bstract OBJECTIVE: To evaluate outcomes of a novel blend of techniques for treating vaginal contractures secondary to previous conventional constructive surgeries. STUDY DESIGN: Balloon vaginoplasty and scar tissue hydrolysis/hydro-disintegrations (BV/STH) were performed for three cases with vaginal scars after previously failed vaginoplasties. The outcomes measured were operative complications, vaginal depths as measured by a calibrated vaginometer, and functional outcomes as measured by changes in the penetration and satisfaction (P/S) scores on a 0-100 point visual analog scale. RESULTS: BV/STH was performed successfully for 3 women with previously failed vaginoplasties. They included a case with a previous partial thickness skin grafting, one with previous labial flaps and one with previous amnion membrane graft. Preoperative P/S scores ranged from 20 to 30 points. Initially BV was done in addition to multiple snips of the scar tissue with a 2mm scalpel. No operative complications were reported but we failed to achieve progressive increase in vaginal depth after day 4. Scar tissue was injected with a mixture of lidocaine and normal saline. Progressive increase in depth was dramatically improved after scar hydro-disintegration. The depths of the resultant neovaginas were 10, 11 and 11.6 cm. Postoperative P/S scores increased up to 90. CONCLUSIONS: BV/STH was successfully performed as a revision surgery for blind vaginas with fibrosis. This report highlights a wider range of possible applications of balloon vaginoplasty. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved. PMID: 22019580

Abstract PURPOSE: The aim of this study was to present the preliminary results of a new technique for horn-vaginal anastomosis. METHODS: Horn-vaginal anastomosis without any dissection at the lower pole of the horn or vaginal apex at the site of anastomosis. This was followed by dilation and silicone stent retention for 4 months. RESULTS: The patient was a 14-year-old presenting with primary amenorrhea and severe recurrent cyclic lower abdominal pain. The total operative time was 115 minutes. No operative complications were reported. The patient developed stenosis of the tract after 2 successive menstrual periods (MP). The third period was retained. Transvaginal dilatation of the communication tract was successfully accomplished, and a silicon stent was left in place for 5 successive MP. The patient is now menstruating in a regular pattern for 15 successive MP, and an office hysteroscopic examination showed a patent tract with a normal hemicavity leading to a normal tubal ostia. CONCLUSIONS: Communication between a well-developed noncommunicating uterine horn and vagina was accomplished with successful establishment of the menstrual outflow tract. Regular menstrual pattern was successfully reestablished for 15 consecutive menstrual periods. Copyright © 2011 Elsevier Inc. All rights reserved. PMID: 21763856 [PubMed - indexed for MEDLINE]

Abstract PURPOSE: The aim of this study was to present the preliminary results of a new technique for horn-vaginal anastomosis. METHODS: Horn-vaginal anastomosis without any dissection at the lower pole of the horn or vaginal apex at the site of anastomosis. This was followed by dilation and silicone stent retention for 4 months. RESULTS: The patient was a 14-year-old presenting with primary amenorrhea and severe recurrent cyclic lower abdominal pain. The total operative time was 115 minutes. No operative complications were reported. The patient developed stenosis of the tract after 2 successive menstrual periods (MP). The third period was retained. Transvaginal dilatation of the communication tract was successfully accomplished, and a silicon stent was left in place for 5 successive MP. The patient is now menstruating in a regular pattern for 15 successive MP, and an office hysteroscopic examination showed a patent tract with a normal hemicavity leading to a normal tubal ostia. CONCLUSIONS: Communication between a well-developed noncommunicating uterine horn and vagina was accomplished with successful establishment of the menstrual outflow tract. Regular menstrual pattern was successfully reestablished for 15 consecutive menstrual periods. Copyright © 2011 Elsevier Inc. All rights reserved. PMID: 21763856 [PubMed - indexed for MEDLINE]

Abstract PURPOSE: The aim of this study was to present the preliminary results of a new technique for horn-vaginal anastomosis. METHODS: Horn-vaginal anastomosis without any dissection at the lower pole of the horn or vaginal apex at the site of anastomosis. This was followed by dilation and silicone stent retention for 4 months. RESULTS: The patient was a 14-year-old presenting with primary amenorrhea and severe recurrent cyclic lower abdominal pain. The total operative time was 115 minutes. No operative complications were reported. The patient developed stenosis of the tract after 2 successive menstrual periods (MP). The third period was retained. Transvaginal dilatation of the communication tract was successfully accomplished, and a silicon stent was left in place for 5 successive MP. The patient is now menstruating in a regular pattern for 15 successive MP, and an office hysteroscopic examination showed a patent tract with a normal hemicavity leading to a normal tubal ostia. CONCLUSIONS: Communication between a well-developed noncommunicating uterine horn and vagina was accomplished with successful establishment of the menstrual outflow tract. Regular menstrual pattern was successfully reestablished for 15 consecutive menstrual periods. Copyright © 2011 Elsevier Inc. All rights reserved. PMID: 21763856 [PubMed - indexed for MEDLINE]

