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Lee R, Choi JE, Mun E, Kim KH, Choi SA, Kim HS. A Case of Chromosome 17q12 Deletion Syndrome with Type 2 Mayer-Rokitansky-Küster-Hauser Syndrome and Maturity-Onset Diabetes of the Young Type 5. CHILDREN (BASEL, SWITZERLAND) 2024; 11:404. [PMID: 38671621 PMCID: PMC11049139 DOI: 10.3390/children11040404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 03/26/2024] [Accepted: 03/26/2024] [Indexed: 04/28/2024]
Abstract
Chromosome 17q12 deletion syndrome (OMIM #614527) is a rare genetic disorder associated with a heterozygous 1.4-1.5 Mb deletion at chromosome 17q12, leading to a spectrum of clinical manifestations, including kidney abnormalities, neurodevelopmental delay, maturity-onset diabetes of the young type 5 (MODY5), and Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome. We present the case of a 14-year-old Korean female diagnosed with chromosome 17q12 deletion syndrome, confirmed by chromosomal microarray analysis. The patient exhibited MODY5 with pancreatic agenesis, MRKH syndrome, dysmorphic facial features, developmental delay, kidney rotation anomaly, portal vein thrombosis with liver hypoplasia, short stature, and scoliosis. Management involved the initiation of multiple daily insulin injections for diabetes control, gynecological evaluation for MRKH syndrome, and multidisciplinary care for associated complications. This case highlights the complexity and varied organ involvement in chromosome 17q12 deletion syndrome. A comprehensive and multidisciplinary approach is crucial for the management of affected individuals, including regular monitoring, tailored interventions across various medical specialties, and providing psychosocial support.
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Affiliation(s)
- Rosie Lee
- Department of Pediatrics, Keimyung University Dongsan Hospital, Daegu 42601, Republic of Korea;
| | - Jung Eun Choi
- Department of Pediatrics, Ewha Womans University College of Medicine, Seoul 07804, Republic of Korea; (J.E.C.); (E.M.); (K.h.K.); (S.A.C.)
| | - Eunji Mun
- Department of Pediatrics, Ewha Womans University College of Medicine, Seoul 07804, Republic of Korea; (J.E.C.); (E.M.); (K.h.K.); (S.A.C.)
| | - Kyung hee Kim
- Department of Pediatrics, Ewha Womans University College of Medicine, Seoul 07804, Republic of Korea; (J.E.C.); (E.M.); (K.h.K.); (S.A.C.)
| | - Sun Ah Choi
- Department of Pediatrics, Ewha Womans University College of Medicine, Seoul 07804, Republic of Korea; (J.E.C.); (E.M.); (K.h.K.); (S.A.C.)
| | - Hae Soon Kim
- Department of Pediatrics, Ewha Womans University College of Medicine, Seoul 07804, Republic of Korea; (J.E.C.); (E.M.); (K.h.K.); (S.A.C.)
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Jensen AH, Herlin MK, Vogel I, Lou S. A life course perspective on Mayer-Rokitansky-Küster-Hauser syndrome: women's experiences and negotiations of living with an underdeveloped uterus and vagina. Disabil Rehabil 2024; 46:1130-1140. [PMID: 36987844 DOI: 10.1080/09638288.2023.2191014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 03/09/2023] [Indexed: 03/30/2023]
Abstract
PURPOSE Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome is characterized by the absence or underdevelopment of the uterus and upper part of the vagina. It is usually diagnosed during adolescence, and the present study investigates how women experience and negotiate to live with MRKH syndrome long-term. METHODS From January to March 2021, eighteen Danish women with MRKH syndrome participated in semi-structured interviews via video conference. The mean time since diagnosis was 11.5 years. A thematic analysis using the life course framework as a theoretical approach was applied. RESULTS The analysis identified the diagnosis as a turning point, that dramatically altered the women's imagined futures. Not conforming to dominant social norms regarding sexuality and pregnancy meant that the women continuously managed and negotiated the meaning and impact of MRKH syndrome in relation to the five principles of the life course perspective: (1) Lifelong development, (2) Timing, (3) Human agency, (4) Linked lives, and (5) Historical time and place. CONCLUSION Using the life course framework contributed to a holistic understanding of life with MRKH syndrome by showing how the meaning and consequences of the congenital condition changed over time and in adaptation to gendered and age-related social norms and expectations.IMPLICATIONS FOR REHABILITATIONThe perceived meaning and impact of living with Mayer-Rokitansky-Küster-Hauser syndrome change over time, and women's information and support needs thus change accordinglySensitive, clinical communication is essential when discussing treatment optionsOnline communities may provide support and reduce feelings of loneliness.
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Affiliation(s)
- Amalie Hahn Jensen
- DEFACTUM - Public Health & Health Services Research, Central Denmark Region, Aarhus, Denmark
| | - Morten Krogh Herlin
- Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Genetics, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Health, Aarhus University, Aarhus, Denmark
| | - Ida Vogel
- Department of Clinical Genetics, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Health, Aarhus University, Aarhus, Denmark
- Center for Fetal Diagnostics, Aarhus University Hospital, Aarhus, Denmark
| | - Stina Lou
- DEFACTUM - Public Health & Health Services Research, Central Denmark Region, Aarhus, Denmark
- Department of Clinical Medicine, Health, Aarhus University, Aarhus, Denmark
- Center for Fetal Diagnostics, Aarhus University Hospital, Aarhus, Denmark
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Pennesi CM, Berkeley J, Lossie AC, Quint EH, Zieman KD, Carroll S. International Experiences with Vaginal Lengthening Treatment Among Individuals with Müllerian Agenesis: A Mixed-Methods Study. J Pediatr Adolesc Gynecol 2023; 36:476-483. [PMID: 37182810 DOI: 10.1016/j.jpag.2023.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 05/05/2023] [Accepted: 05/08/2023] [Indexed: 05/16/2023]
Abstract
STUDY OBJECTIVE To understand variations and experiences of vaginal lengthening internationally in individuals with congenital underdevelopment of the uterus, cervix, and upper vagina or Müllerian agenesis METHODS: In this study, we used a cross-sectional mixed-methods design incorporating quantitative and qualitative questionnaires. Adults with Müllerian agenesis completed questionnaires with quantitative and open-ended qualitative questions about their vaginal lengthening experiences. Data were analyzed using descriptive statistics and inductive thematic analysis. RESULTS Of 616 respondents meeting inclusion criteria (representing 40 countries), 46% (n = 284) reported no vaginal lengthening intervention. Vaginal lengthening was commonly reported by participants from North America and Europe (59%) and less commonly by participants from Africa, Asia, and South America (16%). Of those who had undergone vaginal lengthening, 72% reported dilator use, 34% coital dilation, and 39% surgery. Four major themes were identified in response to the open-ended vaginal lengthening experience question: (1) difficult physical symptoms, (2) practical and psychosocial challenges, (3) intimate relationships and sexual satisfaction, and (4) impact of experiences with healthcare providers. CONCLUSION This study highlights vaginal lengthening practices internationally and shared themes related to significant challenges and positive experiences. The findings show room for improvement in the counseling and care surrounding vaginal lengthening. Future research should investigate factors that influence decision-making about vaginal lengthening and work toward international consensus on best care practices in Müllerian agenesis.
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Affiliation(s)
- Christine M Pennesi
- University of Michigan, Department of Obstetrics and Gynecology, Ann Arbor, Michigan; Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
| | - Jane Berkeley
- Beautiful You MRKH Foundation, Silver Spring, Maryland
| | - Amy C Lossie
- Beautiful You MRKH Foundation, Silver Spring, Maryland
| | - Elisabeth H Quint
- University of Michigan, Department of Obstetrics and Gynecology, Ann Arbor, Michigan
| | | | - Susan Carroll
- Psychology Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, United Kingdom of Great Britain and Northern Ireland, United Kingdom; King's College Hospital NHS Foundation Trust, Denmark Hill, London, United Kingdom of Great Britain and Northern Ireland, United Kingdom
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Brakta S, Hawkins ZA, Sahajpal N, Seman N, Kira D, Chorich LP, Kim HG, Xu H, Phillips JA, Kolhe R, Layman LC. Rare structural variants, aneuploidies, and mosaicism in individuals with Mullerian aplasia detected by optical genome mapping. Hum Genet 2023; 142:483-494. [PMID: 36797380 DOI: 10.1007/s00439-023-02522-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 01/06/2023] [Indexed: 02/18/2023]
Abstract
The molecular basis of Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome remains largely unknown. Pathogenic variants in WNT4 and HNF1B have been confirmed in a small percent of individuals. A variety of copy number variants have been reported, but causal gene(s) remain to be identified. We hypothesized that rare structural variants (SVs) would be present in some individuals with MRKH, which could explain the genetic basis of the syndrome. Large molecular weight DNA was extracted from lymphoblastoid cells from 87 individuals with MRKH and available parents. Optical genome mapping (OGM) was performed to identify SVs, which were confirmed by another method (quantitative PCR, chromosomal microarray, karyotype, or fluorescent in situ hybridization) when possible. Thirty-four SVs that overlapped coding regions of genes with potential involvement in MRKH were identified, 14 of which were confirmed by a second method. These 14 SVs were present in 17/87 (19.5%) of probands with MRKH and included seven deletions, three duplications, one new translocation in 5/50 cells-t(7;14)(q32;q32), confirmation of a previously identified translocation-t(3;16)(p22.3;p13.3), and two aneuploidies. Of interest, three cases of mosaicism (3.4% of probands) were identified-25% mosaicism for trisomy 12, 45,X(75%)/46,XX (25%), and 10% mosaicism for a 7;14 translocation. Our study constitutes the first systematic investigation of SVs by OGM in individuals with MRKH. We propose that OGM is a promising method that enables a comprehensive investigation of a variety of SVs in a single assay including cryptic translocations and mosaic aneuploidies. These observations suggest that mosaicism could play a role in the genesis of MRKH.
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Affiliation(s)
- Soumia Brakta
- Section of Reproductive Endocrinology, Infertility, & Genetics, Department of Obstetrics & Gynecology, Medical College of Georgia, Augusta University, Augusta, Georgia.
| | - Zoe A Hawkins
- Section of Reproductive Endocrinology, Infertility, & Genetics, Department of Obstetrics & Gynecology, Medical College of Georgia, Augusta University, Augusta, Georgia
| | - Nikhil Sahajpal
- Department of Pathology, Medical College of Georgia, Augusta University, Augusta, Georgia.,Department of Genetics, Greenwood Genetics Center, Greenwood, SC, USA
| | - Natalie Seman
- Section of Reproductive Endocrinology, Infertility, & Genetics, Department of Obstetrics & Gynecology, Medical College of Georgia, Augusta University, Augusta, Georgia
| | - Dina Kira
- Section of Reproductive Endocrinology, Infertility, & Genetics, Department of Obstetrics & Gynecology, Medical College of Georgia, Augusta University, Augusta, Georgia
| | - Lynn P Chorich
- Section of Reproductive Endocrinology, Infertility, & Genetics, Department of Obstetrics & Gynecology, Medical College of Georgia, Augusta University, Augusta, Georgia
| | - Hyung-Goo Kim
- Neurological Disorders Research Center, Qatar Biomedical Research Institute, Hamad Bin Khalifa University, Doha, Qatar
| | - Hongyan Xu
- Department of Population Health Sciences, Medical College of Georgia, Augusta University, Augusta, Georgia
| | - John A Phillips
- Division of Medical Genetics and Genomic Medicine, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Ravindra Kolhe
- Department of Pathology, Medical College of Georgia, Augusta University, Augusta, Georgia
| | - Lawrence C Layman
- Section of Reproductive Endocrinology, Infertility, & Genetics, Department of Obstetrics & Gynecology, Medical College of Georgia, Augusta University, Augusta, Georgia. .,Department of Neuroscience and Regenerative Medicine, Medical College of Georgia, Augusta University, Augusta, Georgia. .,Department of Physiology, Medical College of Georgia, Augusta University, Augusta, Georgia.
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Vali S, Jones BP, Saso S, Smith JR. The impact of COVID-19 on the motivations of women seeking a uterus transplant. Future Sci OA 2023; 9:FSO846. [PMID: 37009055 PMCID: PMC10061245 DOI: 10.2144/fsoa-2022-0047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 02/24/2023] [Indexed: 03/30/2023] Open
Abstract
Aim: The aim of this study was to investigate the change if any, in the motivations of women seeking a UTx and determine the impact of the COVID-19 pandemic. Methods: A cross-sectional survey. Results: 59% of women answered they were more motivated in achieving a pregnancy following the COVID-19 pandemic. 80% strongly agreed or agreed the pandemic had no impact on their motivation for a UTx, and 75% strongly agreed or agreed their desire for a baby strongly outweighs the risks of undergoing a UTx during a pandemic. Conclusion: Women continue to express a high level of motivation and desire for a UTx despite the risks imposed by the COVID-19 pandemic.
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Comparison of Sheares vaginoplasty, vaginoplasty using acellular porcine small intestinal submucosa graft and laparoscopic peritoneal vaginoplasty in patients with Mayer-Rokitansky-Küster-Hauser syndrome. Int Urogynecol J 2023; 34:499-505. [PMID: 35467139 DOI: 10.1007/s00192-022-05163-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 01/30/2022] [Indexed: 01/26/2023]
Abstract
INTRODUCTION AND HYPOTHESIS The aim of this study is to compare the perioperative, anatomical and functional outcomes of patients with Mayer-Rokitansky-Küster-Hauser syndrome (MRKHS), undergoing Sheares vaginoplasty, vaginoplasty using acellular porcine small intestinal submucosa (SIS) graft or laparoscopic peritoneal (Davydov) vaginoplasty. METHODS In this retrospective study, a total of 117 patients with MRKHS undergoing creation of a neovagina from 2017 to 2020 were retrospectively investigated. Comparisons between continuous variables were performed using Student's t-test and between qualitative variables using chi-squared tests. RESULTS The operative time, return of bowel activity and return to work were the longest in the laparoscopic Davydov group (P < 0.001). The total cost was the highest in the SIS graft group (P < 0.001). The length of the neovagina was 7.9 ± 1.2 cm in the Sheares group, 7.1 ± 0.8 cm in the SIS graft group and 8.1 ± 1.1 cm in the laparoscopic Davydov group. The difference in the length of the neovagina was significant (P < 0.001). There was significant difference in the duration of continuous mould wearing (P < 0.001). There were no significant differences in the total female sexual function index (FSFI) scores or in the satisfaction scores of the male partner among the three groups. CONCLUSION Sheares vaginoplasty and the vaginoplasty using SIS graft caused less trauma and provided similar functional results to laparoscopic peritoneal vaginoplasty. However, the patients in the Sheares group and SIS graft group needed to wear the mould for a longer duration post-surgery. Sheares vaginoplasty can provide a valuable and economic alternative method for the creation of a neovagina in patients with MRKHS.
