Treatment of vaginal agenesis in Mayer-Rokitansky-Küster-Hauser syndrome in Denmark: a nationwide comparative study of anatomical outcome and complications - Fertility and Sterility

To compare the long-term anatomical outcome and complications in treatments of vaginal agenesis in Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome. A historical comparative follow-up study using medical chart reviews. Public hospitals. A nationwide cohort of patients diagnosed with MRKH syndrome (n = 168). McIndoe vaginoplasty (n = 54), self-dilation (n = 60), coital dilation (n = 20), Baldwin vaginoplasty (n = 4), Williams vaginoplasty (n = 3), Davydov vaginoplasty (n = 2), or no treatment (n = 29). Mean vaginal depth at follow-up, anatomical treatment success rates at levels of ≥6 cm, ≥7 cm, and ≥8 cm, complications, and resurgery. Mean vaginal depths were 7.4 cm (95% confidence interval [CI] 6.8–8.1 cm), 7.3 cm (95% CI 6.7–7.9 cm), and 8.7 cm (95% CI 7.9–9.5 cm) at follow-up in patients treated by McIndoe vaginoplasty, self-dilation, and coital dilation, respectively. Overall complication rates in the three groups were 35/54 (65%), 21/52 (35%), and 1/20 (5%), respectively. Eighteen (33%) of the patients who underwent McIndoe vaginoplasty needed resurgery. Our findings support the current recommendations of dilation therapy as the first-line treatment of vaginal agenesis and emphasize the relevance of coital dilation in patients able to regularly engage in coital activity. However, further studies of functional outcome and patient satisfaction are needed. Tratamiento de la agenesia vaginal en el síndrome de Mayer-Rokitansky-Küster-Hauser en Dinamarca: un estudio comparativo a escala nacional del resultado anatómico y las complicaciones. Comparar el resultado anatómico y complicaciones a largo plazo en tratamientos de agenesia vaginal en síndrome de Mayer-Rokitansky-Küster-Hauser (MRKH). Un estudio de seguimiento histórico comparativo usando revisiones de historias médicas. Hospitales públicos. Una cohorte de pacientes a escala nacional diagnosticadas de MRKH (n = 168). Vaginoplastia de McIndoe (n = 54), auto-dilatación (n = 60), dilatación coital (n = 20), vaginoplastia de Baldwin (n = 4), vaginoplastia de Williams (n = 3), vaginoplastia de Davydov (n = 2) o sin tratamiento (n = 29). Profundidad vaginal media en el seguimiento, tasas de éxito terapéutico anatómico con niveles de ≥ 6 cm, ≥ 7 cm, y ≥ 8 cm, complicaciones y reintervención quirúrgica. Las profundidades vaginales medias fueron 7,4 cm (Intervalo de confianza [CI]del 95% 6,8-8,1 cm), 7,3 cm (95% CI 6,7-7,9 cm), y 8,7 cm (95% CI 7,9-9,5 cm) en el seguimiento de pacientes tratadas con vaginoplastia de McIndoe, auto-dilatación, y dilatación coital, respectivamente. Las tasas de complicaciones