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Retrograde Hysteroscopy: A Technique for Repair of Vaginal Obstruction and Noncommunicating Mullerian Anomalies

Loveless, Meredith Buonanno MD; Cundiff, Geoffrey MD

Journal of Pelvic Medicine and Surgery: September-October 2006 - Volume 12 - Issue 5 - p 269-272
doi: 10.1097/01.spv.0000236017.82743.e0
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Background: Congenital anomalies resulting from failure of fusion of the mullerian structures and urogenital sinus can result in lack of communication between the uterus and external structures. To aid in repair of these anomalies, we created a technique we call retrograde hysteroscopy. To our knowledge, this technique has not been previously described. A hysterotomy is created in the uterine fundus and hysteroscope inserted into the endometrial cavity. The hysteroscope is advanced through the uterus into the noncommunicating space providing visualization and a guide for connection to the external structures.

Cases: Case no. 1 was a 14-year-old diagnosed with vaginal and cervical agenesis. We used retrograde hysteroscopy to guide the connection of the uterine horn to the surgically created vagina. Case no. 2 was a 15-year-old diagnosed with a low, thick transverse vaginal septum. Using retrograde hysteroscopy, the light from the hysteroscope served as a guide for resection of the septum. A neovagina was created. Case no. 3 was a 12-year-old with uterine didelphys and an obstructed hemivagina was transferred for resection of the septum. Entry into the vaginal outpocketing failed to reveal a cervix. Laparoscopic retrograde hysteroscopy identified right cervical agenesis. Hysterectomy of the right uterine horn was performed. Case no. 4 was a 14-year-old who presented with vaginal obstruction after a Stephens-Johnson reaction. We used laparoscopic retrograde hysteroscopy to resect the vaginal obstruction and grafts were used to bridge gaps in the vaginal mucosa.

Conclusion: Retrograde hysteroscopy can be used to define anatomy and increase safety and success during reconstruction of vaginal obstruction resulting from inflammatory conditions and noncommunicating congenital anomalies.

Retrograde hysteroscopy is a novel surgical technique developed to aid in the repair of vaginal obstruction, including noncommunicating congenital anomalies. A series of cases using retrograde hysteroscopy demonstrates the enhanced safety and success this technique offers.

From the Department of Gynecology & Obstetrics/Gynecology, Johns Hopkins School of Medicine, Baltimore, Maryland.

Reprints: Meredith Buonanno Loveless, MD, Department of Obstetrics and Gynecology, Johns Hopkins Bayview Medical Center, 4940 Eastern Ave., Room A1C, Baltimore, MD 21224. E-mail: mlovele1@jhmi.edu.

© 2006 Lippincott Williams & Wilkins, Inc.