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Stepanow C, Naderer A, Alexopoulos J, Walch K, Wenzl R, Leithner K. Sexual health and sexual well-being of women with Mayer-Rokitansky-Kuester-Hauser syndrome after vaginal reconstruction: a qualitative analysis. J Sex Med 2023; 20:57-64. [PMID: 36897238 DOI: 10.1093/jsxmed/qdac011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 09/29/2022] [Accepted: 10/23/2022] [Indexed: 01/15/2023]
Abstract
BACKGROUND Contradictory findings on sexual health in women with Mayer-Rokitansky-Kuester-Hauser syndrome (MRKHS) after vaginal reconstruction point toward the need for more profound assessment of this subject, particularly as it is still unclear what constitutes sexual well-being, especially genital self-image or sexual self-esteem, in women with MRKHS and neovagina. AIM The aim of this qualitative study was to assess individual sexual health and sexual well-being in the context of MRKHS after vaginal reconstruction, with an emphasis on genital self-image, sexual self-esteem, sexual satisfaction, and coping with MRKHS. METHODS Qualitative semistructured interviews were conducted with women with MRKHS after vaginal reconstruction (n = 10) with the Wharton-Sheares-George surgical method and a matched control group without MRKHS (n = 20). Women were surveyed about their previous and current sexual activities, perception of and attitudes toward their genitals, disclosure to others, coping with the diagnosis, and perception of surgery. Data were analyzed through qualitative content analysis and compared with the control group. OUTCOMES The primary outcomes of the study were major categories, such as sexual satisfaction, sexual self-esteem, genital self-image, and dealing with MRKHS, as well as subcategories related to the content analysis. RESULTS Although half the women in the present study indicated that they were coping well with their condition and were satisfied with sexual intercourse, most felt insecure about their neovagina, were cognitively distracted during intercourse, and showed low levels of sexual self-esteem. CLINICAL IMPLICATIONS A better understanding of expectations and uncertainties regarding the neovagina might help professionals to support women with MRKHS after vaginal reconstruction to increase sexual well-being. STRENGTHS AND LIMITATIONS This is the first qualitative study focusing on individual aspects of sexual well-being, especially sexual self-esteem and genital self-image, in women with MRKHS and neovagina. The qualitative study indicates good interrater reliability and data saturation. The limitations of this study include the inherent lack of objectivity resulting from the method but also the fact that all the patients had a particular surgical technique, consequently resulting in limited generalizability of these findings. CONCLUSIONS Our data indicate that integrating the neovagina into the genital self-image is a prolonged process that is essential for sexual well-being and should thus be the focus of sexual counseling.
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Affiliation(s)
- Clara Stepanow
- Department of Psychoanalysis and Psychotherapy, Medical University Vienna, Vienna A-1090, Austria
| | - Andrea Naderer
- Department of Psychoanalysis and Psychotherapy, Medical University Vienna, Vienna A-1090, Austria
| | - Johanna Alexopoulos
- Department of Psychoanalysis and Psychotherapy, Medical University Vienna, Vienna A-1090, Austria
| | - Katharina Walch
- Department of Obstetrics and Gynaecology, Medical University Vienna, Vienna A-1090, Austria
| | - Rene Wenzl
- Department of Obstetrics and Gynaecology, Medical University Vienna, Vienna A-1090, Austria
| | - Katharina Leithner
- Department of Psychoanalysis and Psychotherapy, Medical University Vienna, Vienna A-1090, Austria
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Serrano S, Pereira I, Henriques A, Valentim Lourenço A. Neovagina in Mayer-Rokitansky-Küster-Hauser (MRKH) Syndrome: Vaginoplasty Using Ileal Flap. ACTA MEDICA PORT 2023. [PMID: 36599171 DOI: 10.20344/amp.18563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 09/23/2022] [Indexed: 01/05/2023]
Abstract
INTRODUCTION Surgical treatment of patients with malformations of the female genital tract is a complex problem and there are different techniques described in the literature. The goal of all these techniques is the reconstruction of a neovagina that is anatomically similar to a vagina, with adequate length to facilitate sexual functioning and with the lowest risk of possible complications. The aim of this study is to describe the surgical technique for the reconstruction of a neovagina from an ileal segment without a vascular pedicle. MATERIAL AND METHODS Description of a surgical technique developed in our tertiary university center in a patient with Mayer-Rokitansky-Küster-Hauser syndrome. RESULTS The vaginoplasty surgery using ileal flap was performed in three steps. In the first part of the intervention a laparoscopic hysterectomy with bilateral salpingectomy was performed. The second step consisted of isolating the ileal segment, ileal anastomosis and preparing the ileal segment. After the isolated segment was prepared, it was repositioned in a vagina mold to configure the neovagina. Finally, the third step included the adaptation of the vaginal mold with the ileal mucosa to the vesicorectal space. CONCLUSION Ileal vaginoplasty without a vascular pedicle is an option that can be used to reconstruct the vagina, because it provides an excellent tissue for vaginal replacement. This technique can be used in patients with genital malformations of the genital tract with absence or vaginal hypoplasia.
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Affiliation(s)
- Sílvia Serrano
- Department of Obstetrics, Gynecology and Reproductive Medicine. Hospital de Santa Maria. Centro Hospitalar Universitário Lisboa Norte. Lisbon. Portugal
| | - Inês Pereira
- Department of Gynecology and Obstetrics. Hospital CUF Descobertas. Lisbon; Department of Gynecology and Obstetrics. Hospital CUF Torres Vedras. Torres Vedras. Portugal
| | - Alexandra Henriques
- Department of Obstetrics, Gynecology and Reproductive Medicine. Hospital de Santa Maria. Centro Hospitalar Universitário Lisboa Norte. Lisbon; Lisbon School of Medicine. Lisbon Academical Medical Center. Lisbon. Portugal
| | - Alexandre Valentim Lourenço
- Department of Obstetrics, Gynecology and Reproductive Medicine. Hospital de Santa Maria. Centro Hospitalar Universitário Lisboa Norte. Lisbon; Lisbon School of Medicine. Lisbon Academical Medical Center. Lisbon. Portugal
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Elia E, Brownell D, Chabaud S, Bolduc S. Tissue Engineering for Gastrointestinal and Genitourinary Tracts. Int J Mol Sci 2022; 24:ijms24010009. [PMID: 36613452 PMCID: PMC9820091 DOI: 10.3390/ijms24010009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 12/10/2022] [Accepted: 12/14/2022] [Indexed: 12/24/2022] Open
Abstract
The gastrointestinal and genitourinary tracts share several similarities. Primarily, these tissues are composed of hollow structures lined by an epithelium through which materials need to flow with the help of peristalsis brought by muscle contraction. In the case of the gastrointestinal tract, solid or liquid food must circulate to be digested and absorbed and the waste products eliminated. In the case of the urinary tract, the urine produced by the kidneys must flow to the bladder, where it is stored until its elimination from the body. Finally, in the case of the vagina, it must allow the evacuation of blood during menstruation, accommodate the male sexual organ during coitus, and is the natural way to birth a child. The present review describes the anatomy, pathologies, and treatments of such organs, emphasizing tissue engineering strategies.
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Affiliation(s)
- Elissa Elia
- Centre de Recherche en Organogénèse Expérimentale/LOEX, Regenerative Medicine Division, CHU de Québec-Université Laval Research Center, Québec, QC G1J 1Z4, Canada
| | - David Brownell
- Centre de Recherche en Organogénèse Expérimentale/LOEX, Regenerative Medicine Division, CHU de Québec-Université Laval Research Center, Québec, QC G1J 1Z4, Canada
| | - Stéphane Chabaud
- Centre de Recherche en Organogénèse Expérimentale/LOEX, Regenerative Medicine Division, CHU de Québec-Université Laval Research Center, Québec, QC G1J 1Z4, Canada
| | - Stéphane Bolduc
- Centre de Recherche en Organogénèse Expérimentale/LOEX, Regenerative Medicine Division, CHU de Québec-Université Laval Research Center, Québec, QC G1J 1Z4, Canada
- Department of Surgery, Faculty of Medicine, Université Laval, Québec, QC G1V 0A6, Canada
- Correspondence: ; Tel.: +1-418-525-4444 (ext. 42282)
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Chen N, Song S, Bao X, Zhu L. Update on Mayer-Rokitansky-Küster-Hauser syndrome. Front Med 2022; 16:859-872. [PMID: 36562950 DOI: 10.1007/s11684-022-0969-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 10/12/2022] [Indexed: 12/24/2022]
Abstract
This review presents an update of Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome on its etiologic, clinical, diagnostic, psychological, therapeutic, and reproductive aspects. The etiology of MRKH syndrome remains unclear due to its intrinsic heterogeneity. Nongenetic and genetic causes that may interact during the embryonic development have been proposed with no definitive etiopathogenesis identified. The proportion of concomitant extragenital malformations varies in different studies, and the discrepancies may be explained by ethnic differences. In addition to physical examination and pelvic ultrasound, the performance of pelvic magnetic resonance imaging is crucial in detecting the presence of rudimentary uterine endometrium. MRKH syndrome has long-lasting psychological effects on patients, resulting in low esteem, poor coping strategies, depression, and anxiety symptoms. Providing psychological counseling and peer support to diagnosed patients is recommended. Proper and timely psychological intervention could significantly improve a patient's outcome. Various nonsurgical and surgical methods have been suggested for treatment of MRKH syndrome. Due to the high success rate and minimal risk of complications, vaginal dilation has been proven to be the first-line therapy. Vaginoplasty is the second-line option for patients experiencing dilation failure. Uterine transplantation and gestational surrogacy are options for women with MRKH syndrome to achieve biological motherhood.
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Affiliation(s)
- Na Chen
- National Clinical Research Center for Obstetric and Gynecologic Diseases, Department of Obstetrics and Gynecology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Shuang Song
- National Clinical Research Center for Obstetric and Gynecologic Diseases, Department of Obstetrics and Gynecology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Xinmiao Bao
- National Clinical Research Center for Obstetric and Gynecologic Diseases, Department of Obstetrics and Gynecology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100730, China
- Peking Union Medical College, M.D. Program, Beijing, 100730, China
| | - Lan Zhu
- National Clinical Research Center for Obstetric and Gynecologic Diseases, Department of Obstetrics and Gynecology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100730, China.
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Brownell D, Chabaud S, Bolduc S. Tissue Engineering in Gynecology. Int J Mol Sci 2022; 23:ijms232012319. [PMID: 36293171 PMCID: PMC9603941 DOI: 10.3390/ijms232012319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 10/05/2022] [Accepted: 10/08/2022] [Indexed: 12/01/2022] Open
Abstract
Female gynecological organ dysfunction can cause infertility and psychological distress, decreasing the quality of life of affected women. Incidence is constantly increasing due to growing rates of cancer and increase of childbearing age in the developed world. Current treatments are often unable to restore organ function, and occasionally are the cause of female infertility. Alternative treatment options are currently being developed in order to face the inadequacy of current practices. In this review, pathologies and current treatments of gynecological organs (ovaries, uterus, and vagina) are described. State-of-the-art of tissue engineering alternatives to common practices are evaluated with a focus on in vivo models. Tissue engineering is an ever-expanding field, integrating various domains of modern science to create sophisticated tissue substitutes in the hope of repairing or replacing dysfunctional organs using autologous cells. Its application to gynecology has the potential of restoring female fertility and sexual wellbeing.
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Affiliation(s)
- David Brownell
- Centre de Recherche en Organogéneèse Expérimentale/LOEX, Regenerative Medicine Division, CHU de Québec-Université Laval Research Center, Québec, QC G1J 1Z4, Canada
| | - Stéphane Chabaud
- Centre de Recherche en Organogéneèse Expérimentale/LOEX, Regenerative Medicine Division, CHU de Québec-Université Laval Research Center, Québec, QC G1J 1Z4, Canada
| | - Stéphane Bolduc
- Centre de Recherche en Organogéneèse Expérimentale/LOEX, Regenerative Medicine Division, CHU de Québec-Université Laval Research Center, Québec, QC G1J 1Z4, Canada
- Division of Urology, Department of Surgery, CHU de Québec-Université Laval, Québec, QC G1V 4G2, Canada
- Department of Surgery, Faculty of Medicine, Laval University, Québec, QC G1V 0A6, Canada
- Correspondence:
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Schäffeler N, Beckmann J, Schenk B, Schöller D, Wallwiener D, Enck P, Teufel M, Zipfel S, Rall K, Brucker S. [Burden of Affected Persons with MRKH Syndrome: Effect of an Intervention to Support Surgical Neovaginal Placement]. Psychother Psychosom Med Psychol 2022; 72:473-480. [PMID: 35504296 DOI: 10.1055/a-1778-5194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The diagnosis of Mayer-Rokitansky-Küster-Hauser syndrome (MRKHS), a rare variant of female sexual development, is usually made during puberty. The uncertainty in self-image and the impos-sibility of becoming pregnant often lead to considerable stress. Although psychosomatic support is consistently recommended in the literature, there have been only a few studies on the psychological aspects of MRKHS. The aim of the present study is to investigate the quality of life or distress of women with MRKHS undergoing neovaginal surgery and, on the other hand, to evaluate effects of the intervention for support during treatment. Methods In an explorative quasi-experimental pre-post study at a national centre for neovaginal surgery, all patients were offered a psychosomatic intervention (intervention group IG, n=23) and their sexual function (FSFI), psychological distress (PHQ-D) and health-related quality of life (SF-12) were assessed before surgery (t0) and six months after (t1). These were compared with data from a sample collected before and after the intervention period (comparison group VG, n=30). Results While the physical quality of life (SF-12) of both groups was unremarkable at both time points, there was a significant impairment in the psychological quality of life. Both groups (IG, VG) improved from t0 to t1 in their sexual function (FSFI) and showed lower depression scores (PHQ-D). The specific intervention developed was well accepted by those affected and rated as helpful. However, this subjectively perceived effectiveness of the intervention was not reflected by improvement on the quality of life scale (SF-12) and depression scale (PHQ-D). Conclusion Those affected show a clear, clinically relevant distress (SF-12), but this is not reflected in the form of psychological comorbidity (PHQ-D). This apparent discrepancy points to psychologically stable women with acute distress due to the diagnosis of variant sex de-evolution. For them, a low-threshold support service with a supportive character seems to be necessary and helpful during the surgical treatment. The reconstructive therapy for the creation of a neovagina seems to have a positive influence on the psychological quality of life. The fact that pregnancy is still not possible due to the missing uterus could be a reason for not reaching the quality of life of the average population.
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Affiliation(s)
- Norbert Schäffeler
- Abteilung Psychosomatische Medizin und Psychotherapie, Medizinische Universitätsklinik, Universitätsklinikum Tübingen, Tübingen, Germany
| | - Julia Beckmann
- Abteilung Psychosomatische Medizin und Psychotherapie, Medizinische Universitätsklinik, Universitätsklinikum Tübingen, Tübingen, Germany.,Institut für transkulturelle Gesundheitsforschung, Duale Hochschule Baden-Württemberg - Villingen Schwenningen, Villingen-Schwenningen, Germany
| | - Bernadette Schenk
- Universitäts-Frauenklinik, Universitätsklinikum Tübingen, Tübingen, Germany
| | - Dorit Schöller
- Universitäts-Frauenklinik, Universitätsklinikum Tübingen, Tübingen, Germany
| | | | - Paul Enck
- Abteilung Psychosomatische Medizin und Psychotherapie, Medizinische Universitätsklinik, Universitätsklinikum Tübingen, Tübingen, Germany
| | - Martin Teufel
- Abteilung Psychosomatische Medizin und Psychotherapie, Medizinische Universitätsklinik, Universitätsklinikum Tübingen, Tübingen, Germany.,Klinik für Psychosomatische Medizin und Psychotherapie, LVR-Klinikum Essen, Essen, Germany
| | - Stephan Zipfel
- Abteilung Psychosomatische Medizin und Psychotherapie, Medizinische Universitätsklinik, Universitätsklinikum Tübingen, Tübingen, Germany
| | - Katharina Rall
- Universitäts-Frauenklinik, Universitätsklinikum Tübingen, Tübingen, Germany
| | - Sara Brucker
- Universitäts-Frauenklinik, Universitätsklinikum Tübingen, Tübingen, Germany
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Costa EC, Hemesath TP, Rombaldi MC, Carvalho CG, Leite JCL, Guaragna-Filho G. Laparoscopy as a Facilitator in the Early Diagnosis of a Mullerian Aplasia During Ordinary Surgery. Asian J Endosc Surg 2022; 15:356-358. [PMID: 34605191 DOI: 10.1111/ases.12996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 08/24/2021] [Accepted: 09/22/2021] [Indexed: 11/27/2022]
Abstract
Laparoscopy was introduced more than 100 years ago. However, in some fields its use still meets resistance. Technology such as laparoscopy may help to identify rare and complex disorders, even in very ordinary procedures, such as inguinal hernia repair. This report highlighted the importance of early diagnosis of a complex condition using commonly available technology. To the best of our knowledge, there has not been a similar reported case in such a young patient during laparoscopic inguinal hernia repair.
