Histological features of neovaginal epithelium following vaginoplasty in Mayer-Rokitansky-Küster-Hauser syndrome.

OBJECTIVE: To analyze the features of the epithelia coating neovaginas after vaginoplasty in women affected by Mayer-Rokitansky-Küster-Hauser syndrome.

STUDY DESIGN: We conducted a retrospective analysis of prospectively collected data. Women affected by Rokitansky syndrome, who underwent neovaginal biopsy after vaginoplasty (McIndoe surgery, intestinal vaginoplasty, Vecchietti's surgery and Davydov surgery) were included. Macroscopic mucosal features were assessed through clinical examination and Shilling test. Each biopsy specimen was prepared for examination by light microscopy (LM) and in some cases by scanning electron microscopy (SEM).

RESULTS: 36 patients (4 McIndoe, 2 intestinal vaginoplasty, 14 Vecchietti, and 16 Davydov) were included. All biopsies were performed without complications. In McIndoe's neovaginas, the mucosal microscopic features were similar to normal skin, with large areas of preserved epithelium, heterogeneous presence of dermal papillae, and superficial keratinization. Characteristics of intestinal neovagina's surface were similar to sigmoid colon, with well-shaped glands and cylindrical cells, and with a secreting mucosa. In Vecchietti's neovaginas the surface epithelium was flat and multi-layered, highly similar to that of a normal vagina, with the presence of glycogen and superficial desquamation. Upon SEM medium magnification evaluation, the epithelium presented flattened polygonal cells. Finally, in Davydov's neovaginas, none of the specimens had persistent mesothelial elements. The squamous neo-epithelium had regular aspects of differentiation with the presence of glycogen. At SEM greater magnification, microridges were evident with a regular distribution.

CONCLUSIONS: Each different technique of vaginoplasty lead to unique histological and structural features of the neovagina's mucosa. Knowledge of these elements must be the basis for the choice of the most appropriate intervention.