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

Objective: To compare the long-term anatomical outcome and complications in treatments of vaginal agenesis in Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome. Design: A historical comparative follow-up study using medical chart reviews. Setting: Public hospitals. Patient(s): A nationwide cohort of patients diagnosed with MRKH syndrome (n = 168). Intervention(s): 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). Main outcome measures(s): Mean vaginal depth at follow-up, anatomical treatment success rates at levels of >= 6 cm, >= 7 cm, and >= 8 cm, complications, and resurgery. Result(s): 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 McInd oe vaginoplasty needed resurgery. Conclusion(s): 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. (C) 2018 by American Society for Reproductive Medicine.