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14
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Tsarna E, Eleftheriades A, Eleftheriades M, Kalampokas E, Liakopoulou MK, Christopoulos P. The impact of Mayer–Rokitansky–Küster–Hauser Syndrome on Psychology, Quality of Life, and Sexual Life of Patients: A Systematic Review. CHILDREN 2022; 9:children9040484. [PMID: 35455528 PMCID: PMC9025055 DOI: 10.3390/children9040484] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 03/21/2022] [Accepted: 03/22/2022] [Indexed: 11/16/2022]
Abstract
Background: Mayer–Rokitansky–Küster–Hauser (MRKH) syndrome is a rare congenital syndrome characterized by uterovaginal agenesis. Most patients are diagnosed during adolescence, when body image and sexual identity are shaped. Our main objective was to investigate how MRKH syndrome affects psychology, quality of life (QoL), and the sexual life of patients compared with non-affected individuals. Methods: Original peer-reviewed research papers examining psychological outcomes, QoL, and sexual function of MRKH patients were searched in PubMed. Titles, abstracts, and full text from potentially eligible records were reviewed by two independent reviewers. Case reports and papers published not in English were excluded. Results: Our search identified 63 records, of which 20 were included: 10 examined psychological and psychosocial outcomes, 14 examined sexual function outcomes, and 6 examined QoL outcomes. Results may be affected by selection bias and confounding due to differences between MRKH patients and controls. Conclusions: MRKH could be associated with a higher prevalence of anxiety and depression symptoms and social insecurity compared with women of a similar age without the condition. MRKH could also be associated with greater pain and discomfort during sexual intercourse and limitations in arousal, lubrication, and orgasm. MRKH patients more commonly experience impairment of mental-health-related QoL, but physical-health-related QoL is not affected.
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Affiliation(s)
- Ermioni Tsarna
- 2nd Department of Obstetrics and Gynecology, Medical School, National and Kapodistrian University of Athens, 11528 Athens, Greece; (M.E.); (E.K.); (M.-K.L.); (P.C.)
- Correspondence:
| | - Anna Eleftheriades
- Postgraduate Programme “Fetal Maternal Medicine”, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece;
| | - Makarios Eleftheriades
- 2nd Department of Obstetrics and Gynecology, Medical School, National and Kapodistrian University of Athens, 11528 Athens, Greece; (M.E.); (E.K.); (M.-K.L.); (P.C.)
| | - Emmanouil Kalampokas
- 2nd Department of Obstetrics and Gynecology, Medical School, National and Kapodistrian University of Athens, 11528 Athens, Greece; (M.E.); (E.K.); (M.-K.L.); (P.C.)
| | - Maria-Konstantina Liakopoulou
- 2nd Department of Obstetrics and Gynecology, Medical School, National and Kapodistrian University of Athens, 11528 Athens, Greece; (M.E.); (E.K.); (M.-K.L.); (P.C.)
| | - Panagiotis Christopoulos
- 2nd Department of Obstetrics and Gynecology, Medical School, National and Kapodistrian University of Athens, 11528 Athens, Greece; (M.E.); (E.K.); (M.-K.L.); (P.C.)
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15
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Beisert MJ, Chodecka AM, Walczyk-Matyja K, Szymańska-Pytlińska ME, Kędzia W, Kapczuk K. Psychological correlates of sexual self-esteem in young women with Mayer-Rokitansky-Küster-Hauser syndrome. CURRENT ISSUES IN PERSONALITY PSYCHOLOGY 2022; 10:333-342. [PMID: 38013735 PMCID: PMC10535637 DOI: 10.5114/cipp.2022.114044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 12/12/2021] [Accepted: 02/07/2022] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND Mayer-Rokitansky-Küster-Hauser syndrome (MRKHS) is a difference (disorder) of sex development that results from Müllerian duct aplasia in 46,XX females. The diagnosis of MRKHS is usually established in late adolescence. The purpose of the study was to assess the impact of congenital absence of uterus and vagina (CAUV) on a patient's psychosexual functioning. PARTICIPANTS AND PROCEDURE Thirty-two women with MRKHS (mean age 22.9 years) and 32 matched healthy controls (mean age 24.75 years) completed three study questionnaires: the Sexual Self-Esteem Inventory for Women, the Rosenberg Self-Esteem Scale, and Minnesota Multiphasic Personality Inventory-2 (MMPI-2). Statistical analysis was performed by IBM SPSS Statistics 22. RESULTS There was no difference in global self-esteem between the two study groups. MRKHS females had lower sexual self-esteem and experienced higher intensity of some psychological functioning characteristics (paranoia, psychasthenia, schizophrenia) than their peers. Correlations between sexual self-esteem and results on depression, psychopathic deviate, schizophrenia, social introversion and anxiety scales were observed in patients with MRKHS. Global self-esteem and schizophrenia results were significant predictors of sexual self-esteem in the clinical group. Higher global self-esteem and lower results in the schizophrenia scale were associated with higher sexual self-esteem in patients with MRKHS. CONCLUSIONS Psychological and medical counseling of women with MRKHS should address their impaired sexual self-esteem, especially sexual skills and experiences. While the number of diagnostic responses indicating the presence of specific symptoms in MRKHS females is statistically significantly different, the level of scores obtained does not exceed the threshold of clinical pathology.
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Affiliation(s)
- Maria J. Beisert
- Faculty of Psychology and Cognitive Science, Adam Mickiewicz University, Poznan, Poland
| | | | - Katarzyna Walczyk-Matyja
- Division of Gynecology, Department of Perinatology and Gynecology, Poznan University of Medical Sciences, Poznan, Poland
| | | | - Witold Kędzia
- Division of Gynecology, Department of Perinatology and Gynecology, Poznan University of Medical Sciences, Poznan, Poland
| | - Karina Kapczuk
- Division of Gynecology, Department of Perinatology and Gynecology, Poznan University of Medical Sciences, Poznan, Poland
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16
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Wee A, Bagchi T, Kimble R. Creation and maintenance of neo-vagina with the use of vaginal dilators as first line treatment: Results from a quaternary paediatric and adolescent gynaecology service in Australia. Aust N Z J Obstet Gynaecol 2022; 62:439-444. [PMID: 35179224 DOI: 10.1111/ajo.13487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Vaginal agenesis is an uncommon condition with an estimated incidence of 1/5000 live female births. There are surgical and non-surgical treatment options for neo-vagina creation. Vaginal dilatation has been used to treat vaginal agenesis for over 80 years, but outcome data to date have had poor definitions for 'success'. The optimal method for neo-vagina creation varies with vaginal dilator therapy being the most successful first line therapy in women with Mayer-Rokistansky-Kuster-Hauser syndrome, with little literature to guide best practice in women with more complex congenital conditions. There is a paucity of data from Australian and New Zealand paediatric and adolescent gynaecology services on management of women requiring a functional vagina, for any underlying aetiology. AIMS To determine if creation and maintenance of a functional neo-vagina for vaginal agenesis with non-surgical management (via vaginal dilators) should be the first line treatment. MATERIALS AND METHODS Retrospective observational study between January 2005 and June 2015. RESULTS Of the 23 women, 21 (91.3%) achieved a successful vaginal length defined as achieving vaginal length >6 cm and maximum width using the largest dilator if not sexually active, or ability to have sexual intercourse without discomfort. CONCLUSION Vaginal dilator therapy remains an effective first line treatment for neo-vagina creation and maintenance and can be achieved in an outpatient setting with appropriate support.
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Affiliation(s)
- Amanda Wee
- Royal Brisbane and Women's Hospital, Women's and Newborns Services, Brisbane, Queensland, Australia
| | - Tapasi Bagchi
- Royal Brisbane and Women's Hospital, Women's and Newborns Services, Brisbane, Queensland, Australia
| | - Rebecca Kimble
- Royal Brisbane and Women's Hospital, Women's and Newborns Services, Brisbane, Queensland, Australia
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17
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Vosoughi N, Maasoumi R, Haeri Mehrizi AA, Ghanbari Z. The Effect of Psychosexual Education on Promoting Sexual Function, Genital Self-Image, and Sexual Distress among Women with Rokitansky Syndrome: A Randomized Controlled Clinical Trial. J Pediatr Adolesc Gynecol 2022; 35:73-81. [PMID: 34271197 DOI: 10.1016/j.jpag.2021.06.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 06/13/2021] [Accepted: 06/29/2021] [Indexed: 01/13/2023]
Abstract
STUDY OBJECTIVE To assess the effectiveness of psychosexual education on promoting sexual function and genital self-image and reducing sexual distress through e-learning among women with Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome. DESIGN Randomized controlled trial. SETTING Imam Khomeini Hospital "Pelvic Floor Clinic" in Tehran. PARTICIPANTS Thirty-eight 15- to 49-year-old women with MRKH syndrome who had undergone surgical or nonsurgical vaginal reconstruction techniques more than 6 months before the intervention were assigned to 2 parallel intervention and control groups of 19 each. INTERVENTIONS Psychosexual education was delivered through e-learning for the intervention group over an 8-week period, with no limitations of time and space. Sexual function, genital self-image, and sexual distress were evaluated at baseline, and at 4 and 8 weeks after the intervention. MAIN OUTCOME MEASURES The data collection tools included the Persian version of the Female Sexual Function Index, Female Genital Self-Image Scale, and the Revised Female Sexual Distress Scale. RESULTS The between group mean differences of sexual function, genital self-image, and sexual distress after 4 weeks (-1.2 [95% CI, -2.1 to -0.1], P = .025; -1.9 [95% CI, -2.9 to -0.9], P < .001; 4.2 [95% CI, 2.0-6.4], P < .001, respectively), as well as after 8 weeks (-1.8 [95% CI, -3.1 to -0.5], P = .009; -3.0 [95% CI, -4.5 to -1.5], P < .001; 6.7, 95% CI, 3.9-9.6], P <0.001, respectively) after baseline were significant. CONCLUSION Psychosexual education improved sexual function and genital self-image and reduced sexual distress in women with MRKH syndrome. Therefore, using this approach, we can raise individuals' sexual knowledge and skills and correct their sexual beliefs and attitudes.
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Affiliation(s)
- Nafiseh Vosoughi
- Department of Reproductive Health, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Raziyeh Maasoumi
- Department of Reproductive Health, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran; Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran.
| | - Ali Asghar Haeri Mehrizi
- Health Metrics Research Center, Iranian Institute for Health Sciences Research, ACECR, Tehran, Iran
| | - Zinat Ghanbari
- Department of Obstetrics and Gynecology, Vali-Asr Reproductive Health Research Center, Tehran University of Medical Sciences, Tehran, Iran
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18
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Warren AM, McMinn K, Testa G, Wall AE, Saracino G, Waddimba AC, Johannesson L. Psychological Characteristics of Recipients Pretransplantation in the Dallas UtErus Transplant Study (DUETS). Prog Transplant 2021; 31:330-336. [PMID: 34704857 DOI: 10.1177/15269248211046002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Uterus transplantation is now a viable option for fertility treatment for women with absolute uterine factor infertility. Psychological assessment is recommended as a part of the perioperative evaluation process. RESEARCH OBJECTIVE The purpose of this study was to examine the psychological characteristics and mental health history of the 20 women who participated in the Dallas UtErus Transplant Study (DUETS) trial. DESIGN This retrospective observational descriptive study was part of a prospective clinical trial. Prior to transplant, 20 women completed a clinical psychological interview, 19 of whom also completed psychological assessment measures including the Hospital Anxiety and Depression Scale, Patient Health Questionnaire 9 item, Generalized Anxiety Disorder 7 item, PTSD Checklist for DSM-5, 36-Item Short Form, Connor-Davidson Resilience Scale 10 item, and Dyadic Adjustment Scale. RESULTS Women who participated in the trial had high health-related quality of life and minimal psychological history, with most reporting psychological distress associated with their initial infertility diagnosis (N = 13). None of the participants endorsed psychological distress to meet clinical concerns on the psychological measures used. Satisfaction with relationship adjustment with their partners was also high. CONCLUSIONS Women with absolute uterine factor infertility who underwent uterus transplant demonstrated low psychological distress on assessment measures, were resilient, had high health related quality of life, and strong satisfaction with the quality of relationships with their partners. Although some women reported either current or past psychological diagnosis, most reported psychological distress that occurred at the time of the infertility diagnosis and appeared to resolve over time.
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Affiliation(s)
- Ann Marie Warren
- 466551Baylor Scott & White Research Institute, Dallas, TX, USA.,Division of Trauma, Acute Care, and Critical Care Surgery, Baylor University Medical Center, Dallas, TX, USA
| | - Kenleigh McMinn
- Division of Trauma, Acute Care, and Critical Care Surgery, Baylor University Medical Center, Dallas, TX, USA
| | - Giuliano Testa
- Annette C. and Harold Simmons Transplant Institute, Baylor University Medical Center, Dallas, TX, USA
| | - Anji E Wall
- Annette C. and Harold Simmons Transplant Institute, Baylor University Medical Center, Dallas, TX, USA
| | - Giovanna Saracino
- Annette C. and Harold Simmons Transplant Institute, Baylor University Medical Center, Dallas, TX, USA
| | - Anthony C Waddimba
- 466551Baylor Scott & White Research Institute, Dallas, TX, USA.,Health Systems Science, Department of Surgery, Baylor University Medical Center, Dallas, TX, USA
| | - Liza Johannesson
- Annette C. and Harold Simmons Transplant Institute, Baylor University Medical Center, Dallas, TX, USA
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Tsitoura A, Michala L. The Sexuality of Adolescents and Young Women With MRKH Syndrome: A Qualitative Study. J Sex Med 2021; 18:2012-2019. [PMID: 34649813 DOI: 10.1016/j.jsxm.2021.09.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 08/19/2021] [Accepted: 09/09/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Vaginal agenesis, most commonly referred as Mayer-Rokitansky-Küster-Hauser (MRKH) Syndrome, is mostly diagnosed as primary amenorrhea in teenage girls; although there is plenty of literature concerning the formation of a neovagina, limited research has focused on the psychological burden of this diagnosis to the girls. AIM To enlighten health providers into the finer aspects of sexuality through the own words and experiences of girls with MRKH under our care. METHODS Women currently undergoing vaginal dilation or who had completed vaginal dilation within the past year were recruited from February 2019 to January 2020. A gynecologist with training in Sexual Medicine conducted a semistructured interview, which was recorded and then transcribed to identify common themes among interviewees. OUTCOMES The main outcome explored was the narrative experiences of women with MRKH. RESULTS 7 women participated, with a mean age of 19.7 (range 17-22 years). None of the girls felt stigmatized, however one reported significant distress at diagnosis, stemming from the attitude of health care professionals and exacerbated by an earlier age at disclosure. All girls accepted that VDT was successful, when it was initiated after they had felt sexual interest and arousal. Exact quantification of the vaginal length at onset, worried 4 as they felt pressurized to achieve a specific length. A few girls reported anxiety over sharing the diagnosis with an intimate partner. All of them pretended at some point to have menses. Childbearing was an important issue for most of the interviewees, but it did not concern them for the time being. All girls had supporting families. However, 5 did not want to share information about VDT with them. One girl reported that openness in discussing genital anatomy, VDT and sexuality, helped her both in completing treatment and adapting in a sexual relationship. CLINICAL IMPLICATIONS A multidisciplinary team should aim for age-appropriate disclosure and consultation and guide women through VDT and their sexual relations. STRENGTHS AND LIMITATIONS This is a thorough account of women's perceptions regarding VDT and sexuality in MRKH. However, our conclusions may be limited by the small number of participants. CONCLUSION Gradual provision of information at disclosure and adjusted timing at VDT may reduce stress in girls with MRKH. Tsitoura A, Michala L. The Sexuality of Adolescents and Young Women With MRKH Syndrome: A Qualitative Study. J Sex Med 2021;XX:XXX-XXX.
