Obstructed Hemivagina: Conservative Tx


NEW ORLEANS — Most young patients with obstructed hemivagina and ipsilateral renal anomalies can be managed conservatively with single stage vaginoplasty, Nicole A. Smith, M.D., reported in a poster at the annual meeting of the North American Society for Pediatric and Adolescent Gynecology.

This is true even in the setting of infection, wrote Dr. Smith, who also noted that routine laparoscopy is not essential in the management of this condition, which is fairly common but often misdiagnosed.

Misdiagnosis can lead to inappropriate treatment or can delay appropriate treatment (forcing some girls to live unnecessarily with debilitating pain from a condition that could be easily treated), according to Dr. Smith of Children's Hospital Boston.

A series of 27 cases at that hospital over a 12-year period underscores the need for a high level of clinical suspicion for the syndrome in the presence of a suggestive ultrasound.

In the 27 cases, initial ultrasound was 50% sensitive in suggesting a diagnosis; MRI after referral led to correct diagnosis in 85% of patients.

A total of 26 patients underwent vaginal resection, but only 7 underwent laparoscopy. Only seven required a staged vaginoplasty; the reasons for staged vaginoplasty included incomplete previous resection, infection, anatomic distortion, and restenosis, Dr. Smith noted.

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