Outcome of surgical reconstructive procedures for the treatment of vaginal anomalies

Study Objective: To determine the outcome of corrective surgical procedures used to treat congenital vaginal anomalies. Design: A retrospective international collaborative chart study which accumulated standardized data on patients who presented to these six institutions for surgical correction of vaginal anomalies. Participants: One hundred twenty-four procedures were performed on 74 patients. Forty-seven patients had congenital adrenal hyperplasia (CAH), 22 had congenital absence of the vagina (CAV), and 5 had complex cloacal anomalies. Primary surgical procedures were as follows: 23 of the total 28 vaginoplasties, 44 of the 76 perineoplasty procedures, and all of the 7 pull-through procedures. Main Outcome Measures: Success was based on the presence of a functioning vagina, conditional success on the presence of an acceptable vagina for stage of development, and failure on the need for further operative procedure. Results: Patients with CAH were predominantly prepubertal, noncompliant with dilators and had an overall success rate of 8.5%, conditional success rate of 22.5%, and failure rate of 66.0%. The patients with CAV had an overall success rate of any primary surgical procedure of 68.2% and all but two were postpubertal at the time of initial surgery. All five patients with complex anomalies required more than one surgery. Second procedures were more successful in all patients if performed after the age of 15 years. Conclusions: This study indicated a favorable outcome for vaginoplasty for CAV and for repeat surgical procedures if done after age 15, and that patients with CAH who have prepubertal surgery have a relatively high rate of repeat corrective surgery.