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Affiliation(s)
- Anastasia Tsitoura
- 1st Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Alexandra General Hospital, Athens, Greece.
| | - Lina Michala
- 1st Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Alexandra General Hospital, Athens, Greece
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20
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Xun H, Fadavi D, Darrach H, Fischer N, Yesantharao P, Kraenzlin F, Nickles Fader A, Segars JH, Sacks JM. Recognizing the Vulnerable: Perspectives, Attitudes, and Interests of Women With Uterine Factor Infertility Towards Uterus Allotransplantation. Cureus 2021; 13:e18891. [PMID: 34804735 PMCID: PMC8599396 DOI: 10.7759/cureus.18891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2021] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Uterine allotransplantation (UTx) is a novel therapy to allow women with uterine factor infertility (UFI) to bear their own children. To date, over 60 UTx have been performed, resulting in 15 live births. Our study investigates the attitudes, perspectives, and interests of women with UFI towards UTx. METHODS Anonymous questionnaires were distributed electronically to women diagnosed with UFI at Johns Hopkins Hospital between the years 2003 and 2018. RESULTS Thirty-one women with UFI were identified, resulting in 10 completed surveys. The average age was 31.7 ± 6.31 years, and the average age of diagnosis was 20 years (range 14-31); all 10 surveyed women had congenital UFI. Of note, 80% of women agreed that UTx should be an option for women with UFI, and 90% would consider receiving a UTx. The majority of the nine (90%) women who had previously heard of UTx learned about it from the news (5, 50%). When asked to rank the risks related to UTx in order of personal importance, only two women ranked themselves most important; the other woman ranked fetus and donor as more important. All women had health insurance (70% had private insurance), and 90% believed that UTx should be covered by health insurance. CONCLUSIONS We surveyed women with UFI and found that the majority are willing to have UTx, despite the associated risks of the procedure. Taking into consideration the responses for ranking the importance of risks of the procedure, women with UFI should be considered a vulnerable population, requiring special considerations for UTx informed consents.
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Affiliation(s)
- Helen Xun
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Darya Fadavi
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Halley Darrach
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Nicole Fischer
- Department of Obstetrics and Gynecology, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Pooja Yesantharao
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Franca Kraenzlin
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Amanda Nickles Fader
- Department of Obstetrics and Gynecology, Johns Hopkins University School of Medicine, Baltimore, USA
| | - James H Segars
- Department of Obstetrics and Gynecology, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Justin M Sacks
- Department of Plastic and Reconstructive Surgery, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, USA
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21
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Johal KS, Mishra A, Alkizwini E, Whitehouse H, Batten G, Hachach-Haram N, Lancaster K, Constantinides J, Mohanna PN, Roblin P, Ross DA. Immediate vaginal and perineal reconstruction after abdominoperineal excision using the Inferior Gluteal Artery Perforator Flap (V-IGAP). J Plast Reconstr Aesthet Surg 2021; 75:137-144. [PMID: 34657821 DOI: 10.1016/j.bjps.2021.08.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 06/24/2021] [Accepted: 08/26/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND The fasciocutaneous inferior gluteal artery perforator (IGAP) has been previously demonstrated to be a robust reconstructive choice after abdominoperineal excision (APE), with comparably low morbidity relative to other flaps. In patients who undergo concurrent vaginectomy, we demonstrate in this retrospective cohort study how IGAP modification allows simultaneous vaginal reconstruction with a favourable complication profile and long-term return to sexual activity. METHODS Oncological resection was completed with the patient prone. Unilateral or bilateral IGAP flaps may be used based on vaginal defect size and surgeon preference. In this study, important features of flap design, mobilisation and inset are presented, together with a retrospective cohort study of all cases who underwent vaginal reconstruction. Clinical outcomes were determined by the length of stay, early to late complications, and quality of life assessment including a return to sexual function. RESULTS Over a 10-year period, 207 patients underwent abdominoperineal resection (APE) in our cross-centre study (86% subject to neoadjuvant chemoradiotherapy), with 22/84 female patients electing for vaginal reconstruction (19 partial, 3 total vaginectomies). Minor complications were observed in 6/22 cases, with two patients progressing to healing after-theatre debridement (major). The median follow-up time was 410 days. Quality of life questionnaires reported high patient satisfaction, with 70% of patients returning to sexual activity. CONCLUSIONS For patients undergoing APE with concurrent vaginectomy, the IGAP flap can be used alone for both perineal dead space management and neovaginal reconstruction, negating the need for an alternative second flap and avoiding significant donor morbidity. This study shows excellent long-term clinical outcomes, including a return to sexual activity.
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Affiliation(s)
- Kavan S Johal
- Department of Plastic Surgery, St Thomas' Hospital, London, United Kingdom.
| | - Ankit Mishra
- Department of Plastic Surgery, St Thomas' Hospital, London, United Kingdom
| | - Eman Alkizwini
- Department of Colorectal Surgery, St Mark's Hospital, Middlesex, United Kingdom
| | - Harry Whitehouse
- Department of Plastic Surgery, St Thomas' Hospital, London, United Kingdom
| | - Gemma Batten
- Department of Plastic Surgery, St Thomas' Hospital, London, United Kingdom
| | | | - Katie Lancaster
- Department of Plastic Surgery, St Thomas' Hospital, London, United Kingdom
| | - Joannis Constantinides
- Department of Plastic Surgery, St Thomas' Hospital, London, United Kingdom; Department of Plastic Surgery, St Mark's Hospital, Middlesex, United Kingdom
| | - Pari-Naz Mohanna
- Department of Plastic Surgery, St Thomas' Hospital, London, United Kingdom
| | - Paul Roblin
- Department of Plastic Surgery, St Thomas' Hospital, London, United Kingdom
| | - David A Ross
- Department of Plastic Surgery, St Thomas' Hospital, London, United Kingdom; Department of Plastic Surgery, St Mark's Hospital, Middlesex, United Kingdom
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Foster C, Daigle R, Rowe CK. Tissue Engineering Opportunities for Vaginal Replacement in a Pediatric Population. TISSUE ENGINEERING PART B-REVIEWS 2021; 28:476-487. [PMID: 33843276 DOI: 10.1089/ten.teb.2020.0376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Treatment for children born with vaginal agenesis remains difficult, without a clear gold standard for tissue replacement. An autologous-engineered vaginal replacement would significantly improve quality of life for people born with this condition. The aim of this study was to critically review literature on the current state of tissue engineering for vaginal reconstruction in a pediatric population. An electronic literature search was conducted using PubMed for articles describing pediatric vaginal tissue engineering from January 2003 to December 2020. Nine studies met inclusion criteria and were reviewed. The model, methods, cell type and source, scaffold type, and time of analysis and evaluation were compared. Three studies used in vitro and six used an in vivo design. Of the six in vivo studies, one was able to investigate autologous vaginal epithelial cells in human clinical trials. This review discusses the current knowledge and progress of vaginal tissue engineered replacements that can potentially be used as a basis for both future preclinical animal and clinical human studies. Impact statement The current methods of treatment for congenital vaginal anomalies leave room for improvement. The state of tissue engineering may provide a method to improve the surgical interventions provided for these patients, in hopes of providing increased vaginal functionally and quality of life.
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Affiliation(s)
- Christopher Foster
- Department of Pediatrics, University of Connecticut School of Medicine, Farmington, Connecticut, USA
| | - Ryan Daigle
- Department of Pediatrics, University of Connecticut School of Medicine, Farmington, Connecticut, USA
| | - Courtney K Rowe
- Division of Pediatric Urology, Connecticut Children's Medical Center, Hartford, Connecticut, USA
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Pontecorvi P, Megiorni F, Camero S, Ceccarelli S, Bernardini L, Capalbo A, Anastasiadou E, Gerini G, Messina E, Perniola G, Benedetti Panici P, Grammatico P, Pizzuti A, Marchese C. Altered Expression of Candidate Genes in Mayer-Rokitansky-Küster-Hauser Syndrome May Influence Vaginal Keratinocytes Biology: A Focus on Protein Kinase X. BIOLOGY 2021; 10:biology10060450. [PMID: 34063745 PMCID: PMC8223793 DOI: 10.3390/biology10060450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 05/13/2021] [Accepted: 05/20/2021] [Indexed: 11/16/2022]
Abstract
Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome is a rare and complex disease defined by congenital aplasia of the vagina and uterus in 46,XX women, often associated with kidney and urinary tract anomalies. The aetiopathogenesis of MRKH syndrome is still largely unknown. Herein, we investigated the role of selected candidate genes in the aetiopathogenesis of MRKH syndrome, with a focus on PRKX, which encodes for protein kinase X. Through RT-qPCR analyses performed on vaginal dimple samples from patients, and principal component analysis (PCA), we highlighted a phenotype-related expression pattern of PRKX, MUC1, HOXC8 and GREB1L in MRKH patients. By using an in vitro approach, we proved that PRKX ectopic overexpression in a cell model of vaginal keratinocytes promotes cell motility through epithelial-to-mesenchymal transition (EMT) activation, a fundamental process in urogenital tract morphogenesis. Moreover, our findings showed that PRKX upregulation in vaginal keratinocytes is able to affect transcriptional levels of HOX genes, implicated in urinary and genital tract development. Our study identified the dysregulation of PRKX expression as a possible molecular cause for MRKH syndrome. Moreover, we propose the specific role of PRKX in vaginal keratinocyte biology as one of the possible mechanisms underlying this complex disease.
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Affiliation(s)
- Paola Pontecorvi
- Department of Experimental Medicine, Sapienza University of Rome—Viale Regina Elena 324, 00161 Rome, Italy; (P.P.); (F.M.); (S.C.); (E.A.); (G.G.); (E.M.); (A.P.)
| | - Francesca Megiorni
- Department of Experimental Medicine, Sapienza University of Rome—Viale Regina Elena 324, 00161 Rome, Italy; (P.P.); (F.M.); (S.C.); (E.A.); (G.G.); (E.M.); (A.P.)
| | - Simona Camero
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome—Viale Regina Elena 324, 00161 Rome, Italy; (S.C.); (G.P.); (P.B.P.)
| | - Simona Ceccarelli
- Department of Experimental Medicine, Sapienza University of Rome—Viale Regina Elena 324, 00161 Rome, Italy; (P.P.); (F.M.); (S.C.); (E.A.); (G.G.); (E.M.); (A.P.)
| | - Laura Bernardini
- Division of Medical Genetics, IRCCS Casa Sollievo della Sofferenza Foundation-Viale Cappuccini, 1, 71013 San Giovanni Rotondo (FG), Italy; (L.B.); (A.C.)
| | - Anna Capalbo
- Division of Medical Genetics, IRCCS Casa Sollievo della Sofferenza Foundation-Viale Cappuccini, 1, 71013 San Giovanni Rotondo (FG), Italy; (L.B.); (A.C.)
| | - Eleni Anastasiadou
- Department of Experimental Medicine, Sapienza University of Rome—Viale Regina Elena 324, 00161 Rome, Italy; (P.P.); (F.M.); (S.C.); (E.A.); (G.G.); (E.M.); (A.P.)
| | - Giulia Gerini
- Department of Experimental Medicine, Sapienza University of Rome—Viale Regina Elena 324, 00161 Rome, Italy; (P.P.); (F.M.); (S.C.); (E.A.); (G.G.); (E.M.); (A.P.)
| | - Elena Messina
- Department of Experimental Medicine, Sapienza University of Rome—Viale Regina Elena 324, 00161 Rome, Italy; (P.P.); (F.M.); (S.C.); (E.A.); (G.G.); (E.M.); (A.P.)
| | - Giorgia Perniola
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome—Viale Regina Elena 324, 00161 Rome, Italy; (S.C.); (G.P.); (P.B.P.)
| | - Pierluigi Benedetti Panici
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome—Viale Regina Elena 324, 00161 Rome, Italy; (S.C.); (G.P.); (P.B.P.)
| | - Paola Grammatico
- Division of Medical Genetics, Department of Molecular Medicine, Sapienza University of Rome-San Camillo-Forlanini Hospital, Circonvallazione Gianicolense, 87, 00152 Rome, Italy;
| | - Antonio Pizzuti
- Department of Experimental Medicine, Sapienza University of Rome—Viale Regina Elena 324, 00161 Rome, Italy; (P.P.); (F.M.); (S.C.); (E.A.); (G.G.); (E.M.); (A.P.)
- Division of Medical Genetics, IRCCS Casa Sollievo della Sofferenza Foundation-Viale Cappuccini, 1, 71013 San Giovanni Rotondo (FG), Italy; (L.B.); (A.C.)
| | - Cinzia Marchese
- Department of Experimental Medicine, Sapienza University of Rome—Viale Regina Elena 324, 00161 Rome, Italy; (P.P.); (F.M.); (S.C.); (E.A.); (G.G.); (E.M.); (A.P.)
- Correspondence: ; Tel.: +39-06-4997-2872
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Ibidapo-Obe O, Okudo J, Filani O. Incidental Finding of Leiomyoma in Mayer-Rokitansky-Kuster-Hauser Syndrome. J Investig Med High Impact Case Rep 2021; 9:23247096211014690. [PMID: 33985356 PMCID: PMC8127750 DOI: 10.1177/23247096211014690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome is a sexual developmental disorder. In this disorder, there is a congenital absence of the uterus and vagina with normal external genitalia. The etiology is not well understood. Variations of this condition exist that may include congenital abnormalities and psychological problems. In this article, we discuss the case of a 47-year-old African American female who presented with acute renal failure, solitary right kidney, and a pelvic mass extending from the pelvis to the right hypochondrium determined to be a fibroid. The patient was managed by a multidisciplinary team, dialyzed, and planned for removal of the mass. While understanding the low probability of having fibroids without a uterus, fibroids should not be excluded from such patients. It is also important to consider the emotional and psychological well-being of such patients.
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Hatim H, Zainuddin AA, Anizah A, Kalok A, Daud TIM, Ismail A, Nurazurah AG, Grover S. The Missing Uterus, the Missed Diagnosis, and the Missing Care. Mayer-Rokitansky-Küster-Hauser Syndrome in the Lives of Women in Malaysia. J Pediatr Adolesc Gynecol 2021; 34:161-167. [PMID: 33189898 DOI: 10.1016/j.jpag.2020.11.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 10/18/2020] [Accepted: 11/06/2020] [Indexed: 11/26/2022]
Abstract
STUDY OBJECTIVE To explore the effect of the diagnosis of Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome on affected Malaysian women. DESIGN Qualitative study with a quantitative component. SETTING Pediatric and adolescent gynecology unit at Universiti Kebangsaan Malaysia Medical Centre, Malaysia. PARTICIPANTS Twelve women with MRKH. INTERVENTIONS Face-to-face interview and short questionnaire. MAIN OUTCOME MEASURES Thematic analysis was used to understand participants' experiences. RESULTS There were 7 themes identified: (1) delayed diagnoses; (2) doctors' roles and attitudes; (3) gender identity; (4) family and society's response; (5) reaction toward infertility; (6) managing sexual intimacy; and (7) coping mechanisms. Several participants consulted their physicians regarding their primary amenorrhea at an opportunistic setting. When they were referred to the gynecologists, they were dismayed at the lack of information given. The term, "MRKH" plays an important role to ease information-seeking. Participants felt that the doctors were insensitive toward them. Mental illness is a significant complication of MRKH. All participants acknowledged that infertility was the hardest part of the condition. The importance of blood lineage affects their outlook on childbearing options. Some were afraid of sexual intimacy and worried that they would not be able to satisfy their partners. Participants gained support and bonded with their counterparts in the MRKH support group. CONCLUSION A multidisciplinary approach including medical, psychological, and social support is essential for the management of MRKH. Adequate information and sexual education plays the utmost importance in preventing social-related complications of MRKH.
