Uterocervicoplasty with a bladder mucosa layer for the treatment of complete cervical agenesis.

OBJECTIVE

To create an endocervical canal in a patient with a complete cervical agenesis.

DESIGN

Case report.

SETTING

University hospital.

PATIENT(S): A 12-year-old girl presented with lower abdominal pain. On examination, complete vaginal agenesis was noted, with a 2-cm vaginal dimple. A pelvic magnetic resonance imaging scan disclosed an hematometra and absence of the cervix and vagina.

INTERVENTION(S): Initial surgical therapy consisted of a vaginoplasty with a sigmoid bowel segment and opening of the uterus by puncture and stenting. The cervical permeation failed, with immediate complete stenosis. A new attempt was made through a low sagittal hysterotomy by removing a central muscular cylinder and lining the channel with a free tubularized bladder mucosa graft. A stent was left in place.

MAIN OUTCOME MEASURE(S): Hysteroscopy, hysterography, and clinical follow-up evaluation.

RESULT(S): The cervical stent was removed after 5 months. A hysterography and hysteroscopy confirmed the permeability of the cervix, which was lined by a well-vascularized longitudinally folded mucosa. Regular menses had been noted for more than 3 years as of this report.

CONCLUSION(S): Cervicoplasty with mucosal lining permits the creation of a patent cervical canal, even in the reputedly unfavorable forms of congenital cervical agenesis.