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Construction of Neovagina via McIndoe Technique on a Reconstructed Pelvic Floor

Construction of Neovagina via McIndoe Technique on a Reconstructed Pelvic Floor

Video Presenter(s)

Aileen Abankwa, MD (she/her/hers)

Urogynecology Fellow
New York Presbyterian/Weill Cornell Medicine
Franklin Park, New Jersey, United States

Co-Author(s)

Stephanie Sansone, MD

Urogynecology Attending
Hackensack Meridian Jersey Shore University Medical Center
Neptune, New Jersey, United States
SS

Saya Segal, MD, MSCE

Assistant Attending & Professor of OB/GYN, Div. of Urogynecology
New York Presbyterian/Weill Cornell Medicine
New York, New York, United States
TA

Tirsit Asfaw, MD

Associate Attending & Professor of OB/GYN, Div. of Urogynecology
New York Presbyterian/Weill Cornell Medicine
New York, New York, United States

Objectives: To display our technique of a McIndoe neovagina creation in a patient with a history of cloacal malformation, multiple genitourinary, and colorectal reconstructive surgeries. We demonstrate the use of a silicone-based obstetrical balloon as the mold for split-thickness skin graft placement in the reconstructed vaginal cavity.

Methods: This is a case of a 20-year-old G0 with a history of cloacal malformation and prior failed vaginal reconstructive surgery who presented to our institution seeking creation of a neovagina. She had previously undergone bilateral ureteral reimplantation, urethral, perineal, and anal reconstruction in childhood and desired vaginal intercourse. She had attempted vaginal dilation for several months without much success. Pre-operative MRI findings include a 5.8 cm uterus deviated to the left hemipelvis without an identifiable cervix, small and short vagina of 1.1 cm, and normal appearing bilateral ovaries. Exam under anesthesia, vaginoscopy, and cystoscopy were performed, showing a 5-cm by 0.3-cm stenotic vagina deviated to the left possibly with a cervical os (remnant) visualized. Following EUA, she was counseled about risks and benefits of a McIndoe procedure and opted to proceed. This video highlights our dissection to create the neovagina, harvesting of a split thickness skin graft, and the use of an obstetrical balloon mold.

Clinical Relevance: We present a case of a McIndoe procedure in a patient with a cloacal malformation and prior colorectal and urologic surgeries. The careful dissection of the rectovaginal space in such patients is of utmost importance given extensive scarring and altered anatomy. Close post operative monitoring for graft perfusion and integrity as well as properly timed initiation of dilation is essential for post operative success. Additionally, we show the successful use of an obstetric balloon mold to secure the graft in place, which may be readily available at most institutions.