Early prolapse of a neovagina created with self-dilatation and treated with sacrospinous ligament suspension in a patient with Mayer-Rokitansky-Küster-Hauser syndrome: a case report

Abstract

Objective: To report a case of a patient who had an early prolapse of the neovagina, while using Frank's dilators method, that was successfully treated with sacrospinous ligament suspension.

Design: Case report.

Setting: Tertiary-care university hospital.

Patient(s): A 22-year-old woman with Mayer-Rokitansky-Küster-Hauser syndrome.

Intervention(s): Frank's vaginal dilators method.

Main outcome measure(s): Vaginal elongation by self-dilatation. Early prolapse of the neovagina. Surgical repair with vaginal sacrospinous ligament suspension.

Result(s): A few months after the beginning of the treatment the patient had a prolapse of the neovagina. On pelvic examination, the total vaginal length was 5 cm with eversion of the vaginal apex 3 cm beyond the hymen with strain. Vaginal length was not satisfactory for the patient yet; therefore, the vaginal dilation program was continued to reach the prefixed vaginal length. Two months later the total vaginal length was 8 cm with eversion of the vaginal apex 6 cm beyond the hymen with strain. The patient underwent a sacrospinous ligament suspension. Twenty months after surgery, the patient had no symptoms and was highly satisfied with the result.

Conclusion(s): Prolapse of a neovagina may occur early after conservative treatment. If the initial prefixed goal of vaginal length has not been reached when prolapse develops, the vaginal dilatation program may be continued. In our case vaginal sacrospinous ligament fixation was successful, with good anatomic and functional results.