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Affiliation(s)
- H Hatim
- Department of Obstetric and Gynaecology, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia.
| | - A A Zainuddin
- Paediatric Adolescent Gynaecology Unit, Department of Obstetric and Gynaecology, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - A Anizah
- Department of Obstetric and Gynaecology, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - A Kalok
- Department of Obstetric and Gynaecology, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - T I Mohd Daud
- Department of Psychiatry, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - A Ismail
- Department of Public Health, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - A G Nurazurah
- Paediatric Adolescent Gynaecology Unit, Department of Obstetric and Gynaecology, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - S Grover
- Department of Gynaecology, Royal Children Hospital Melbourne, Melbourne, Australia
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Long Term Findings Concerning the Mental and Physical Condition, Quality of Life and Sexuality after Laparoscopically Assisted Creation of a Neovagina (Modified Vecchietti Technique) in Young MRKHS (Mayer-Rokitansky-Küster-Hauser-Syndrome) Patients. J Clin Med 2021; 10:jcm10061269. [PMID: 33803863 PMCID: PMC8003280 DOI: 10.3390/jcm10061269] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 03/10/2021] [Accepted: 03/12/2021] [Indexed: 11/17/2022] Open
Abstract
The Mayer-Rokitansky-Küster-Hauser-syndrome (MRKHS) is characterized by a congenital uterine and vaginal aplasia. A large body of literature reports that a diagnosis of MRKHS has a variety of psychological effects on patients and doubts about female identity. The aim of the underlying study was to detect the patient-reported physical and mental health and sexual function before and after laparoscopically assisted creation of a neovagina. 160 women with MRKHS who underwent this type of surgery between September 2009 and December 2015 were invited to complete the questionnaires. Packages consisting of six questionnaires were handed out before surgery, six and 12 months after surgery. Data from 82 patients could be included in the study. Patients had a mean age of 19.9 years at inclusion in the study. We detected an impairment of the health-related mental quality of life. There was no higher risk for psychological disorders. MRKHS patients show similar self-acceptance and normal body image compared to the general population. The sexual function is limited before surgery and normalizes after surgery. Useful factors for coping with the disease are an interdisciplinary approach in diagnostics and treatment, psychosocial adaptation as well as a supportive social environment.
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Perspectives of 281 patients with Mayer-Rokitansky-Küster-Hauser Syndrome on uterine transplantation. Fertil Steril 2021; 115:1074-1083. [PMID: 33468312 DOI: 10.1016/j.fertnstert.2020.10.044] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 09/23/2020] [Accepted: 10/13/2020] [Indexed: 01/24/2023]
Abstract
OBJECTIVES To investigate the personal, ethical, and financial perspectives of individuals with Mayer-Rokitansky-Küster-Hauser syndrome (MRKH), a congenital uterine factor infertility condition, regarding uterine transplantation (UTx). DESIGN Cross-sectional, quantitative survey. SETTING A 60-item anonymous electronic questionnaire was disseminated via social media sites. PATIENTS International members of the Beautiful You MRKH Foundation. INTERVENTIONS None. MAIN OUTCOME MEASURES The survey contained UTx educational materials followed by questions assessing participants' baseline knowledge, global perceptions, financial concerns, and ethical considerations regarding UTx. RESULTS We received 281 responses, with a mean participant age of 28.2 ± 9.8 years. After reviewing the education material, most participants considered receiving a UTx (73%), believed that it should be an option for all women with uterine factor infertility (86%), and believed that it should be covered by health insurance (78%). Respondents perceived the benefits of the procedure to outweigh the risks (67%) and considered it to be an ethical procedure (82%). Almost one-half (49%) were willing to spend more than $10,000 out of pocket to receive the procedure. When asked to rank the risk of UTx to self, donor, and fetus in order of personal importance, 21% ranked their own safety last. CONCLUSION There is a profound desire in the MRKH community for UTx to become more widely available and affordable. MRKH patients may represent a vulnerable population requiring special considerations for informed consent and rigorous evaluation for UTx. Providers caring for MRKH patients should be prepared to provide education about UTx and to thoughtfully engage with news and media outlets to communicate evidence-supported information.
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Pontecorvi P, Bernardini L, Capalbo A, Ceccarelli S, Megiorni F, Vescarelli E, Bottillo I, Preziosi N, Fabbretti M, Perniola G, Benedetti Panici P, Pizzuti A, Grammatico P, Marchese C. Protein-protein interaction network analysis applied to DNA copy number profiling suggests new perspectives on the aetiology of Mayer-Rokitansky-Küster-Hauser syndrome. Sci Rep 2021; 11:448. [PMID: 33432050 PMCID: PMC7801512 DOI: 10.1038/s41598-020-79827-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 12/14/2020] [Indexed: 12/21/2022] Open
Abstract
Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome is a rare disease, characterised by the aplasia of vagina and uterus in women with a 46,XX karyotype. Most cases are sporadic, but familial recurrence has also been described. Herein, we investigated an Italian cohort of 36 unrelated MRKH patients to explore the presence of pathogenic copy number variations (CNVs) by array-CGH and MLPA assays. On the whole, aberrations were found in 9/36 (25%) patients. Interestingly, one patient showed a novel heterozygous microduplication at Xp22.33, not yet described in MRKH patients, containing the PRKX gene. Moreover, a novel duplication of a specific SHOX enhancer was highlighted by MLPA. To predict the potential significance of CNVs in MRKH pathogenesis, we provided a network analysis for protein-coding genes found in the altered genomic regions. Although not all of these genes taken individually showed a clear clinical significance, their combination in a computational network highlighted that the most relevant biological connections are related to the anatomical structure development. In conclusion, the results described in the present study identified novel genetic alterations and interactions that may be likely involved in MRKH phenotype determination, so adding new insights into the complex puzzle of MRKH disease.
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Affiliation(s)
- Paola Pontecorvi
- Department of Experimental Medicine, Sapienza Università Di Roma, Viale del Policlinico, 155, 00161, Rome, Italy
| | - Laura Bernardini
- Division of Medical Genetics, IRCCS Casa Sollievo Della Sofferenza Foundation, San Giovanni Rotondo, FG, Italy
| | - Anna Capalbo
- Division of Medical Genetics, IRCCS Casa Sollievo Della Sofferenza Foundation, San Giovanni Rotondo, FG, Italy
| | - Simona Ceccarelli
- Department of Experimental Medicine, Sapienza Università Di Roma, Viale del Policlinico, 155, 00161, Rome, Italy
| | - Francesca Megiorni
- Department of Experimental Medicine, Sapienza Università Di Roma, Viale del Policlinico, 155, 00161, Rome, Italy
| | - Enrica Vescarelli
- Department of Experimental Medicine, Sapienza Università Di Roma, Viale del Policlinico, 155, 00161, Rome, Italy
| | - Irene Bottillo
- Division of Medical Genetics, Department of Molecular Medicine, Sapienza Università di Roma, Rome, Italy
| | - Nicoletta Preziosi
- Division of Medical Genetics, Department of Molecular Medicine, Sapienza Università di Roma, Rome, Italy
| | - Maria Fabbretti
- Division of Medical Genetics, IRCCS Casa Sollievo Della Sofferenza Foundation, San Giovanni Rotondo, FG, Italy
| | - Giorgia Perniola
- Department of Maternal, Infantile and Urological Sciences, Sapienza Università di Roma, Rome, Italy
| | | | - Antonio Pizzuti
- Department of Experimental Medicine, Sapienza Università Di Roma, Viale del Policlinico, 155, 00161, Rome, Italy.,Division of Medical Genetics, IRCCS Casa Sollievo Della Sofferenza Foundation, San Giovanni Rotondo, FG, Italy
| | - Paola Grammatico
- Division of Medical Genetics, Department of Molecular Medicine, Sapienza Università di Roma, Rome, Italy
| | - Cinzia Marchese
- Department of Experimental Medicine, Sapienza Università Di Roma, Viale del Policlinico, 155, 00161, Rome, Italy.
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Anxiety symptoms in patients with Mayer-Rokitansky-Küster-Hauser syndrome: a cross-sectional study. Chin Med J (Engl) 2020; 133:388-394. [PMID: 31977552 PMCID: PMC7046242 DOI: 10.1097/cm9.0000000000000648] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background: As a congenital malformation that results in infertility and an inability to have vaginal intercourse, Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome places a considerable psychological burden on patients, which results in anxiety symptoms. However, only single case studies or a few small to medium-sized cross-sectional studies were identified to focus on anxiety symptoms in MRKH patients. Thus, the aim of this study was to explore the status of anxiety symptoms and the related factors in patients with MRKH syndrome. Methods: This cross-sectional study involving 141 patients with MRKH syndrome and 178 healthy women was conducted from January 2018 to December 2018. All participants were required to complete a demographic questionnaire and the Generalized Anxiety Disorder 7-item scale (GAD-7), Patient Health Questionnaire-9, Eysenck Personality Questionnaire-Revised, Short Scale for Chinese, and Chinese Version of the Female Sexual Function Index. The main outcome was the anxiety symptoms measured by the GAD-7. Main outcome was compared between the MRKH syndrome group and the healthy control group. Then, we explored the related factors by comparing patients with and without anxiety symptoms. Results: Of the respondents, 24.1% experienced moderate to severe anxiety symptoms. Patients with MRKH syndrome manifested more severe anxiety symptoms than healthy women. Negative self-evaluation of femininity (odds ratio [OR] 2.706, 95% confidence interval [CI] 1.010–7.247), neurotic personality traits (OR 1.100, 95% CI 1.029–1.175), and coexisting depressive symptoms (OR 4.422, 95% CI 1.498–13.049) were more prevalent in anxious patients. Conclusion: The findings stress the importance of anxiety symptom screening in MRKH patients and identify patients at risk of anxiety symptoms, providing a possible basis for future intervention.
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Carroll S, Laufer MR, Thomas-Kowal P, Lossie AC, Moss-Morris R. From Engulfment to Enrichment: Associations Between Illness Representations, Self-Concept, and Psychological Adjustment in Mayer-Rokitansky-Küster-Hauser Syndrome. J Pediatr Adolesc Gynecol 2020; 33:639-648. [PMID: 32688051 DOI: 10.1016/j.jpag.2020.07.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 05/07/2020] [Accepted: 07/09/2020] [Indexed: 02/07/2023]
Abstract
STUDY OBJECTIVE Mayer-Rokitansky-Küster-Hauser syndrome (MRKH) is a female reproductive disorder characterized by the absence or underdevelopment of the uterus, cervix and vagina. Limited research has examined factors related to psychological adjustment in MRKH. This study aimed to explore associations among illness representations, self-concept, psychological distress, and self-esteem in MRKH. DESIGN Cross-sectional. SETTING Participants were recruited globally online and from patient meetings. PARTICIPANTS A total of 263 patients with MRKH (age 16.1-74.4 years; mean = 31.7 years) completed questionnaires. INTERVENTION None. MAIN OUTCOME MEASURES Validated self-reported measures of psychological distress and self-esteem (outcomes) and illness representations, self-concept, social support-seeking, and positive affect (hypothesized correlates) were explored in correlation and hierarchical regression analyses, alongside demographic and clinical variables. RESULTS Younger age and shorter time since diagnosis was associated with higher distress and lower self-esteem. Patients with MRKH reported significantly higher distress and lower self-esteem than the general population. Higher distress and lower self-esteem were associated with higher reported engulfment (defining one's identity or feeling consumed by MRKH) and beliefs about the serious consequences of MRKH, and lower reported MRKH coherence, enrichment (positive changes to self-identity because of MRKH) and positive affect. CONCLUSIONS Findings suggest that the impact of MRKH on identity plays an important role in adjustment. High perceived coherence and maintenance of positive affect may play a protective role in psychological adjustment. A 12-month follow-up study is planned to examine associations among these variables longitudinally. Baseline data suggest that early availability of psychological support would be beneficial, and interventions focused on identity and psychoeducation about MRKH would be valuable.
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Affiliation(s)
- Susan Carroll
- Psychology Department, Institute of Psychiatry, Psychology & Neuroscience at King's College London, London, UK.
| | - Marc R Laufer
- Division of Gynecology, Department of Surgery, Boston Children's Hospital, Boston, MA; Center for Young Women's Health and Division of Gynecology, Boston Children's Hospital, Boston, MA
| | - Phaedra Thomas-Kowal
- Center for Young Women's Health and Division of Gynecology, Boston Children's Hospital, Boston, MA
| | - Amy C Lossie
- Beautiful You MRKH Foundation, Silver Spring, MD; The Global MRKH Consortium, Silver Spring, MD
| | - Rona Moss-Morris
- Psychology Department, Institute of Psychiatry, Psychology & Neuroscience at King's College London, London, UK
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Weijenborg PTM, Kluivers KB, Dessens AB, Kate-Booij MJ, Both S. Sexual functioning, sexual esteem, genital self-image and psychological and relational functioning in women with Mayer-Rokitansky-Küster-Hauser syndrome: a case-control study. Hum Reprod 2020; 34:1661-1673. [PMID: 31418785 DOI: 10.1093/humrep/dez130] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 06/19/2019] [Indexed: 01/08/2023] Open
Abstract
STUDY QUESTION Do sexual functioning, sexual esteem, genital self-image and psychological and relational functioning in women with Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome differ from a comparison group of women without the condition? SUMMARY ANSWER In comparison to controls, women with MRKH with a non-surgically or surgically created neovagina did not differ in psychological and relational functioning but reported lower sexual esteem and more negative genital self-image, intercourse-related pain, clinically relevant sexual distress and sexual dysfunction, with sexual esteem levels strongly associated with sexual distress and sexual dysfunction. WHAT IS KNOWN ALREADY Studies on sexual functioning measured with standardized questionnaires in women with MRKH syndrome compared with women without the condition have yielded contradictory results. Factors associated with sexual functioning in this patient population have rarely been investigated. STUDY DESIGN, SIZE, DURATION Between November 2015 and May 2017, 54 women with MRKH syndrome with a neovagina and 79 age-matched healthy women without the condition were enrolled in this case-control study. PARTICIPANTS/MATERIALS, SETTING, METHODS All participants had to be at least 18-years old and had to live in a steady heterosexual relationship. Women with MRKH syndrome were asked to participate by their (former) gynecologists at three university hospitals and by MRKH peer support group. Controls were recruited via advertisement in local newspapers and social media. Standardized questionnaires were administered to assess sexual functioning, sexual esteem, genital self-image and psychological and relational functioning. MAIN RESULTS AND THE ROLE OF CHANCE Women with MRKH syndrome with a surgically or non-surgically created neovagina reported significantly more pain during intercourse (P < 0.05, d = 0.5), but did not differ in overall sexual functioning from control women. More women with MRKH syndrome reported clinically relevant sexuality-related distress (P < 0.05, odds ratio (OR): 2.756, 95% CI 1.219-6.232) and suffered a sexual dysfunction (P < 0.05, OR: 2.654, 95% CI: 1.088-6.471) in comparison with controls. MRKH women scored significantly lower on the sexual esteem scale (SES) (P < 0.01, d = 0.5) and the female genital self-image scale (FGSIS) (P < 0.01, d = 0.6) than controls. No significant differences were found between the two groups regarding psychological distress, anxiety and depression, global self-esteem and relational dissatisfaction. Sexual esteem was significantly associated with the presence of clinically relevant sexual distress (ß = 0.455, P = 0.001) and suffering a sexual dysfunction (ß = 0.554, P = 0.001) and explained, respectively, 40% and 28% of the variance. LIMITATIONS, REASONS FOR CAUTION Given the nature of the study focusing on sexual functioning, a potential selection bias cannot be excluded. It is possible that those women with the most severe sexual and/or psychological disturbances did or did not choose to participate in our study. WIDER IMPLICATIONS OF THE FINDINGS The study results add new data to the very limited knowledge about psychosexual functioning of women with MRKH syndrome and are of importance for more adequate counseling and treatment of these women. STUDY FUNDING/COMPETING INTEREST(S) The research was financially supported by the Dutch Scientific Society of Sexology (Nederlandse wetenschappelijke Vereniging Voor Seksuologie). The funding was unrestricted, and there was no involvement in the conduct of the research. There are no conflicts of interest to declare.
