Ç. Urethral coitus in a case of vaginal agenesis - is only vaginoplasty enough to treat the urinary problems? Journal of Clinical and Diagnostic Research. 2016;10(8):QD01–QD03. doi: 10.7860/JCDR/2016/20106.8256.
    1. Bianchi M., Sola V., Ricci P., Pomes C. Late postoperative urinary stress incontinence after a laparoscopic-assisted Vecchietti procedure for neovagina creation in a patient with Rokitansky syndrome: successful treatment with the TVT-O technique. Journal of Minimally Invasive Gynecology. 2007;14(1):116–118. doi: 10.1016/j.jmig.2006.07.006.
    1. Aniuliene R., Aniulis P. Mayer–Rokitansky–Kuster–Hauser syndrome and stress urinary incontinence. European Journal of Obstetrics & Gynecology and Reproductive Biology. 2015;194:233–235. doi: 10.1016/j.ejogrb.2015.09.017.
    1. Huebner M., DeLancey J. O. L., Reisenauer C., et al. Magnetic resonance imaging of vaginal support structure before and after Vecchietti procedure in women with Mayer–Rokitansky–Küster–Hauser syndrome. Acta Obstetricia et Gynecologica Scandinavica. 2018;97(7):830–837. doi: 10.1111/aogs.13350.
    1. Pastor Z., Froněk J., Nováčková M., Chmel R. Sexual life of women with mayer-rokitansky-küster-hauser syndrome after laparoscopic vecchietti vaginoplasty. Sexual Medicine. 2017;5(2):e106–e113. doi: 10.1016/j.esxm.2016.12.003.
    1. McQuillan S. K., Grover S. R. Systematic review of sexual function and satisfaction following the management of vaginal agenesis. International Urogynecology Journal. 2014;25(10):1313–1320. doi: 10.1007/s00192-013-2316-3.
    1. Brucker S. Y., Gegusch M., Zubke W., Rall K., Gauwerky J. F., Wallwiener D. Neovagina creation in vaginal agenesis: development of a new laparoscopic Vecchietti-based procedure and optimized instruments in a prospective comparative interventional study in 101 patients. Fertility and Sterility. 2008;90(5):1940–1952. doi: 10.1016/j.fertnstert.2007.08.070.

Source: PubMed

Sponsors en medewerkers

Medische omstandigheden

Geneesmiddelinterventies

3
Abonneren