A Clinical Analysis Of Two Different Vaginoplasty

Objective: In order to provide rationgal reference for surgeon in choosing the appropriate vaginoplasty for different patients,we evaluate the surgical techniques and therapeutic results between laparoscopic peritoneal vaginoplasty and amniotic membrane vaginoplastyMethods: There were 67 patients with congental vafina agenesis diagnosed and treated in our hospital from January 2005 to Jun 2015,clinical data of which were analyzed retrospectively.According to the different kinds of vaginoplasty,these patients were divided into two groups.In group of peritoneal,patients underwent laparoscopic peritoneal vaginoplasty and in group of amniotic membrane,patients underwent amniotic membrane vaginoplasty.We analyze the classification,constituent ratio and clinical features of 67 cases of congenital vaginal dysplasia retrospectively and summarized the surgical situation(operative time,blood loss,hospital stay,complications)and surgical results(the length,width and anatomical success rate of artificial vagina).We used female sexual function index(FSFI)to evaluate the psychosexual function.Results: 1.There were 67.2% patients with MRKH in 67 patients who suffered congenital vaginal dysplasia,which occupied the majority.Among these MRKH ones,there were 17.8% patients associated with malformation of urinary and skeletal system.There were 28.4% patients with congenital vaginal atresia and 4.4% patients with AIS.2.The reasons of patients that they come to hospital include primary amenorrhea(43%),abdominal pain(20%),sexual difficulty(11.2%),pelvic mass(10.3%),infertility(7.5%)and so on.3.Analysis of surgical conditions:The operating time of amniotic membrane group(75.4±14.1min)were shorter than that of peritoneal gpoup(91.6±13.6min)(P<0.05).The intraoperative blood loss of amniotic membrane group(27.7±13.7m L)was less than that of peritoneal group(44.4±25.9m L)(P<0.05).The postoperative hospital stay and complication between peritoneal group and amniotic membrane group have no different(P>0.05).4.Analysis of surgical results:The lengths of reconstructed vagina in peritoneal group(7.7±1.1cm)were longer than that of amniotic membrane group(6.9±1.1cm)(P<0.05).And the anatomical success rate of peritoneal group were much higher(P<0.05).The stenosis rate and sexual dysfunction rate between peritoneal group and amniotic membrane group have no different(P>0.05).5.Survey of FSFI:There were 28 patients answered the FSFI.The survey revealed that vaginal inbrication,sexual satisfaction,sexual pain and total score of FSFI in the laparoscopic peritoneal group were better than those in amniotic membrane group.However,there were no significant differences in sexual desire,sexual arousal and sexual orgasmic were found between two groups.Conclusion: 1.The most congenital vaginal dysplasia patients is MRKH(congential absence of vagina),followed by congenital vaginal atresia.AIS is rarest.2.Compared with amniotic membrane vaginoplasty,laparoscopic peritoneal vaginoplasty should be extended clinically for its higher anatomical success rate,longer lengths of reconstructed vagina and better reaction in vaginal inbrication,sexual satisfaction and sexual pain.3.Different vaginoplasties have diverse advantages and disadvantages.We should fully assess the patient's anatomic features and our technology and experience to make sure safity and invasiveness.Only in this way,can treatment be individualized.