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Affiliation(s)
- P T M Weijenborg
- Outpatient Clinic Psychosomatic Gynaecology and Sexology, Department of Gynaecology, Leiden University Medical Centre, Leiden, The Netherlands
| | - K B Kluivers
- Department of Gynaecology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - A B Dessens
- Department of Child and Adolescent Psychiatry and Psychology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - M J Kate-Booij
- Department of Gynaecology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - S Both
- Outpatient Clinic Psychosomatic Gynaecology and Sexology, Department of Gynaecology, Leiden University Medical Centre, Leiden, The Netherlands
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Herlin MK, Petersen MB, Brännström M. Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome: a comprehensive update. Orphanet J Rare Dis 2020; 15:214. [PMID: 32819397 PMCID: PMC7439721 DOI: 10.1186/s13023-020-01491-9] [Citation(s) in RCA: 87] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 08/05/2020] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome, also referred to as Müllerian aplasia, is a congenital disorder characterized by aplasia of the uterus and upper part of the vagina in females with normal secondary sex characteristics and a normal female karyotype (46,XX). MAIN BODY The diagnosis is often made during adolescence following investigations for primary amenorrhea and has an estimated prevalence of 1 in 5000 live female births. MRKH syndrome is classified as type I (isolated uterovaginal aplasia) or type II (associated with extragenital manifestations). Extragenital anomalies typically include renal, skeletal, ear, or cardiac malformations. The etiology of MRKH syndrome still remains elusive, however increasing reports of familial clustering point towards genetic causes and the use of various genomic techniques has allowed the identification of promising recurrent genetic abnormalities in some patients. The psychosexual impact of having MRKH syndrome should not be underestimated and the clinical care foremost involves thorough counselling and support in careful dialogue with the patient. Vaginal agenesis therapy is available for mature patients following therapeutical counselling and education with non-invasive vaginal dilations recommended as first-line therapy or by surgery. MRKH syndrome involves absolute uterine factor infertility and until recently, the only option for the patients to achieve biological motherhood was through gestational surrogacy, which is prohibited in most countries. However, the successful clinical trial of uterus transplantation (UTx) by a Swedish team followed by the first live-birth in September, 2014 in Gothenburg, proofed the first available fertility treatment in MRKH syndrome and UTx is now being performed in other countries around the world allowing women with MRKH syndrome to carry their own child and achieve biological motherhood. CONCLUSION Several advances in research across multiple disciplines have been made in the recent years and this kaleidoscopic review provides a current status of various key aspects in MRKH syndrome and provides perspectives for future research and improved clinical care.
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Affiliation(s)
- Morten Krogh Herlin
- Department of Clinical Genetics, Aalborg University Hospital, Aalborg, Denmark.
- Department of Clinical Genetics, Aarhus University Hospital, Brendstrupgårdsvej 21C, DK-8200, Aarhus N, Denmark.
| | - Michael Bjørn Petersen
- Department of Clinical Genetics, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Mats Brännström
- Department of Obstetrics and Gynecology, Sahlgrenska Academy, Gothenburg, Sweden
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Living-Donor Uterus Transplantation: Pre-, Intra-, and Postoperative Parameters Relevant to Surgical Success, Pregnancy, and Obstetrics with Live Births. J Clin Med 2020; 9:jcm9082485. [PMID: 32756295 PMCID: PMC7464820 DOI: 10.3390/jcm9082485] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 07/24/2020] [Accepted: 07/27/2020] [Indexed: 01/10/2023] Open
Abstract
Uterus transplantation (UTx) can provide a route to motherhood for women with Mayer–Rokitansky–Küster–Hauser syndrome (MRKHS), a congenital disorder characterized by uterovaginal aplasia, but with functional ovaries. Based on our four successful living-donor transplantations and two resulting births, this analysis presents parameters relevant to standardizing recipient/donor selection, UTx surgery, and postoperative treatment, and their implementation in routine settings. We descriptively analyzed prospectively collected observational data from our four uterus recipients, all with MRKHS, their living donors, and the two newborns born to two recipients, including 1-year postnatal follow-ups. Analysis included only living-donor/recipient pairs with completed donor/recipient surgery. Two recipients, both requiring ovarian restimulation under immunosuppression after missed pregnancy loss in one case and no pregnancy in the other, each delivered a healthy boy by cesarean section. We conclude that parameters crucial to successful transplantation, pregnancy, and childbirth include careful selection of donor/recipient pairs, donor organ quality, meticulous surgical technique, a multidisciplinary team approach, and comprehensive follow-up. Surgery duration and blood vessel selection await further optimization, as do the choice and duration of immunosuppression, which are crucial to timing the first embryo transfer. Data need to be collected in an international registry due to the low prevalence of MRKHS.
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Järvholm S, Enskog A, Hammarling C, Dahm-Kähler P, Brännström M. Uterus transplantation: joys and frustrations of becoming a ‘complete’ woman—a qualitative study regarding self-image in the 5-year period after transplantation. Hum Reprod 2020; 35:1855-1863. [DOI: 10.1093/humrep/deaa143] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Revised: 05/06/2020] [Indexed: 12/28/2022] Open
Abstract
Abstract
STUDY QUESTION
How is a women’s self-image affected by uterus transplantation (UTx)?
SUMMARY ANSWER
Women experienced receiving a uterus in both positive and negative ways, but in general, their self-image was positively affected; regardless of whether they have given birth to a child or not, recipients describe themselves as being ‘back to normal’ after the hysterectomy to remove the transplanted uterus.
WHAT IS KNOWN ALREADY
UTx has repeatedly proved to be a successful treatment for absolute uterine factor infertility. However, there has been no previous qualitative long-term research into the self-image of women undergoing UTx.
STUDY DESIGN, SIZE, DURATION
This complete, prospective cohort study included the nine recipients of the first UTxs performed in Sweden mostly in 2013. Interviews took place in the 5 years following surgery.
PARTICIPANTS/MATERIALS, SETTING, METHODS
Eight out of the nine recipients had congenital absence of the uterus, a characteristic of Mayer–Rokitansky–Küster–Hauser syndrome, and one recipient lacked a uterus after a radical hysterectomy due to cervical cancer. The mean age of participants was 31.5 years at inclusion and at this time they all lived in stable marital relationships. Post-transplantation, interviews were performed annually for 5 years, comprising a total of 43 interviews. The interview followed a semi-structured guide. All interviews (median duration of around 25 minutes) were recorded, transcribed verbatim and then analysed by thematic approach.
MAIN RESULTS AND THE ROLE OF CHANCE
The joys and frustrations of becoming a ‘complete’ woman are seen as a master theme, which influences the three underlying subthemes, a changed self-perception, a changed body and a changed sexuality. Each of these subthemes have three underlying categories.
LIMITATIONS, REASONS FOR CAUTION
The small sample size is a limitation.
WIDER IMPLICATIONS OF THE FINDINGS
The results provide information that will be helpful in pre-operative screening procedures and in the psychological support offered both to women who experienced successful and unsuccessful outcomes following UTx.
STUDY FUNDING/COMPETING INTEREST(S)
Funding was received from the Jane and Dan Olsson Foundation for Science; the Knut and Alice Wallenberg Foundation; an ALF grant from the Swedish state under an agreement between the government and the county councils; the Swedish Research Council; a Ferring Pharmaceuticals scholarship in memory of Robert Edwards; and the Iris Jonzén-Sandblom and Greta Jonzén Foundation. The authors have no competing interests.
TRIAL REGISTRATION NUMBER
NCT01844362.
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Affiliation(s)
- Stina Järvholm
- Department of Obstetrics & Gynecology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Anders Enskog
- Department of Anesthesia and Intensive Care, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Catrina Hammarling
- Department of Obstetrics & Gynecology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Pernilla Dahm-Kähler
- Department of Obstetrics & Gynecology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Mats Brännström
- Department of Obstetrics & Gynecology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Stockholm IVF-EUGIN, Stockholm, Sweden
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Vaginal Reconstruction in Patients with Mayer-Rokitansky-Küster-Hauser Syndrome-One Centre Experience. MEDICINA-LITHUANIA 2020; 56:medicina56070327. [PMID: 32630225 PMCID: PMC7404697 DOI: 10.3390/medicina56070327] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 06/23/2020] [Accepted: 06/30/2020] [Indexed: 11/16/2022]
Abstract
Background and Objectives: The Mayer–Rokitansky–Küster–Hauser syndrome is a congenital condition in which patients are born with vaginal and uterus agenesis, affecting the ability to have a normal sexual life and to bear children. Vaginal reconstruction is a challenging procedure for plastic surgeons. The aim of this study is to report our experience in the management of twelve patients with congenital absence of the vagina due to the MRKH syndrome. Materials and Methods: We performed a retrospective study on 12 patients admitted to the Plastic Surgery Department of the Clinical Emergency Hospital “Prof. Dr. Agrippa Ionescu”, Bucharest, Romania, for vaginal reconstruction within a period of eleven years (January 2009–December 2019). All patients were diagnosed by the gynaecologists with vaginal agenesis, as part of the Mayer–Rokitansky–Küster–Hauser syndrome. The Abbe‘–McIndoe technique with an autologous skin graft was performed in all cases. Results: The average age of our patients was 20.16 (16–28) years. All patients were 46 XX. The average surgical timing was 3.05 h (range 2.85–4h). Postoperative rectovaginal fistula was encountered in 1 patient. Postoperative average vaginal length was 10.4 cm (range 9.8–12.1 cm). Regular sexual life was achieved in 10 patients. Conclusion: Nowadays, there is no established standard method of vaginal reconstruction. In Romania, the McIndoe technique is the most applied. Unfortunately, even if the MRKH syndrome is not uncommon, less and less surgeons are willing to perform the procedure to create a neovagina.
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Dadhwal R, Nayyar R, Krishna A, Kumar P. Laparoscopic sigmoid vaginoplasty: a salvage option for genitourinary fistula after failed McIndoe's repair. BMJ Case Rep 2020; 13:13/6/e235297. [PMID: 32606127 DOI: 10.1136/bcr-2020-235297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 30-year-old woman presented with vesicovaginal fistula after a forceful intercourse. She was diagnosed as a case of Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome 14 years ago and had underwent McIndoe's vaginoplasty using amniotic membrane. Similarly, another 14-year-old girl presented with an iatrogenic urethral and bladder neck injury during an attempt at McIndoe's vaginoplasty 4 months ago at another centre leading to urinary fistula with absent vagina. A laparoscopic salvage was done for both the cases along with repair of genitourinary fistula using sigmoid colon. There was no further requirement of vaginal dilation. Both patients remain fully continent at 1 year follow-up. Laparoscopic sigmoid vaginoplasty is a worthy minimally invasive salvage method for the patients of MRKH who develop fistulous complication after a previous attempt at neovagina creation. The bowel wall provides a structurally strong layer to withstand the repeated sexual trauma of the vagina.
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Affiliation(s)
- Rohit Dadhwal
- Department of Urology, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Rishi Nayyar
- Department of Urology, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Asuri Krishna
- Department of General Surgery, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Prashant Kumar
- Department of Urology, All India Institute of Medical Sciences, New Delhi, Delhi, India
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Brucker SY, Pösch LS, Graf J, Sokolov AN, Schaeffeler N, Kronenthaler A, Hiltner H, Wagner A, Ueding E, Rieger MA, Schöller D, Stefanescu D, Rall KK, Wallwiener D, Simoes E. Rare genital malformations in women's health research: sociodemographic, regional, and disease-related characteristics of patients with Mayer-Rokitansky-Küster-Hauser syndrome. BMC WOMENS HEALTH 2020; 20:135. [PMID: 32600323 PMCID: PMC7322870 DOI: 10.1186/s12905-020-00969-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2017] [Accepted: 05/04/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND The Mayer-Rokitansky-Küster-Hauser syndrome, MRKHS, is a rare (orphan) disease characterized by the aplasia or hypoplasia of the uterus and the vagina. In women's health research, little is known as to how much care provision for patients with MRKHS takes into account their socio-demographic together with their clinical characteristics. This work examines the patients' socio-demographic characteristics, highlighting issues of inappropriate and deficient provision of care. METHODS The study was carried out as part of the larger TransCareO project and included a group of N=129 MRKHS patients who underwent surgery between 2008 and 2012. Using a specially developed questionnaire, we analyzed MRKHS patients' data found both in the clinical documentation of the Department for Women's Health, University Hospital of Tübingen and the patient surveys of the Center for Rare Genital Malformations (CRGM/ ZSGF). Patients who took part in interviews were compared with non-respondents. RESULTS Patient respondents and non-respondents did not differ as to the parameters of interest. In most cases, primary amenorrhea was reported as an admission reason. In 24% of patients, a medical intervention (hymenal incision or hormone treatment) already occurred before admission to the Center in Tübingen and proper diagnosis of MRKHS. About one third received in advance inappropriate treatment. During the therapy, more than half of the patients were in a solid partnership. 10% of the family anamneses documented the occurrence of urogenital malformations. CONCLUSIONS Care provision for MRKHS patients is largely characterized by delayed proper diagnosis and in part, by inappropriate treatment attempts; there are also indications of regional differences. Anamnestic clues such as an asymptomatic amenorrhea or renal abnormalities of unclear origin still fail to result early enough in referral to a center on the basis of suspected MRKHS diagnosis. Urogenital malformations in the family are more common in patients than in the general population. For patients, a wide range of burdens are associated with the diagnosis. Abnormalities compared to their female peers occur, for instance, in the partnership status: MRKHS patients have more rarely a partner.
