Outflow Obstructions Treatment & Management
- Author: Latha Chandran, MBBS, MD, MPH; Chief Editor: Andrea L Zuckerman, MD more...
Medical Care
In considering the appropriate management of the patient, the age of the patient as well as the psychological implications for the patient due to the condition must be taken into account.
An accurate assessment of the structural anatomy is imperative prior to surgical intervention.
Surgical Care
- Although repair is facilitated when estrogen stimulation is present, repair of an imperforate hymen can be performed in infancy, childhood, or adolescence. A Bovie with three fourths of its tip shielded can be used to excise the hymen close to the hymenal ring. After the fluid is drained, the hymenal area is opened further, and the vaginal mucosa is sutured to the hymenal ring to prevent recurrence.
- Puncture and drainage of a hematocolpos without a definitive surgical procedure is not recommended. The fluid is viscous and may not adequately drain, which increases the risk of an ascending infection.
- Surgery for a transverse vaginal septum depends on location, thickness, and need for vaginoplasty. Repair usually involves excision of the septum with end-to-end anastomosis of the vaginal walls. Image-guided balloon vaginoplasty,[4] hysteroscopic resection,[5] , as well as excision and insertion of a coated tracheobronchial stent to maintain patency until full epithelialization[6] have all been described as techniques to manage vaginal septa.
- In patients with Müllerian agenesis, vaginal reconstruction is performed. However, repeat operations are often required and complications, such as stenosis and fistula formation, are not uncommon.[7] Vaginal strictures may follow requiring repeated dilatation.
Consultations
- After establishing the diagnosis, consultation with a pediatric gynecologist or urologist who is familiar with these conditions is recommended.
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