Uterovaginal anastomosis for cases of cryptomenorrhea due to cervical atresia with vaginal aplasia: benefits and risks

Abstract Study objective The objective of this study is to assess short term benefits and risks of utero-vaginal anastomosis done for cases of cryptomenorrhea due to cervical atresia with vaginal aplasia. Design prospective study Setting Surgical operations were done between December 2013 and September 2015 at the department of Obstetrics and Gynecology, Cairo University Hospital. Participants Five patients who had cryptomenorrhea due to cervical atresia associated with vaginal aplasia were included. Interventions Utero-vaginal anastomoses were performed in two stages; a stage of McIndoe vaginoplasty and a stage of excision of the atretic cervical tissue and anastomosing the uterus to the neovagina. Follow up was done by examination and ultrasound in a duration ranged from 12 to 36 months. Main outcome measures occurrence of regular menstrual flow and relief of the severe cyclic pain. Results All patients had relief of the severe cyclic pain. Four patients had regular menstrual flow. One patient developed occlusion of the track after one year and needed dilatation once. Three patients developed low vaginal stenosis without occlusion of the track. One patient had rectal injury repaired without causing postoperative morbidity. Conclusion Uterovaginal anastomosis is a promising conservative management option for cervical atresia with vaginal aplasia which has benefits but is not free of risks . Long term follow up is still needed to judge its feasibility . We recommend performing McIndoe vaginoplasty as a starting stage before the anastomosis preferably in a separate setting.