Results
A total of 42 women with MRKH syndrome underwent surgery with Uncu Modified Remnant-Supported Laparoscopic Double-Layer Peritoneal Pull-Down Vaginoplasty Operation. The mean age was 27.3 + 4.7 years, and the mean body mass index was 23.4 + 3.6 kg/m2. Two of the 42 patients’ karyotype was 46 XY and diagnosed with testicular feminization. The other forty patients had normal female karyotype. Thirty-six of the patients had a normal urinary scan. Three patients were diagnosed with unilateral renal agenesis, and three patients were diagnosed with the double ureter. There were four perioperative complications. Three of the complications were bladder injury during the vaginal dissection through the Douglas pouch. One of the complications was rectum serosa injury which occurred during peritoneal preparation. All the injuries were laparoscopically repaired during the operation. There was no need for a second operation for these patients. There were four long-term complications during follow-up. One patient with vesicovaginal fistula, one patient with rectovaginal fistula, and two patients with vaginal stenosis because of incompliance with regular mold exercise. The patient with vesicovaginal fistula was recovered with continued Foley catheterization for two weeks. The patient with rectovaginal fistula was diagnosed three months after surgery. She underwent another operation to repair the fistula and divert a colostomy. The colostomy was closed at six months after the second operation.
The mean vaginal length at one-year control was 8.4 + 1.9 cm with enough width for sexual intercourse. A standard speculum could easily be inserted into the vagina of all patients except for the two patients who did not regularly exercise and dropped out from follow-up. The vaginal surface epithelium was completely was formed at one-year control. There was not an obvious external sign of the surgery in any patients.
There were thirty-six patients with a sexual partner and accepted the FSFI survey. The mean FSFI score was 31.5 + 3.9 (min:24-max:36)
Five of the 31 patients were not in a desire of motherhood. The other 31 patients answered their motherhood plans. Twenty-one patients (68%) wanted to be a mother by uterine transplantation if possible in our country. Three patients (9.6%) thought to be a mother by maternal surrogacy after ICSI, and seven patients (22.5%) were planning to be a mother by adopting a child.