Vaginal Dilation in Mayer Rokitansky Kuster Hauser (MRKH
Transcription
Vaginal Dilation in Mayer Rokitansky Kuster Hauser (MRKH
Vaginal Dilation in Mayer Rokitansky Kuster Hauser (MRKH) Syndrome Ashradha Ketheeswaran, Jennifer Morrisey, A/Prof Jason Abbott, Dr. Rebecca Deans Background and Objectives Results Patients with MRKH have failed formation of Mullerian ducts causing an absent uterus and shortened/absent vagina. Vaginal dilation is the mainstay of treatment. The aim of our study was to evaluate the effect of adjuvant and analgesic agents at the time of vaginal dilator therapy for the creation of a functional neovagina in MRKH patients. Demographics -Median age at diagnosis: 17 years, (range 11-28); Median age beginning treatment: 18 years, (range: 13-36) -Median hospital admission length: 3 days, (range 1-5) -Median episodes of treatment per admission: 9, (range 2-15) -60/63 (95%) of patients used adjuvants during treatment Functional Outcomes -29/30 (97%) who had attempted intercourse were satisfied posttreatment -1/30 (3%) had tried unsuccessfully to have sexual intercourse Anatomical Outcomes -Median change in vaginal length: 3.5cm -Median change in vaginal width: 1.75cm - 30/46 (65.2%) of patients had a full anatomical neovagina (7cm or greater in length) by the end of intensive therapy - 27/28 (96%) of patients achieved a neovagina of 7cm or greater by first follow up; median length to first follow up: 46 days Methods Between 2000 and 2014, seventy-two women with MRKH receiving vaginal dilator treatment were identified from a tertiary hospital. One specialist nurse performed the intensive dilator treatments and administered adjuvants, and counselled subjects. Treatment consisted of a specialist nurse-guided dilation sessions of one hour length, several times per day depending of patient’s motivation and ability to cope. Adjuvant therapies used in conjunction with dilation included; topical estriol cream, anxiolytics (oral and inhaled), local anaesthetic gels and oral analgesia. Relevant patient demographics and treatment outcomes were collected and analysed Vaginal length pre-Tx: 3cm (range: 0-7.5) Vaginal length post-Tx: 7.25cm (range: 3-12) p≤0.0001 0 Vaginal width pre-Tx: 1.75cm (range: 0-3.5) Vaginal width post-Tx: 3.5cm (range: 1-4) P≤0.001 Conclusion Vaginal dilation delivered by intensive treatment with the use of adjuvants in a multidisciplinary context is an effective first line treatment for women with MRKH in the creation of a neovagina. References 1. Burel A, Mouchel T, Odent S, et al. Role of HOXA7 to HOXA13 and PBX1 genes in various forms of MRKH syndrome (congenital absence of uterus and vagina). J Negat Results Biomed. 2006; 5:4. 2. Ismail-Pratt IS, Bikoo M, Liao LM, et al. Normalization of the vagina by dilator treatment alone in Complete Androgen Insensitivity Syndrome and Mayer-Rokitansky-Kuster-Hauser Syndrome. Hum Reprod. 2007; 22:2020-2024. 3. Nakhal RS, Creighton SM. Management of vaginal agenesis. J Pediatr Adolesc Gynecol. 2012; 25:352-357.