Understanding Physician Practices and Preferences Using Vaginal Stents to Prevent Post-operative Vaginal Stenosis in Pediatric and Adolescent Patients

The purpose of this study is to describe practices to prevent vaginal stenosis in pediatric and adolescent patients and to evaluate the strengths and weaknesses of available vaginal stents. An online survey was distributed to North American Society for Pediatric and Adolescent Gynecology (NASPAG) members with an optional follow up focus group. Quantitative and qualitative data were synthesized to highlight physician practices and preferences using vaginal stents, strengths and weakness of stents, and ideal stent properties. Twenty physicians completed at least 50% of the survey and 4 participated in the focus group. Most were pediatric and adolescent gynecology (PAG) specialists (95%) with fellowship training (60%) and experience in managing Müllerian anomalies (80%). Physicians reported they "always" used a vaginal stent when performing vaginoplasty for distal vaginal agenesis with a graft (62.5%) or without a graft (37.5%), and for transverse vaginal septa (57.1%). The most common type of stents used were packed condoms (60%), tracheobronchial stents (40%), Foley catheters (35%), and custom stents (35%). Participants described an ideal vaginal stent as something that would stay in place, cause little discomfort, expand, and come in a variety of lengths. There are limited vaginal stent options for the PAG population. Participants reported variability in stents used to prevent vaginal stenosis with commonly used vaginal stents having significant weaknesses. Future efforts are needed to identify and develop post-operative clinical guidelines to prevent vaginal stenosis.