Query: Girl small vagina

title: Robotic assisted Reconstruction of the Cervix and Vagina by Small Intestinal Submucosa Graft and Fusion of the Hemiuterus.
abstract: To describe our technique of robotic assisted reconstruction of the cervix and vagina using a small intestinal submucosa (SIS) graft and fusion of the hemiuterus.  A step by step explanation of the procedure using video.  Congenital complete vaginal and cervical atresia is rare. Some patients have urinary system abnormality. No standardized surgical treatment guideline was available, and the performance varies for each patient.  We performed a robotic assisted reconstruction of the cervix and vagina using an SIS graft (Cook Medical, Bloomington, IN) and fusion of the hemiuterus for a 12 year old girl from China diagnosed with congenital vaginal and cervical atresia (U4C4V4) She complained of severe abdominal periodic pain for 2 months. Mammary development and her serum sex hormone were within normal range. The patient has a single kidney. The diagnosis was made according to clinical characteristics, physical examination, and magnetic resonance imaging and classified using the European Society of Human Reproduction and Embryology /European Society for Gynaecological Endoscopy (ESHRE/ESGE) system. There was a hematometra of 7 cm diameter in her pelvis. We constructed a novel vagina by sharp and blunt separation and connected it to the uterine cavity. With the SIS graft, we reconstructed her cervix and vagina, and we fused the hemiuterus to make the uterine cavity spacious. The operating time was 260 minutes, and blood loss was 300 mL. She recovered well after the operation without any complications. After surgery, the patient has had normal menstruation without pain. She insists on wearing the vaginal mold 24 hours per day. The follow up was 10 months. The length of the vagina was 9 cm and the width was 3 cm.  Robotic assisted reconstruction of the cervix and vagina using an SIS graft and fusion of the hemiuterus is feasible and safety. However, additional studies are required.

title: Vaginal lithiasis in a 9 year old young girl with female genital mutilations: A case report.
abstract: Female genital mutilations are among the most common widespread traditional practices in sub Saharan Africa and Mali particularly. The mutilations cause dramatic psychosomatic disorders and may severely compromise the external genital structures with eventual obstetric complications. Infibulation is one of the most fatal complications. It is a major and advanced type of female genital mutilation with small and large lips or partial resection and suture narrowing of the vaginal opening therefore responsible of serious structural sexual and functional complications. We report a rare complication of vaginal lithiasis in a 9 year old young girl who had infibulation following external genitals excision at younger age. Surgical reconstruction of the vagina and urethra recanalization were performed; and the patient recovered well but remained with high risk obstetrical complications.

title: VAGINAl lIThIASIS IN A 9 yEAR OlD yOuNG GIRl wITh FEMAlE GENITAl MuTIlATIONS A CASE REPORT
abstract: Female genital mutilations are among the most common widespread traditional practices in sub Saharan Africa and Mali particularly. The mutilations cause dramatic psychosomatic disorders, and may severely compromise the external genital structures with eventual obstetric complications. Infibulation is one of the most fatal complications. It is a major and advanced type of female genital mutilation with small and large lips, or partial resection and suture narrowing of the vaginal opening therefore responsible of serious structural, sexual and functional complications. We report a rare complication of vaginal lithiasis in a 9 year old young girl who had infibulation following external genitals excision at younger age. Surgical reconstruction of the vagina, and urethra recanalization were performed; and the patient recovered well but remained with high risk obstetrical complications.

title: An earring incidentally diagnosed and removed through two step vaginoscopy in a pubertal virgin girl with miliary tuberculosis.
abstract: A vaginal foreign body is detected in approximately 4% of pediatric gynecologic outpatient examinations  Vaginoscopy using small diameter hysteroscopes is a safe, convenient, and efficient diagnostic and therapeutic method in such cases [2,3] Herein is reported an exceptional case of an earring in the vagina, which was incidentally detected at abdominopelvic radiography in a virgin adolescent girl and removed via 2 step vaginoscopy using miniature instruments.

title: The primary experience of single incision laparoscopic sigmoid colpopoiesis in the treatment of congenital absence of vagina
abstract: To report our primary experience of single incision laparoscopic sigmoid colpopoiesis in the treatment of congenital absence of vagina and to discuss its technical feasibility,effect and operative techniques.(Methods) The clinical data of our first case single incision laparosciopic sigmoid colpopoieses performed in 2010 was collected.A 21 girl with congenital absence of vagina underwent this new operation.Only one small incision was created on the umbilicus.A segment of sigmoid colon was transplanted to the pelvic as an artificial vagina.No other unnecessary scar besides the umbilical incision was left on the abdominal wall.(Results) The operation duration was 160 min.The blood lose in operation was 100 mL.The postoperative hospitalization was 11 days.No anastomotic leakage or sigmoid colon graft ischemic necrosis occurred.The umbilical incision showed a satisfactory cosmetic effect.(Conclusion) Single incision laparoscopic sigmoid colpopoiesis is safe and feasible and has a better cosmetic effect.

