Autologous In Vitro Cultured Vaginal Tissue for Vaginoplasty in Women With Mayer-Rokitansky-Küster-Hauser Syndrome: Anatomic and Functional Results

Abstract Study Objective To present the procedure and the results of a technique in which in vitro autologous cell cultures were used for the canal lining in patients with Mayer-Rokitansky-Kuster-Hauser syndrome (MRKHS) subjected to vaginoplasty with a modified Abbe-McIndoe technique. MRKHS is a rare anomaly characterized by vaginal agenesis with variable mullerian duct abnormalities. The Abbe-McIndoe procedure is 1 of the most frequent surgical treatments adopted in these women. In the last decades, several modifications have been introduced by different authors, mostly changing the lining material, but no consensus has been reached on what material should be used for the neovagina canal wall lining. Design A pilot study (Canadian Task Force classification II-1). Setting Policlinico Umberto I, “Sapienza” University of Rome. Patients A consecutive series of 23 women with MRKHS underwent neovaginoplasty with autologous vaginal tissue as the graft material between 2006 and 2013. Interventions Each patient with MRKHS was subjected to a full-thickness mucosal biopsy from the vaginal vestibule. After enzymatic dissociation, cells were inoculated onto collagen IV–coated plates and cultured for 2 to 3 weeks. The patients were subjected to vaginoplasty with a modified Abbe-McIndoe technique with autologous in vitro cultured vaginal tissue. Patients underwent clinical follow-up visits at 1, 3, 6, and 12 months after surgery and every year thereafter. Anatomic, functional, and sexual results were assessed. Measurements and Main Results In all cases, the vagina appeared normal in length and depth. A vaginal cytology and a vaginal biopsy obtained at the 3-month follow-up visit revealed physiological vaginal tissue. All 23 patients completed the Female Sexual Function Index questionnaire at 12 months after surgery. The results showed a total score of 27.2. These results indicate a satisfactory quality of sexual life. Conclusion The modified Abbe-McIndoe technique with autologous vaginal tissue appears to be safe and feasible. This technique allows normal and satisfying sexual intercourse. Larger series with longer follow-ups will be necessary to confirm if this technique represents the ideal procedure for vaginal agenesis.