Meyer Hannah, Trosclair Lexus, Clayton Sean D, O'Quin Collyn, Connelly Zachary, Rieger Ross, Dao Nhi, Alhaque Ahmed, Minagar Andrew, White Luke A, Solitro Giovanni, Shah-Bruce Mila, Welch Valerie L, Villalba Stephanie, Alexander Jonathan Steven, Sorrells Donald
Department of Surgery, LSU Health Shreveport, Shreveport, LA 71103, USA.
Department of Molecular and Cellular Physiology, LSU Health Shreveport, Shreveport, LA 71103, USA.
Bioengineering (Basel). 2023 Mar 12;10(3):351. doi: 10.3390/bioengineering10030351.
Vaginal atresia is seen in genetic disorders such as Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome, which can cause significant sexual dysfunction. Current treatments include surgical reconstruction or mechanical dilation of the vaginal canal. Mechanical dilation requires patients to be highly motivated and compliant while surgical reconstruction has high rates of complications. This study evaluated a novel vaginal expansion sleeve (VES) method as an alternative treatment for vaginal atresia. The proprietary cylindrical VES is a spring-like device consisting of polyethylene terephthalate helicoid trusses capped at each end with a fixed diameter resin cap for fixation within tissues. Following the development of the VES and mechanical characterization of the force-length relationships within the device, we deployed the VES in Sprague Dawley rat vaginas anchored with nonabsorbable sutures. We measured the VES length-tension relationships and post-implant vaginal canal expansion ex vivo. Vaginal histology was examined before and after implantation of the VES devices. Testing of 30 mm sleeves without caps resulted in an expansion force of 11.7 ± 3.4 N and 2.0 ± 0.1 N at 50% and 40%, respectively. The implanted 20 mm VES resulted in 5.36 mm ± 1.18 expansion of the vaginal canal, a 32.5 ± 23.6% increase ( = 0.004, Student test). Histological evaluation of the VES implanted tissue showed a significant thinning of the vaginal wall when the VES was implanted. The novel VES device resulted in a significant expansion of the vaginal canal ex vivo. The VES device represents a unique alternative to traditional mechanical dilation therapy in the treatment of vaginal atresia and represents a useful platform for the mechanical distension of hollow compartments, which avoids reconstructive surgeries and progressive dilator approaches.
阴道闭锁见于诸如迈耶-罗基坦斯基-库斯特-豪泽（MRKH）综合征等遗传性疾病中，这类疾病可导致严重的性功能障碍。目前的治疗方法包括阴道管的手术重建或机械扩张。机械扩张要求患者积极性高且依从性好，而手术重建的并发症发生率很高。本研究评估了一种新型阴道扩张套管（VES）方法作为阴道闭锁的替代治疗方法。专有的圆柱形VES是一种类似弹簧的装置，由聚对苯二甲酸乙二酯螺旋桁架组成，两端各有一个固定直径的树脂帽，用于在组织内固定。在开发出VES并对该装置内的力-长度关系进行力学表征后，我们将VES植入用不可吸收缝线固定的斯普拉格-道利大鼠阴道中。我们在体外测量了VES的长度-张力关系以及植入后阴道管的扩张情况。在植入VES装置前后对阴道组织学进行了检查。对无帽的30 mm套管进行测试，在50%和40%时的扩张力分别为11.7±3.4 N和2.0±0.1 N。植入的20 mm VES使阴道管扩张了5.36 mm±1.18，增加了32.5±23.6%（ = 0.004，学生t检验）。对植入VES的组织进行组织学评估显示，植入VES时阴道壁明显变薄。新型VES装置在体外导致阴道管显著扩张。VES装置是治疗阴道闭锁的传统机械扩张疗法的一种独特替代方法，并且代表了用于中空腔室机械扩张的有用平台，可避免重建手术和渐进式扩张器方法。