Abstract STUDY OBJECTIVE: To highlight the coexistence of uterine septum in cases diagnosed as bicornuate uterus on basis of the external shape of uterine fundus. STUDY DESIGN: Case report with description of the technique. SETTING: Women's Health Assiut University Hospital. PARTICIPANTS: An adolescent female with progressive pains dating since menarche. INTERVENTIONS: Hysteroscopic resection under laparoscopic monitoring through an intact hymen. MAIN OUTCOME MEASURE: Operative time, complications, postoperative abdominal pain, appearance of the uterine cavity RESULTS: A patient with a septate uterus with a fundal depression and hemiuterine obstruction underwent hysteroscopic resection under laparoscopic monitoring. Laparoscopy was beneficial in diagnosis and treatment of associated pathology and monitoring the hysteroscopic procedure. Hysteroscopic metroplasty was performed and resulted in unification of the lower two thirds of the uterus. Dysmenorrhea was dramatically improved after the procedure. Subsequent office hysteroscopy confirmed restoration of a unified lower uterine corpus anatomy mimic to the original bicornuate state. CONCLUSIONS: External fundal depression which characterizes bicornuate uterus was associated with a septate uterus with hemi uterine obstruction. This report demonstrates the coexistence of the two anomalies. Endoscopic management of this patient was safe and successful. 2011 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved. PMID: 21514191 [PubMed - indexed for MEDLINE]

Abstract STUDY OBJECTIVE: To highlight the coexistence of uterine septum in cases diagnosed as bicornuate uterus on basis of the external shape of uterine fundus. STUDY DESIGN: Case report with description of the technique. SETTING: Women's Health Assiut University Hospital. PARTICIPANTS: An adolescent female with progressive pains dating since menarche. INTERVENTIONS: Hysteroscopic resection under laparoscopic monitoring through an intact hymen. MAIN OUTCOME MEASURE: Operative time, complications, postoperative abdominal pain, appearance of the uterine cavity RESULTS: A patient with a septate uterus with a fundal depression and hemiuterine obstruction underwent hysteroscopic resection under laparoscopic monitoring. Laparoscopy was beneficial in diagnosis and treatment of associated pathology and monitoring the hysteroscopic procedure. Hysteroscopic metroplasty was performed and resulted in unification of the lower two thirds of the uterus. Dysmenorrhea was dramatically improved after the procedure. Subsequent office hysteroscopy confirmed restoration of a unified lower uterine corpus anatomy mimic to the original bicornuate state. CONCLUSIONS: External fundal depression which characterizes bicornuate uterus was associated with a septate uterus with hemi uterine obstruction. This report demonstrates the coexistence of the two anomalies. Endoscopic management of this patient was safe and successful. 2011 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved. PMID: 21514191 [PubMed - indexed for MEDLINE]

Abstract STUDY OBJECTIVE: To highlight the coexistence of uterine septum in cases diagnosed as bicornuate uterus on basis of the external shape of uterine fundus. STUDY DESIGN: Case report with description of the technique. SETTING: Women's Health Assiut University Hospital. PARTICIPANTS: An adolescent female with progressive pains dating since menarche. INTERVENTIONS: Hysteroscopic resection under laparoscopic monitoring through an intact hymen. MAIN OUTCOME MEASURE: Operative time, complications, postoperative abdominal pain, appearance of the uterine cavity RESULTS: A patient with a septate uterus with a fundal depression and hemiuterine obstruction underwent hysteroscopic resection under laparoscopic monitoring. Laparoscopy was beneficial in diagnosis and treatment of associated pathology and monitoring the hysteroscopic procedure. Hysteroscopic metroplasty was performed and resulted in unification of the lower two thirds of the uterus. Dysmenorrhea was dramatically improved after the procedure. Subsequent office hysteroscopy confirmed restoration of a unified lower uterine corpus anatomy mimic to the original bicornuate state. CONCLUSIONS: External fundal depression which characterizes bicornuate uterus was associated with a septate uterus with hemi uterine obstruction. This report demonstrates the coexistence of the two anomalies. Endoscopic management of this patient was safe and successful. 2011 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved. PMID: 21514191 [PubMed - indexed for MEDLINE]