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Affiliation(s)
- Sara Yvonne Brucker
- University Hospital Tübingen, Department of Women's Health, Tübingen, Germany.,University Hospital Tübingen, Department of Women's Health, Research Institute for Women's Health, Tübingen, Germany
| | - Leonie-Sophia Pösch
- University Hospital Tübingen, Department of Women's Health, Tübingen, Germany.,University Hospital Tübingen, Department of Women's Health, Research Institute for Women's Health, Tübingen, Germany
| | - Joachim Graf
- University Hospital Tübingen, Department of Women's Health, Tübingen, Germany. .,University Hospital Tübingen, Department of Women's Health, Research Institute for Women's Health, Tübingen, Germany. .,University Hospital Tübingen, Institute for Health Sciences, Section of Midwifery Science, Tübingen, Germany.
| | - Alexander N Sokolov
- University Hospital Tübingen, Department of Women's Health, Tübingen, Germany.,University Hospital Tübingen, Department of Women's Health, Research Institute for Women's Health, Tübingen, Germany.,Department for Psychiatry and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
| | - Norbert Schaeffeler
- University Hospital Tübingen, Internal Medicine, Department of Psychosomatic Medicine and Psychotherapy, Tübingen, Germany
| | | | - Hanna Hiltner
- University of Tübingen, Department of Sociology, Tübingen, Germany
| | - Anke Wagner
- University Hospital Tübingen, Institute of Occupational and Social Medicine and Health Services Research, Tübingen, Germany
| | - Esther Ueding
- University Hospital Tübingen, Department of Women's Health, Research Institute for Women's Health, Tübingen, Germany
| | - Monika A Rieger
- University Hospital Tübingen, Institute of Occupational and Social Medicine and Health Services Research, Tübingen, Germany
| | - Dorit Schöller
- University Hospital Tübingen, Department of Women's Health, Tübingen, Germany
| | - Diana Stefanescu
- University Hospital Tübingen, Department of Women's Health, Tübingen, Germany
| | | | - Diethelm Wallwiener
- University Hospital Tübingen, Department of Women's Health, Tübingen, Germany
| | - Elisabeth Simoes
- University Hospital Tübingen, Department of Women's Health, Tübingen, Germany.,University Hospital Tübingen, Department of Women's Health, Research Institute for Women's Health, Tübingen, Germany.,University Hospital Tübingen, Staff Section Social Medicine, Tübingen, Germany
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Ghosh S, Roy S, Halder A. Study of frequency and types of chromosomal abnormalities in phenotypically female patients with amenorrhea in Eastern Indian population. J Obstet Gynaecol Res 2020; 46:1627-1638. [PMID: 32515109 DOI: 10.1111/jog.14318] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Revised: 02/04/2020] [Accepted: 05/07/2020] [Indexed: 01/15/2023]
Abstract
AIM This comprehensive review article aims to comprehend the frequency and prevalence of chromosomal abnormalities in both primary amenorrhea (PA) and secondary amenorrhea (SA) cases and correlating it with their phenotypes, clinical features and hormonal profiles. METHODS Research publications on prevalence of chromosomal abnormalities in both PA and SA cases worldwide and its etiology, clinical features, hormonal profiles; their correlation with chromosomal profiles were searched for on the internet, including general search engines and respective scientific sites. Only published, relevant and authentic data conducted on phenotypically female patients were considered. Another aspect of amenorrhea occurs due to several clinical conditions apart from cytogenetic viewpoint were not considered or discussed in detail. RESULTS As literature study suggests; considering various etiology of amenorrhea counting anatomic defect of the hypothalamus or genetic defect, and various acquired causes of chromosomal anomalies contribute to be one of the major etiologies of both PA and SA; ranging from 15.9% to 63.3% in case of PA and from 3.9% to 44.4% in case of SA. In spite of the presence of any other factors responsible condition, the genetic factors need to be emphasized, which might include single gene disorders or chromosomal disorders. Individuals with chromosomal anomalies reported a wide range of abnormalities in phenotypes, as well as in other clinical features and hormonal profiles. CONCLUSION This comprehensive review is the first structured review article that encompasses the cytogenetic profile of the amenorrhea cases and correlating it with their phenotypes, clinical features and hormonal profiles from Eastern India.
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Affiliation(s)
- Shanoli Ghosh
- Department of Genetics, Vivekananda Institute of Medical Sciences, Kolkata, India
| | - Sanchita Roy
- Department of Anatomy, Diamond Harbour Government Medical College and Hospita, Diamond Harbour, India
| | - Ajanta Halder
- Department of Genetics, Vivekananda Institute of Medical Sciences, Kolkata, India
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Sexual function and quality of life after the creation of a neovagina in women with Mayer-Rokitansky-Küster-Hauser syndrome: comparison of vaginal dilation and surgical procedures. Fertil Steril 2020; 113:1024-1031. [DOI: 10.1016/j.fertnstert.2020.01.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 12/17/2019] [Accepted: 01/13/2020] [Indexed: 11/13/2022]
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Facchin F, Francini F, Ravani S, Restelli E, Gramegna MG, Vercellini P, Aimi G. Psychological impact and health-related quality-of-life outcomes of Mayer-Rokitansky-Küster-Hauser syndrome: A systematic review and narrative synthesis. J Health Psychol 2020; 26:26-39. [PMID: 31960723 DOI: 10.1177/1359105319901308] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Mayer-Rokitansky-Küster-Hauser syndrome causes absence or underdevelopment of uterus and vagina, but women's subjective experience remains understudied. This systematic review was conducted to examine the psychological and health-related quality-of-life outcomes of Mayer-Rokitansky-Küster-Hauser syndrome. In total, 22 articles identified through electronic search matched the inclusion criteria and were included in our review. Mayer-Rokitansky-Küster-Hauser syndrome may be associated with psychological symptoms and impaired quality of life, but especially with poor sexual esteem and genital image. Women may experience difficulties managing intimacy and disclosing to partners. Mothers may be perceived as overinvolved, with consequent negative emotions in women with the disease.
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Affiliation(s)
| | | | | | - Elisa Restelli
- Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Italy
| | | | - Paolo Vercellini
- Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Italy.,Università degli Studi di Milano, Italy
| | - Giorgio Aimi
- Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Italy
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Anant M, Raj N, Yadav N, Prasad A, Kumar S, Saxena AK. Two Distinctively Rare Syndromes in a Case of Primary Amenorrhea: 18p Deletion and Mayer-Rokitansky-Kuster-Hauser Syndromes. J Pediatr Genet 2019; 9:193-197. [PMID: 32714621 DOI: 10.1055/s-0039-1700577] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 09/25/2019] [Indexed: 10/25/2022]
Abstract
Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome and 18p deletion syndrome, two genetic disorders having distinct genetic etiologies, have an exceedingly rare likelihood of coexistence. Vaginal agenesis or MRKH syndrome, the developmental failure of Mullerian ductal system-derived structures in a genotypic female fetus (46, XX), leads to congenital absence of uterus and vagina in variable degree. The 18p deletion syndrome is a rare chromosomal disorder, characterized by dysmorphic features, stunted growth, and mental retardation, which is caused by deletion of a part or all of the short arm of chromosome 18. A detailed evaluation of primary amenorrhea in a 16-year-old girl yielded both MRKH syndrome and 18p deletion syndrome. Extensive literature search could not identify any reported case bearing this combination of syndromes. This case presentation and review emphasizes on the importance of karyotyping in MRKH patients having atypical features.
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Affiliation(s)
- Monika Anant
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, Patna, Bihar, India
| | - Nutan Raj
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, Patna, Bihar, India
| | - Neelu Yadav
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, Patna, Bihar, India
| | - Arun Prasad
- Department of Pediatrics, All India Institute of Medical Sciences, Patna, Bihar, India
| | - Subhash Kumar
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Patna, Bihar, India
| | - Ajit K Saxena
- Department of Pathology/Laboratory medicine, All India Institute of Medical Sciences, Patna, Bihar, India
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Candiani M, Vanni VS, Papaleo E, Delprato D, Tandoi I, Gervasio V, Parma M, Corti L, Girardelli S, Fedele L. Oocyte Retrieval during Laparoscopic Vaginoplasty to Reduce Invasiveness in the Treatment of Mayer-Rokitansky-Küster-Hauser Syndrome. J Minim Invasive Gynecol 2019; 27:74-79. [PMID: 31129299 DOI: 10.1016/j.jmig.2019.02.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 02/06/2019] [Accepted: 02/08/2019] [Indexed: 10/26/2022]
Abstract
STUDY OBJECTIVE To evaluate the treatment of patients with Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome with a combination of oocyte retrieval and surgical vaginoplasty in a single laparoscopic procedure. DESIGN A case series. SETTING The study was conducted at 2 tertiary referral facilities for MRKH syndrome in Milan, Italy, between July 2017 and September 2018. PATIENTS Eleven patients presented with MRKH and required surgical vaginoplasty while expressing a desire for future fertility. INTERVENTIONS Two experienced surgeons and an expert in assisted reproductive technology performed concomitant vaginoplasty according to the modified technique of Davydov and laparoscopic oocyte retrieval for gamete cryopreservation. MEASUREMENTS AND MAIN RESULTS Before the procedure, patients underwent extensive counseling and gave written consent. At the start of surgery, 10.4 ± 4.4 (mean ± standard deviation [SD]) oocytes were retrieved laparoscopically, and 8.8 ± 3.1 (SD) mean mature oocytes were cryopreserved. After oocyte retrieval, the steps of the modified Davydov technique were followed. The total operative time was 116 ± 16 minutes (mean ± SD), and no intraoperative/postoperative complications were observed. CONCLUSION This is the first report of combined oocyte retrieval and vaginoplasty for patients with MRKH syndrome. The approach was found to be feasible in patients with a desire for future fertility. It is our belief that physicians treating patients with MRKH should refer patients to centers with expertise in both vaginoplasty and assisted reproductive technology.
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Affiliation(s)
- Massimo Candiani
- Obstetrics and Gynaecology Department, IRCCS San Raffaele Scientific Institute, Milan, Italy (Drs. Candiani, Vanni, Papaleo, Delprato, Tandoi, Parma, and Girardelli; Ms. Gervasio; and Ms. Corti)
| | - Valeria S Vanni
- Obstetrics and Gynaecology Department, IRCCS San Raffaele Scientific Institute, Milan, Italy (Drs. Candiani, Vanni, Papaleo, Delprato, Tandoi, Parma, and Girardelli; Ms. Gervasio; and Ms. Corti)
| | - Enrico Papaleo
- Obstetrics and Gynaecology Department, IRCCS San Raffaele Scientific Institute, Milan, Italy (Drs. Candiani, Vanni, Papaleo, Delprato, Tandoi, Parma, and Girardelli; Ms. Gervasio; and Ms. Corti).
| | - Diana Delprato
- Obstetrics and Gynaecology Department, IRCCS San Raffaele Scientific Institute, Milan, Italy (Drs. Candiani, Vanni, Papaleo, Delprato, Tandoi, Parma, and Girardelli; Ms. Gervasio; and Ms. Corti)
| | - Iacopo Tandoi
- Obstetrics and Gynaecology Department, IRCCS San Raffaele Scientific Institute, Milan, Italy (Drs. Candiani, Vanni, Papaleo, Delprato, Tandoi, Parma, and Girardelli; Ms. Gervasio; and Ms. Corti)
| | - Valeria Gervasio
- Obstetrics and Gynaecology Department, IRCCS San Raffaele Scientific Institute, Milan, Italy (Drs. Candiani, Vanni, Papaleo, Delprato, Tandoi, Parma, and Girardelli; Ms. Gervasio; and Ms. Corti)
| | - Marta Parma
- Obstetrics and Gynaecology Department, IRCCS San Raffaele Scientific Institute, Milan, Italy (Drs. Candiani, Vanni, Papaleo, Delprato, Tandoi, Parma, and Girardelli; Ms. Gervasio; and Ms. Corti)
| | - Laura Corti
- Obstetrics and Gynaecology Department, IRCCS San Raffaele Scientific Institute, Milan, Italy (Drs. Candiani, Vanni, Papaleo, Delprato, Tandoi, Parma, and Girardelli; Ms. Gervasio; and Ms. Corti)
| | - Serena Girardelli
- Obstetrics and Gynaecology Department, IRCCS San Raffaele Scientific Institute, Milan, Italy (Drs. Candiani, Vanni, Papaleo, Delprato, Tandoi, Parma, and Girardelli; Ms. Gervasio; and Ms. Corti)
| | - Luigi Fedele
- Obstetrics and Gynaecology Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy (Dr. Fedele)
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Primary Amenorrhea, Aplastic Uterus, and a Functional Vagina: A Rare Case of Mayer-Rokitansky-Küster-Hauser Syndrome. Case Rep Obstet Gynecol 2019; 2019:3409548. [PMID: 31275680 PMCID: PMC6582900 DOI: 10.1155/2019/3409548] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 04/09/2019] [Accepted: 05/22/2019] [Indexed: 01/09/2023] Open
Abstract
Background Müllerian agenesis, also known as Mayer-Rokitansky-Küster-Hauser syndrome (MRKHS), a failure of female urogenital development, typically results in a completely stenotic or rudimentary dimple vagina, both of which are generally nonfunctional in adulthood without mechanical dilation or surgical reconstruction. Case A 20-year-old Tanner stage V heterosexual woman with normal sexual function since coitarche presented with a chief complaint of primary amenorrhea. She was found to have aplastic uterine buds, absent endometrium/cervix, normal ovaries, and an unusually well-developed lower vagina, a rare presentation of MRKHS. We discuss mechanisms by which the anomaly may have arisen. Summary & Conclusion This case thus expands the clinical presentation of MRKHS to include a normal appearing vagina with intact sexual function from first sexual encounter, raising interesting questions about the basic underlying embryology.
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Taran FA, Schöller D, Rall K, Nadalin S, Königsrainer A, Henes M, Bösmüller H, Fend F, Nikolaou K, Notohamiprodjo M, Grasshoff C, Heim E, Zipfel S, Schäffeler N, Bakchoul T, Heyne N, Guthoff M, Krämer B, Reisenauer C, Hoopmann M, Kagan KO, Brännström M, Wallwiener D, Brucker SY. Screening and evaluation of potential recipients and donors for living donor uterus transplantation: results from a single-center observational study. Fertil Steril 2019; 111:186-193. [PMID: 30611405 DOI: 10.1016/j.fertnstert.2018.09.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 09/12/2018] [Accepted: 09/13/2018] [Indexed: 01/15/2023]
Abstract
OBJECTIVE To report our experience with the screening and selection of potential recipients and living donors of our uterus transplantation (UTx) program. DESIGN Part of an observational program. SETTING University hospital. PATIENT(S) Patients with absolute uterine factor infertility (AUFI). INTERVENTION(S) Screening by e-mail and telephone, selection during surgical consultation, and preoperative investigations according to a multistep procedure for living donation. MAIN OUTCOME MEASURE(S) Age, cause of AUFI, exclusion reasons, and preoperative workup. RESULT(S) A total of 212 potential recipients expressed interest in participation. Among the 46 potential recipients and 49 directed donors were 4 potential recipients, each with 2 directed donors. Mean (range) age of potential recipients was 29.6 (19-41) years. Of the potential recipients, 39 (84.8%) had congenital AUFI and 7 (17.3%) had acquired AUFI. Ultimately, 15 potential recipients with 16 directed donors were selected for participation, with 1 potential recipient having 2 directed donors. Mean age of included potential recipients was 28.9 (22-35) years, and mean donor age was 51.3 (37-62) years. Fourteen potential recipients (93.3%) had congenital AUFI, and one potential recipient (6.7%) had undergone hysterectomy for obstetric complications. CONCLUSION(S) The number of potential candidates for UTx is not inconsiderable, with congenital AUFI being the leading cause of AUFI in our cohort. However, our findings highlight that large numbers of AUFI patients need to be screened, considering our exclusion rates were >50%, owing to ABO incompatibility, unavailability of a directed donor, and self-withdrawal. Moreover, meticulous preoperative screening, including in-depth psychological assessment, is mandatory to maximize living donor safety and UTx success.