title: A Rare Case of Labial Fusion Presenting with Urinary Retention
abstract: A 13 year old, premenarchal girl had urinary retention for 3 days, which was due to chronic local inflammation. Local examination showed labial fusion. Urethral opening was not seen. A small 0.5 mm punctum was present in the centre which was gradually dilated to relieve retention. Estrogen application with surgical lysis was done. Normal vagina, urethra and cervix visualized. Local Estrogen application for 1 month was advised. Follow up showed normal vulva and urethra (Figs. 1, 2, 3, 4)

title: 1655 Laparoscopic Unification of Non Communicating Horn with Hemi Uterus
abstract: To demonstrate new idea of laparoscopic unification of functional non communicating horn with hemi uterus instead of removal to improve obstetric outcome in future. Setting an academic tertiary care hospital. A 14 year old girl presented with complaints of pain in lower abdomen, on and off for 2 months. Her previous 2 cycles were regular; she had cyclic dysmenorrhoea since her menarche which was now become intolerable and continuous. Secondary sexual characteristic was normal. hormone profile normal and on local examination normal external genitalia found. A thin dilator passed into vagina to confirm patent vagina. ultrasound suggested a unicornuate hemi uterus and right non communicating horn with a turbid collection. MRI also confirm the same.  On Hysteroscopy a small right uterine cavity with only one ostium on right. Cervical canal was normal with normal crypts. vagina also normal and spacious. On diagnostic laparoscopy: A unicornuate right hemi uterus with a non communicating left horn was noted on the right side of the round ligament, tube and ovary were seen normal with small hemi uterus. On the left, small uterine horn seen with absent tube but normal ovary and round ligament attachment. First, we were planned resection of non communicating horn as described in literature but after assessing the anatomical proximity and good size of horn and small size of hemi uterus we decided for unification of both. After injecting diluted inj. vasopressin, linear medial incision given in full thickness of myometrium with monopolar energy and opening the cavity with scissors. Both the walls sutured together first posteriorly and then anteriorly in double layer with no. 1 polyglactin 910 suture.  Good normal size, shape and contour of uterus appreciated after completion of procedure. After surgery patient had one normal menses without any pain suggest success of surgery.

title: Laparoscopic assisted uterovaginal anastomosis for uterine cervix atresia with vaginal aplasia using a silicone stent lined with acellular porcine small intestinal submucosa graft inserted using a 16F Foley catheter.
abstract: Herein is reported a novel technique for cervical reconstruction of congenital cervicovaginal atresia. The patient was a 16 year old girl with congenital atresia of the cervix and vagina, didelphic uterus, and right hematosalpinx. At laparoscopic assisted creation of a neocervix, a silicone stent was inserted using a 16F Foley catheter and lined with an acellular porcine small intestinal submucosa graft under ultrasound guidance. At 3 month clinical follow up after placement of the stent, the patient had regular menstrual flow. The neocervix was completely mucosalized on the inner surface at 4 months after surgery. There were no complications related to the silicone stent or the cervical stent. Cervical reconstruction using a vaginal mucosa lined silicone stent is accessible and effective, and provides an alternative option to preserve reproductive potential in patients with cervicovaginal atresia.

title: Hematometrocolpos Due to an Imperforate Hymen
abstract: A 14 year old girl presented to the emergency department. She complained of chronic back pain that recently started to irradiate towards the abdomen. The pain was persistent and progressive. The blood analysis showed a slight increase in white blood cell count and C reactive protein (CRP) Subsequently abdominal ultrasound (US) was requested. A large well circumscribed hypogastric mass was seen. The mass had a hyporeflective content and a small amount of hyperreflective material posteriorly, compatible with debris in a midline cyst  The day after, magnetic resonance imaging (MRI) was performed. The mass appeared to be a dilatation of the vagina, in continuity with the uterine cavity (Figure 2A, sagittal image: arrow uterine cervix) The content was T2 hyperto iso intense and T1 hyperintense (Figure 2B, axial image) The hyperreflective material seen on ultrasound, showed susceptibility artifacts on T2* weighted images, which corresponds to hemosiderin (Figure 2C, axial image) There was no pathologic diffusion restriction. After MRI, the patient was seen by a gynecologist. He found out that the abdominal pain had a cyclic pattern on a monthly base, and that the patient never had menses. On clinical examination, a mass was felt and the hymen was bombed and painful. Based on these findings, the diagnosis of a hematometrocolpos, due to an imperforate hymen, was made. The patient underwent hymenotomy to remove the large amount of blood.  Sagittal US image showing a large hypogastric mass with hyporeflective content and a small amount of hyperreflective material posteriorly.

title: Uterine conserving surgery in a case of cervicovaginal agenesis with cloacal malformation
abstract: Cervico vaginal agenesis (MRKHS) with normally formed uterus along with cloacal malformation is a very rare mullerian anomaly. We report a case, of a 13 year old girl who was admitted at our tertiary care center with complaints of primary amenorrhea and cyclical lower abdominal pain for 3 months. Clinical examination and radiological investigations revealed complete cervico vaginal agenesis with normal uterus with hematometra with horse shoe kidney. Vaginoplasty was done by McIndoe's method with uterovaginal anastomosis and neocervix formation. Malecot's catheter was inserted in uterine cavity. Vaginal mould was kept in the neovagina. Mould was removed after 10 days under anaesthesia and repeat hysteroscopy with insertion of a small piece of malecot's catheter was performed under hysteroscopic guidance into the uterine cavity through neocervix and lower end fixed to the vagina. After 3 months, the malecot's catheter was removed. During follow up, she was menstruating normally at 6 months post operatively and had a completely healed vaginal mucosa. Earlier hysterectomy was considered as a definitive surgery for this condition; however, it has been replaced with more conservative approach, like uterovaginal anastomosis with creation of neovagina. In literature, successful pregnancy has been reported in these patients who underwent conservative surgery.