University of Vermont, Vermont Children's Hospital, Burlington, VT, USA.
J Pediatr Urol. 2010 Oct;6(5):464-8. doi: 10.1016/j.jpurol.2009.12.009. Epub 2010 Mar 3.
Vaginal septation is a congenital defect seen in patients with persistent cloaca, urogenital sinus and disorders of Müllerian duct aplasia. Rarely, these patients present with symptoms in infancy and childhood with the exception of hydrocolpos. Treatment traditionally consists of surgical excision of the vaginal septum. We present our experience with minimally invasive endoscopic ablation of vaginal septa.
We reviewed retrospectively the management of four patients with vaginal septae: Herlyn-Werner-Wunderlich syndrome (1), cloacal malformations (2), and urogenital sinus (1). All were prepubertal (aged 2-9 years). The first patient presented with hydrocolpos. The others were asymptomatic and identified during definitive reconstruction. All four underwent endoscopic ablation in ≤30 min, using a pediatric resectoscope.
One of the cloacal patients developed a postoperative perineal/vestibular infection leading to urethral stenosis and currently requires intermittent catheterization. There were no other complications. Endoscopic examination under anesthesia at 6 months in all patients revealed no septal scarring or vaginal stenosis.
The advantage of endoscopic ablation over traditional open repair is that it is minimally invasive and can be easily performed as an outpatient procedure or at the time of definitive reconstruction. Our results suggest that endoscopic ablation should be considered as the primary approach for correction of vaginal septa.
阴道隔是一种先天性缺陷，见于持续性泄殖腔、尿生殖窦和 Müller 管发育不全的患者。这些患者很少在婴儿期和儿童期出现症状，除了阴道积水。传统的治疗方法是手术切除阴道隔。我们介绍了微创内镜消融阴道隔的经验。
我们回顾性地研究了 4 例阴道隔患者的治疗情况：Herlyn-Werner-Wunderlich 综合征（1 例）、泄殖腔畸形（2 例）和尿生殖窦（1 例）。所有患者均为青春期前（年龄 2-9 岁）。第 1 例患者表现为阴道积水。其他患者无症状，在明确重建期间发现。所有 4 例患者均在 ≤30 分钟内采用小儿电切镜进行内镜消融。
1 例泄殖腔患者术后会阴/前庭感染，导致尿道狭窄，目前需要间歇性导尿。无其他并发症。所有患者在 6 个月时进行麻醉下内镜检查，未见隔痕或阴道狭窄。
与传统的开放修复相比，内镜消融的优点是微创，可以作为门诊手术或在明确重建时轻松进行。我们的结果表明，内镜消融应被视为治疗阴道隔的主要方法。
