Noncongenital Vaginal Obliteration: Surgical Restoration of Vaginal Patency for GVHD.
J Minim Invasive Gynecol
; 31(7): 555, 2024 Jul.
Article
in En
| MEDLINE
| ID: mdl-38493830
ABSTRACT
STUDY OBJECTIVE:
To provide a brief overview of noncongenital causes of vaginal obliteration and stenosis, discuss a unique case of vaginal agglutination in a patient who developed genital graft-versus-host disease (GVHD) after receiving a bone marrow transplant (BMT), and present the steps of a laparoscopic total hysterectomy and lysis of vaginal adhesions that successfully restored vaginal patency without the need for grafting.DESIGN:
This video gives an overview of noncongenital causes of vaginal obliteration with a focus on genital GVHD.SETTING:
GVHD is a known possible complication of BMT. This condition can lead to vaginal obliteration, affecting sexual performance and quality of life.INTERVENTIONS:
We discuss the clinical course of a 54-year-old female with history of acute monocytic leukemia treated with chemotherapy and a BMT. She subsequently developed genital GVHD with complete vaginal obliteration, precluding penetrative intercourse and causing pain, discomfort, and decreased quality of life. We present a combined laparoscopic and vaginal surgical procedure that allowed for the creation of a neovagina with a normal length and caliber. While grafting is sometimes necessary due to inflammation and scarring, we were able to avoid a graft by using a combined laparoscopic and vaginal approach, followed by restoration of continuity between the unaffected upper and lower vaginal tissues.CONCLUSION:
GVHD can be quite debilitating for patients. A combined surgical approach is a feasible option for patients with complex pathology not amenable to simple transvaginal adhesiolysis. Surgical restoration of the vagina does not necessarily require the use of a graft if the anatomy is reestablished successfully. VIDEO ABSTRACT.Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Vagina
/
Bone Marrow Transplantation
/
Graft vs Host Disease
Limits:
Female
/
Humans
/
Middle aged
Language:
En
Journal:
J Minim Invasive Gynecol
Journal subject:
GINECOLOGIA
Year:
2024
Type:
Article