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Affiliation(s)
- Florin-Andrei Taran
- Department of Obstetrics and Gynecology, University of Tübingen, Tübingen, Germany.
| | - Dorit Schöller
- Department of Obstetrics and Gynecology, University of Tübingen, Tübingen, Germany
| | - Katharina Rall
- Department of Obstetrics and Gynecology, University of Tübingen, Tübingen, Germany
| | - Silvio Nadalin
- Department of General, Visceral, and Transplant Surgery, University of Tübingen, Tübingen, Germany
| | - Alfred Königsrainer
- Department of General, Visceral, and Transplant Surgery, University of Tübingen, Tübingen, Germany
| | - Melanie Henes
- Department of Obstetrics and Gynecology, University of Tübingen, Tübingen, Germany
| | - Hans Bösmüller
- Department of Pathology, University of Tübingen, Tübingen, Germany
| | - Falko Fend
- Department of Pathology, University of Tübingen, Tübingen, Germany
| | - Konstantin Nikolaou
- Department of Diagnostic and Interventional Radiology, University of Tübingen, Tübingen, Germany
| | - Mike Notohamiprodjo
- Department of Diagnostic and Interventional Radiology, University of Tübingen, Tübingen, Germany
| | - Christian Grasshoff
- Department of Anesthesiology and Intensive Care Medicine, University of Tübingen, Tübingen, Germany
| | - Eckhard Heim
- Department of Anesthesiology and Intensive Care Medicine, University of Tübingen, Tübingen, Germany
| | - Stephan Zipfel
- Department of Psychosomatic Medicine, University of Tübingen, Tübingen, Germany
| | - Norbert Schäffeler
- Department of Psychosomatic Medicine, University of Tübingen, Tübingen, Germany
| | - Tamam Bakchoul
- Center for Transfusion Medicine, University of Tübingen, Tübingen, Germany
| | - Nils Heyne
- Department of Endocrinology and Diabetology, Angiology, Nephrology, and Clinical Chemistry, University of Tübingen, Tübingen, Germany
| | - Martina Guthoff
- Department of Endocrinology and Diabetology, Angiology, Nephrology, and Clinical Chemistry, University of Tübingen, Tübingen, Germany
| | - Bernhard Krämer
- Department of Obstetrics and Gynecology, University of Tübingen, Tübingen, Germany
| | - Christl Reisenauer
- Department of Obstetrics and Gynecology, University of Tübingen, Tübingen, Germany
| | - Markus Hoopmann
- Department of Obstetrics and Gynecology, University of Tübingen, Tübingen, Germany
| | - Karl-Oliver Kagan
- Department of Obstetrics and Gynecology, University of Tübingen, Tübingen, Germany
| | - Mats Brännström
- Department of Obstetrics and Gynecology, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden; Stockholm IVF, Stockholm, Sweden
| | - Diethelm Wallwiener
- Department of Obstetrics and Gynecology, University of Tübingen, Tübingen, Germany
| | - Sara Y Brucker
- Department of Obstetrics and Gynecology, University of Tübingen, Tübingen, Germany
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Treatment guidelines for persistent cloaca, cloacal exstrophy, and Mayer–Rokitansky–Küster–Häuser syndrome for the appropriate transitional care of patients. Surg Today 2019; 49:985-1002. [DOI: 10.1007/s00595-019-01810-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 02/26/2019] [Indexed: 11/30/2022]
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Fliegner M, Richter-Appelt H, Krupp K, Brucker SY, Rall K, Brunner F. Living with permanent infertility: A German study on attitudes toward motherhood in individuals with Complete Androgen Insensitivity Syndrome (CAIS) and Mayer-Rokitansky-Küster-Hauser Syndrome (MRKHS). Health Care Women Int 2018; 39:1295-1315. [PMID: 30362901 DOI: 10.1080/07399332.2018.1490739] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
In this study the authors examined the issue of permanent infertility in two diagnoses of the diverse sex developments (DSD) spectrum: Complete Androgen Insensitivity Syndrome (CAIS) and Mayer-Rokitansky-KÏster-Hauser Syndrome (MRKHS). The participants with CAIS (n = 12) was older, showed a lower wish for a child and was less distressed about their infertility compared to participants with MRKHS (n = 49). Our data indicated an "indifferent" attitude toward motherhood in CAIS and an "ambivalent" attitude in MRKHS. Depression was frequent in both. Infertility is a source of distress. However, the two groups seem to cope in different ways. Comprehensive medical information and psychological support should be provided.
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Affiliation(s)
| | - Hertha Richter-Appelt
- a University Medical Center Hamburg-Eppendorf, Institute for Sex Research and Forensic Psychiatry , Hamburg , Germany
| | - Kerstin Krupp
- a University Medical Center Hamburg-Eppendorf, Institute for Sex Research and Forensic Psychiatry , Hamburg , Germany
| | - Sara Y Brucker
- b Tübingen University Hospital, Center for Women's Health , Tübingen , Germany
| | - Katharina Rall
- b Tübingen University Hospital, Center for Women's Health , Tübingen , Germany
| | - Franziska Brunner
- a University Medical Center Hamburg-Eppendorf, Institute for Sex Research and Forensic Psychiatry , Hamburg , Germany
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Cheikhelard A, Bidet M, Baptiste A, Viaud M, Fagot C, Khen-Dunlop N, Louis-Sylvestre C, Sarnacki S, Touraine P, Elie C, Aigrain Y, Polak M. Surgery is not superior to dilation for the management of vaginal agenesis in Mayer-Rokitansky-Küster-Hauser syndrome: a multicenter comparative observational study in 131 patients. Am J Obstet Gynecol 2018; 219:281.e1-281.e9. [PMID: 30036500 DOI: 10.1016/j.ajog.2018.07.015] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2018] [Revised: 07/06/2018] [Accepted: 07/16/2018] [Indexed: 01/13/2023]
Abstract
BACKGROUND Vaginal agenesis in Mayer-Rokitansky-Küster-Hauser syndrome can be managed either by various surgeries or dilation. The choice still depends on surgeon's preferences rather than on quality comparative studies and validated protocols. OBJECTIVE We sought to compare dilation and surgical management of vaginal agenesis in Mayer-Rokitansky-Küster-Hauser syndrome, in terms of quality of life, anatomical results, and complications in a large multicenter population. STUDY DESIGN Our multicenter study included 131 patients >18 years, at least 1 year after completing vaginal agenesis management. All had an independent gynecological evaluation including a standardized pelvic exam, and completed the World Health Organization Quality of Life instrument (general quality of life) as well as the Female Sexual Function Index and Female Sexual Distress Scale-Revised (sexual quality of life) scales. Groups were: surgery (N = 84), dilation therapy (N = 26), and intercourse (N = 20). One patient was secondarily excluded because of incomplete surgical data. For statistics, data were compared using analysis of variance, Student, Kruskal-Wallis, Wilcoxon, and Student exact test. RESULTS Mean age was 26.5 ± 5.5 years at inclusion. In all groups, World Health Organization Quality of Life scores were not different between patients and the general population except for lower psychosocial health and social relationship scores (which were not different between groups). Global Female Sexual Function Index scores were significantly lower in the surgery and dilation therapy groups (median 26 range [2.8-34.8] and 24.7 [2.6-34.4], respectively) than the intercourse group (30.2 [7.8-34.8], P = .044), which had a higher score only in the satisfaction dimension (P = .004). However, the scores in the other dimensions of Female Sexual Function Index were not different between groups. The Female Sexual Distress Scale-Revised median scores were, respectively, 17 [0-52], 20 [0-47], and 10 [10-40] in the surgery, dilation therapy, and intercourse groups (P = .38), with sexual distress in 71% of patients. Median vaginal depth was shorter in dilatation therapy group (9.6 cm [5.5-12]) compared to surgery group (11 cm [6-15]) and intercourse group (11 cm [6-12.5]) (P = .039), but remained within normal ranges. One bias in the surgery group was the high number of sigmoid vaginoplasties (57/84, 68%), but no differences were observed between surgeries. Only 4 patients achieved vaginas <6.5 cm. Delay between management and first intercourse was 6 months (not significant). Seventy patients (53%) had dyspareunia (not significant), and 17 patients all from the surgery group had an abnormal pelvic exam. In the surgery group, 34 patients (40.5%) had complications, requiring 20 secondary surgeries in 17 patients, and 35 (42%) needed postoperative dilation. In the dilation therapy group, 13 (50%) needed maintenance dilation. CONCLUSION Surgery is not superior to therapeutic or intercourse dilation, bears complications, and should therefore be only a second-line treatment. Psychological counseling is mandatory at diagnosis and during therapeutic management.
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Affiliation(s)
- Alaa Cheikhelard
- Departments of Pediatric Surgery and Urology, Assistance Publique - Hôpitaux de Paris, Hôpital Necker, Paris, France; National Reference Center for Rare Gynecological Diseases (PGR), Assistance Publique - Hôpitaux de Paris, Hôpital Necker, Paris, France.
| | - Maud Bidet
- Department of Pediatric Endocrinology, Gynecology, and Diabetology, Assistance Publique - Hôpitaux de Paris, Hôpital Necker, Paris, France; National Reference Center for Rare Gynecological Diseases (PGR), Assistance Publique - Hôpitaux de Paris, Hôpital Necker, Paris, France
| | - Amandine Baptiste
- Clinical Research Unit/Clinical Investigation Center, Assistance Publique - Hôpitaux de Paris, Hôpital Necker, Paris, France
| | - Magali Viaud
- Department of Pediatric Endocrinology, Gynecology, and Diabetology, Assistance Publique - Hôpitaux de Paris, Hôpital Necker, Paris, France; National Reference Center for Rare Gynecological Diseases (PGR), Assistance Publique - Hôpitaux de Paris, Hôpital Necker, Paris, France
| | - Christine Fagot
- Department of Pediatric Endocrinology, Gynecology, and Diabetology, Assistance Publique - Hôpitaux de Paris, Hôpital Necker, Paris, France
| | - Naziha Khen-Dunlop
- Departments of Pediatric Surgery and Urology, Assistance Publique - Hôpitaux de Paris, Hôpital Necker, Paris, France; Université Paris Descartes, Paris, France
| | | | - Sabine Sarnacki
- Departments of Pediatric Surgery and Urology, Assistance Publique - Hôpitaux de Paris, Hôpital Necker, Paris, France; Université Paris Descartes, Paris, France
| | - Philippe Touraine
- Department of Endocrinology and Reproductive Medicine, Assistance Publique - Hôpitaux de Paris, Institut Endocrinologie, Médecine Interne et Maladies Métaboliques, Hôpital Pitié-Salpêtrière, Paris, France; Médecine Sorbonne Université, Paris, France
| | - Caroline Elie
- Clinical Research Unit/Clinical Investigation Center, Assistance Publique - Hôpitaux de Paris, Hôpital Necker, Paris, France
| | - Yves Aigrain
- Departments of Pediatric Surgery and Urology, Assistance Publique - Hôpitaux de Paris, Hôpital Necker, Paris, France; National Reference Center for Rare Gynecological Diseases (PGR), Assistance Publique - Hôpitaux de Paris, Hôpital Necker, Paris, France; Université Paris Descartes, Paris, France
| | - Michel Polak
- Department of Pediatric Endocrinology, Gynecology, and Diabetology, Assistance Publique - Hôpitaux de Paris, Hôpital Necker, Paris, France; Université Paris Descartes, Paris, France
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Kelly GS, Baluyot MF, Anders JF. Cyclical Abdominal Pain in an Adolescent Female: A Case Report of Agenesis of the Lower Vagina. Pediatr Emerg Care 2018; 34:e136-e138. [PMID: 29912089 DOI: 10.1097/pec.0000000000001528] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Congenital agenesis of the lower vagina is a rare disorder characterized by separation between the unaffected proximal vagina and the distal vagina by a band of fibrous tissue. The typical presentation is an early adolescent female with chronic, cyclic abdominal pain and primary amenorrhea. In this case report, we describe an adolescent who presented to the pediatric emergency department on 2 occasions with a chief complaint of lower abdominal pain.
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Affiliation(s)
| | | | - Jennifer F Anders
- Department of Pediatrics and Pediatric Emergency Medicine, Johns Hopkins Hospital, Baltimore, MD
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Demir Eksi D, Shen Y, Erman M, Chorich LP, Sullivan ME, Bilekdemir M, Yılmaz E, Luleci G, Kim HG, Alper OM, Layman LC. Copy number variation and regions of homozygosity analysis in patients with MÜLLERIAN aplasia. Mol Cytogenet 2018; 11:13. [PMID: 29434669 PMCID: PMC5797403 DOI: 10.1186/s13039-018-0359-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2017] [Accepted: 01/16/2018] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Little is known about the genetic contribution to Müllerian aplasia, better known to patients as Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome. Mutations in two genes (WNT4 and HNF1B) account for a small number of patients, but heterozygous copy number variants (CNVs) have been described. However, the significance of these CNVs in the pathogenesis of MRKH is unknown, but suggests possible autosomal dominant inheritance. We are not aware of CNV studies in consanguineous patients, which could pinpoint genes important in autosomal recessive MRKH. We therefore utilized SNP/CGH microarrays to identify CNVs and define regions of homozygosity (ROH) in Anatolian Turkish MRKH patients. RESULTS Five different CNVs were detected in 4/19 patients (21%), one of which is a previously reported 16p11.2 deletion containing 32 genes, while four involved smaller regions each containing only one gene. Fourteen of 19 (74%) of patients had parents that were third degree relatives or closer. There were 42 regions of homozygosity shared by at least two MRKH patients which was spread throughout most chromosomes. Of interest, eight candidate genes suggested by human or animal studies (RBM8A, CMTM7, CCR4, TRIM71, CNOT10, TP63, EMX2, and CFTR) reside within these ROH. CONCLUSIONS CNVs were found in about 20% of Turkish MRKH patients, and as in other studies, proof of causation is lacking. The 16p11.2 deletion seen in mixed populations is also identified in Turkish MRKH patients. Turkish MRKH patients have a higher likelihood of being consanguineous than the general Anatolian Turkish population. Although identified single gene mutations and heterozygous CNVs suggest autosomal dominant inheritance for MRKH in much of the western world, regions of homozygosity, which could contain shared mutant alleles, make it more likely that autosomal recessively inherited causes will be manifested in Turkish women with MRKH.
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Affiliation(s)
- Durkadin Demir Eksi
- Department of Medical Biology, Alanya Alaaddin Keykubat University, Faculty of Medicine, Antalya, Turkey
| | - Yiping Shen
- Guangxi Maternal and Child Health Hospital, Nanning, China
- Department of Pathology, Harvard Medical School, Boston, MA 02115 USA
- Division of Genetics and Genomics, Boston Children’s Hospital, Boston, MA 02115 USA
- Shanghai Children’s Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, 200127 China
| | - Munire Erman
- Department of Obstetrics and Gynecology, Akdeniz University, Faculty of Medicine, Antalya, Turkey
| | - Lynn P. Chorich
- Section of Reproductive Endocrinology, Infertility, & Genetics, Department of Obstetrics & Gynecology Medical College of Georgia at Augusta University, Augusta, GA USA
- Department of Neuroscience & Regenerative Medicine, Medical College of Georgia at Augusta University, 1120 15th Street, CA2041, Augusta, GA 30912 USA
| | - Megan E. Sullivan
- Section of Reproductive Endocrinology, Infertility, & Genetics, Department of Obstetrics & Gynecology Medical College of Georgia at Augusta University, Augusta, GA USA
- Department of Neuroscience & Regenerative Medicine, Medical College of Georgia at Augusta University, 1120 15th Street, CA2041, Augusta, GA 30912 USA
| | - Meric Bilekdemir
- Department of Obstetrics and Gynecology, Akdeniz University, Faculty of Medicine, Antalya, Turkey
| | - Elanur Yılmaz
- Department of Medical Biology and Genetics, Akdeniz University, Faculty of Medicine, 07058 Antalya, Turkey
| | - Guven Luleci
- Department of Medical Biology and Genetics, Akdeniz University, Faculty of Medicine, 07058 Antalya, Turkey
| | - Hyung-Goo Kim
- Section of Reproductive Endocrinology, Infertility, & Genetics, Department of Obstetrics & Gynecology Medical College of Georgia at Augusta University, Augusta, GA USA
- Department of Neuroscience & Regenerative Medicine, Medical College of Georgia at Augusta University, 1120 15th Street, CA2041, Augusta, GA 30912 USA
| | - Ozgul M. Alper
- Department of Medical Biology and Genetics, Akdeniz University, Faculty of Medicine, 07058 Antalya, Turkey
| | - Lawrence C. Layman
- Section of Reproductive Endocrinology, Infertility, & Genetics, Department of Obstetrics & Gynecology Medical College of Georgia at Augusta University, Augusta, GA USA
- Department of Neuroscience & Regenerative Medicine, Medical College of Georgia at Augusta University, 1120 15th Street, CA2041, Augusta, GA 30912 USA
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Soedjana H, Hasibuan LY, Septiani GA, Davita TR. Case report in experience with neovaginal reconstruction using the inverted Y flap in Mayer-Rokitansky-Küster-Hauser syndrome and androgen insensitive syndrome: A pilot study. INTERNATIONAL JOURNAL OF SURGERY OPEN 2018. [DOI: 10.1016/j.ijso.2018.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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