Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome: (Vaginal / Mullerian Agenesis)
A rare congenital disorder (1:4500) of the female reproductive system, the vagina and uterus are absent, although external genitalia are normal. Affected women usually do not have menstrual periods due to the absent uterus. Women with MRKH syndrome have a female chromosome pattern (46XX) and normally functioning ovaries.
Treatment is by vaginal dilatation or by vaginal reconstruction. An artificial vagina can be constructed using a skin graft, amniotic membrane graft or peritoneum, placed over a mold and inserted in the vagina to create a neo-vaginal canal, thus lengthening the vagina.
Uterine Suspension: (uterine prolapse)
Uterine prolapse occurs when pelvic floor muscles and ligaments stretch and weaken, providing inadequate support for the uterus. Child birth trauma, chronic cough, constipation, obesity and aging are predisposing factors of uterine & vaginal prolapse. The uterus may drop down into the vagina or protrudes out from the vaginal opening; depending on the degree of prolapse and age of the patient, individual treatment is designed.
Uterine prolapse is more common in post menapausal women who’ve had multiple vaginal deliveries, in women over 50 years with a protruding uterus from the vagina, a vaginal hysterectomy would be the best method of treatment.
If the patient is young and future pregnancy is desired, a uterine suspension procedure is performed via the abdominal or vaginal route, preserving the womb for future pregnancy.
When the prolapse is mild, treatment usually isn’t needed, but if it causes discomfort or disrupts normal daily life treatment is necessary.
Causes of uterine prolaps
-Damage to pelvic floor tissues (childbirth)
-Loss of estrogen (menopause)
-Repeated straining (constipation)
Uterine prolapse can cause dragging pelvic pain, uterine bleeding, and urinary incontinence or retention. In cases of severe uterine prolapse, and the patient has completed her family, the uterus can be surgically removed via the vaginal route. This is sometimes better than using mesh augmented pelvic repair, the surgical repair of a prolapsed bladder and rectum can be performed at the same time.
Vault Prolapse of the vaginal cuff may happen after a hysterectomy due to weak pelvic ligament support, several abdominal and vaginal procedures are designed to re-attach the vagina to a pelvic structure, thus elevating the vagina to its normal anatomical position.
– Abdominal Vaginal Sling & Sacrocolpopexy
– Vaginal Sacro-Spinous Fixation
– Bilateral Ileo-Coccgeal Hitch
– Posterior Vaginal Sling
Anterior + Posterior Vaginal Reconstruction: (with mesh or without)
Anterior vaginal prolapse (cystocele) & Posterior vaginal prolapse (rectocele) happens due to weakness of pelvic floor muscles and damage to pelvic ligaments that hold them in place.
A cystocele (bladder fall) and rectocele (rectal fall) developed when their supporting pelvic ligaments are damaged, after childbirth, chronic cough, constipation, obesity, pelvic trauma, or age related hormonal changes. This condition causes pelvic pain, heaviness, discomfort, and urinary /fecal incontinence, it also causes vaginal widening and unsatisfactory sexual relationships.
Vaginal reconstruction repair is done by re-suturing torn muscles while repairing and shortening ligaments, thus restoring pelvic organs to their original position. When there is severe weakness of the pelvic tissue a synthetic mesh or biological tissue graft may be used. Synthetic mesh systems are rarely used now due to increased complications.