Abstract OBJECTIVE: To evaluate the safety and feasibility of enhancement balloon vaginoplasty (EBV) in cases with blind vagina due to androgen insensitivity syndrome. DESIGN: Case series with description of the technique. SETTING: Women's Health Center, Assiut University, and Sohage Teaching Hospital, Sohage University. PATIENT(S): Three X,Y females (two cases presenting with apareunia and the third presenting with severe dyspareunia). INTERVENTION(S): Laparoscopy-assisted EBV. MAIN OUTCOME MEASURE(S): Operative time, complications, depth and width of neovagina, and functional status. RESULT(S): Our cases were currently married phenotypical females and had 46,X,Y karyotypes. They had well developed secondary sexual characters, but they presented with failure of intravaginal intercourse. EBV was performed successfully for three X,Y females. The total operative time was 38-45 minutes. No operative complications were reported, and there were no reported postoperative complications as a result of moving the direction of traction. The resultant neovagina's depths were 10, 11, and 12 cm, respectively. Sexual intercourse was set off on the day of discharge. Penetration and satisfaction scores increased up to 90 points for both partners. CONCLUSION(S): It was feasible and safe to move centrally the direction of traction and to move the point of catheter exit up with apparently better outcomes than conventional balloon vaginoplasty for treatment of blind vagina due to androgen insensitivity syndrome. Copyright © 2011 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

Abstract OBJECTIVE: To evaluate the safety and feasibility of enhancement balloon vaginoplasty (EBV) in cases with blind vagina due to androgen insensitivity syndrome. DESIGN: Case series with description of the technique. SETTING: Women's Health Center, Assiut University, and Sohage Teaching Hospital, Sohage University. PATIENT(S): Three X,Y females (two cases presenting with apareunia and the third presenting with severe dyspareunia). INTERVENTION(S): Laparoscopy-assisted EBV. MAIN OUTCOME MEASURE(S): Operative time, complications, depth and width of neovagina, and functional status. RESULT(S): Our cases were currently married phenotypical females and had 46,X,Y karyotypes. They had well developed secondary sexual characters, but they presented with failure of intravaginal intercourse. EBV was performed successfully for three X,Y females. The total operative time was 38-45 minutes. No operative complications were reported, and there were no reported postoperative complications as a result of moving the direction of traction. The resultant neovagina's depths were 10, 11, and 12 cm, respectively. Sexual intercourse was set off on the day of discharge. Penetration and satisfaction scores increased up to 90 points for both partners. CONCLUSION(S): It was feasible and safe to move centrally the direction of traction and to move the point of catheter exit up with apparently better outcomes than conventional balloon vaginoplasty for treatment of blind vagina due to androgen insensitivity syndrome. Copyright © 2011 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

Abstract OBJECTIVE: To evaluate the safety and feasibility of enhancement balloon vaginoplasty (EBV) in cases with blind vagina due to androgen insensitivity syndrome. DESIGN: Case series with description of the technique. SETTING: Women's Health Center, Assiut University, and Sohage Teaching Hospital, Sohage University. PATIENT(S): Three X,Y females (two cases presenting with apareunia and the third presenting with severe dyspareunia). INTERVENTION(S): Laparoscopy-assisted EBV. MAIN OUTCOME MEASURE(S): Operative time, complications, depth and width of neovagina, and functional status. RESULT(S): Our cases were currently married phenotypical females and had 46,X,Y karyotypes. They had well developed secondary sexual characters, but they presented with failure of intravaginal intercourse. EBV was performed successfully for three X,Y females. The total operative time was 38-45 minutes. No operative complications were reported, and there were no reported postoperative complications as a result of moving the direction of traction. The resultant neovagina's depths were 10, 11, and 12 cm, respectively. Sexual intercourse was set off on the day of discharge. Penetration and satisfaction scores increased up to 90 points for both partners. CONCLUSION(S): It was feasible and safe to move centrally the direction of traction and to move the point of catheter exit up with apparently better outcomes than conventional balloon vaginoplasty for treatment of blind vagina due to androgen insensitivity syndrome. Copyright © 2011 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.