We evaluated the feasibility and operative and postoperative outcomes of office balloon vaginoplasty. Office balloon vaginoplasty was performed successfully for a case with vaginal aplasia. She was currently married and presenting with minimal penetration and dyspareunia. We successfully performed the procedure through retro-pubic space under local anesthesia within 25 min total operative time and it was well tolerated by the patient. No operative complications were reported. The resulting neovagina was cosmetically attractive and 10 cm in depth. Sexual intercourse was started on the day of catheter removal. Penetration and satisfaction scores increased up to 90 points for both partners.
Problem: hospitalization required
Recently El Saman introduced a method of retropubic balloon vaginoplasty (RBV) that quickly provides patients with a natural neovagina, a technique associated with very low complication rates, shorter operative time, fewer technical demands, earlier establishment of coital activities, and a cosmetically appealing outcome. Functional and anatomical results have been comparable with those obtained with laparoscopic balloon vaginoplasty. Nonetheless, the procedure has required general anesthesia and a hospital stay.
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An important intrinsic benefit of RBV is extraperitoneal passage of the catheter, which makes it possible to perform the procedure without laparoscopic monitoring. As a result, only 1 abdominal puncture instead of 2 is required. In this report, we describe implementation of RBV as an office procedure under local anesthesia using conventional instruments, a first, as far as we know. This work was conducted at the Woman’s Health Hospital, Assiut University, Assiut, Egypt, after obtaining institutional review board approval.
Our solution
A married woman with congenital vaginal aplasia was counseled on our modified technique for RBV, which was to be accomplished under local anesthesia. Married, she presented with failure of intravaginal intercourse because of a very short vaginal dimple. Penetration and satisfaction scores were measured for both the patient and her husband. The procedure was carried out in the hysteroscopy unit.
First, the patient was draped in the dorsal lithotomy position, and the operative area was sterilized. Lidocaine, 10 mL, was infiltrated into the skin and subcutaneous tissues at the planned puncture site. This was followed by spinal anesthesia to infiltrate the retropubic space at the planned catheter insertion tract. In our earlier cases, we used general anesthetic and the current procedure was performed under local anesthesia. Finally, lidocaine, 10 mL, was injected at the catheter exit site in the vaginal dimple ( Video Clip ).
A small (4 mm) puncture was made in the infiltrated suprapubic skin, and a conventional suction drain inserter was passed through the puncture and across the previously infiltrated insertion tract to the dimple. Next, a silicone-coated Foley balloon catheter, 18 Fr, was threaded with a silk suture, which was then fixed to the caudal end of the inserter ( Figure 1 ). The inserter was passed until it could be extracted from the dimple side. At that point, the silk suture was cut near the inserter so that the remaining silk suture was still attached to the catheter tip ( Video Clip ). During the insertion process, the patient was asked to report any pain or discomfort. After the procedure, this was scored on a 0-100 visual analog scale.
Once the balloon-bearing segment of the catheter appeared at the dimple, a purse string suture was taken around it. After that, the balloon was inflated with 15 mL saline, and traction was exerted from the abdominal side until the balloon traveled up, carrying the stretched dimple above the introitus ( Figure 2 ). In our earlier series, a multilayered dressing was wrapped elegantly around the catheter to serve as a supporting platform, but here we used a single-port laparoscopy trocar instead ( Figure 3 ). Office hysteroscopy was used to ensure the integrity of the urethra and bladder. The patient’s remaining care was the same as that described in the earlier series of patients undergoing balloon vaginoplasty.
