MCINDOE PROCEDURE FOR VAGINAL AGENESIS: LONG-TERM OUTCOMES AND EFFECT ON QUALITY OF LIFE.

Christopher J. Klingele, M.D., John B, Gebhart, M.D., Andrew J. Croak, D.O., Connie S, DiMarco, M.D., Raymond A. Lee, M.D. Section of Urogynecology/Pelvic Reconstructive Surgery, Mayo Clinic, Rochester, MN.

   OBJECTIVES: To assess the long-term outcomes of the McIndoe procedure for vaginal agenesis and evaluate its effect on quality of life.

   MATERIALS AND METHODS: The medical records of women with vaginal agenesis treated with the McIndoe procedure at the Mayo Clinic between January 1950 and January 2000 were identified through a computer search. Medical records were abstracted for pertinent information, including initial postoperative course and long-term follow-up. All patients had an extensive history, physical exam, and radiographic evaluation when deemed necessary. Psychological referral was offered. Eligible patients were mailed an in-depth questionnaire to assess long-term outcomes and quality-of-life issues.

   RESULTS: 224 women were identified who underwent the McIndoe procedure for vaginal agenesis. 72/224 (32% response rate) responded to an in-depth questionnaire focusing on the number of subsequent surgical procedures, urinary or anorectal dysfunction, complication of the harvest site/neovagina, functional use, self-image, body appearance and quality of life issues. Overall satisfaction and patient understanding of vaginal agenesis was assessed. Charts were reviewed for surgical findings and immediate postoperative results. The average age at time of surgery was 21.3 (range 15-49 years). Mean operating time was 135 minutes (range 90- 187 minutes). Average number of days in the hospital was 9 days (range 4-14). Percent take of skin graft at time of temporary mold removal was 85%. Infection rate in the immediate postop period was 3% of patients (2 graft infections and 4-donor site infections). 13% of patients had previous attempts at surgical correction. Vaginal infection ! after recovery was only a frequent problem in 7% of patients. Urinary incontinence was never or only occasionally a problem in 89% of patients, while 8% had daily urinary incontinence. 3% of respondents reported weekly loss of stool without control. Burning at donor site was found in 8.5% of respondents, with 20% experiencing skin irritation. 86% of patients wore the mold postoperatively with the majority of patients wearing it for 8-12 months postoperatively. 70% found the mold manageable while 30% found it a daily nuisance. 31% found the graft site disfiguring. Further surgery was required in12% of patients. 89% of patients were sexually active after the procedure with 81% able to achieve orgasm. Two patients felt their vagina was not functional. Self-image after the procedure was improved in 55% of women. 78% of women stated the McIndoe procedure improved their life. 21% of women after undergoing the procedure would have considered using dilators. Finally, 32% report! ed confusion understanding their diagnosis at the time of surgery

   CONCLUSION: Surgical correction of vaginal agenesis by the McIndoe procedure provides a satisfactory and functional vagina in the majority of patients. Complications of surgery are minimal and overall satisfaction with vaginal function is high. Patient counseling should be thorough to fully disclose the nature of their vaginal agenesis, and discuss the surgical procedure and likely outcome with respect to function, body changes and risk of minor problems.

   Key Words: Vaginal Agenesis, McIndoe, and Quality of life