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Uterocervicoplasty with a bladder mucosa layer for the treatment of complete cervical agenesis
Philippe Bugmann1, Monique Amaudruz, Sylviane Hanquinet
1Clinique et Policlinique de Chirurgie Pédiatrique, Hôpital des Enfants, Geneva, Switzerland. bugmann@hcuge.ch
Objective:
To create an endocervical canal in a patient with a complete cervical agenesis.
Design:
Case report.
Setting:
University hospital.
Patient(S):
A 12-year-old girl presented with lower abdominal pain. On examination, complete vaginal agenesis was noted, with a 2-cm vaginal dimple. A pelvic magnetic resonance imaging scan disclosed an hematometra and absence of the cervix and vagina.
Intervention(S):
Initial surgical therapy consisted of a vaginoplasty with a sigmoid bowel segment and opening of the uterus by puncture and stenting. The cervical permeation failed, with immediate complete stenosis. A new attempt was made through a low sagittal hysterotomy by removing a central muscular cylinder and lining the channel with a free tubularized bladder mucosa graft. A stent was left in place.
Main Outcome Measure(S):
Hysteroscopy, hysterography, and clinical follow-up evaluation.
Result(S):
The cervical stent was removed after 5 months. A hysterography and hysteroscopy confirmed the permeability of the cervix, which was lined by a well-vascularized longitudinally folded mucosa. Regular menses had been noted for more than 3 years as of this report.
Conclusion(S):
Cervicoplasty with mucosal lining permits the creation of a patent cervical canal, even in the reputedly unfavorable forms of congenital cervical agenesis.
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