183 / 492
S13-10
(P)
A NOVEL SURGICAL TECHNIQUE FOR THE MANAGEMENT OF TRANSVERSE
VAGINAL SEPTUM USING BALLOON DILATION
Martin KAEFER
1
, Allison KEENAN
2
, Benjamin WHITTAM
2
and Richard RINK
2
1) Riley Hospital for Children, Pediatric Urology, Indianapolis, USA - 2) Indiana University Medical School, Pediatric
Urology, Indianapolis, USA
PURPOSE
Transverse vaginal septum is a structural abnormality of the vagina, which arises from a failure of complete canalization
of the urogenital sinus and müllerian ducts. Patients typically present with amenorrhea and a distended upper vagina. A
septum may be located in the upper (46%) middle (40%) or lower (14%) vagina. Surgical treatment involves drainage
of the hematometrocolpos and resection of the septal tissue. Safe entry into the distended vagina can be challenging in
the nulliparous patient. We describe a percutaneous technique that serves to improve the ease and safety of disruption
of the transverse vaginal septum.
MATERIAL AND METHODS
Three consecutive patients presenting with symptoms of cyclic abdominal pain, amenorrhea and progressive lower
abdominal distension were treated with this technique. CT scan revealed hydrometrocolpos. The patients were taken to
the operating room and under ultrasound guidance a 14-gauge angiocatheter was placed through the thick transverse
vaginal septum. After aspiration revealed thick blood a 0.35 mm Sensor™ wire was placed through the angiocatheter
and a Nephromax™ Balloon Dilating System placed over the wire. The balloon was insufflated and subsequently
removed providing a generous aperture (36 French) through which the remainder of the septum could be readily
visualized and excised.
RESULTS
All three patients tolerated the procedure well. Follow up endoscopic evaluation revealed a normal caliber vagina with
no residual obstructing tissue and smooth transition between the proximal and distal vaginal segments. All patients are
asymptomatic at an average follow up of 4 years.
CONCLUSIONS
Percutaneous dilation of the transverse vaginal septum allows for safe entry into the dilated vaginal segment with
excellent visualization of the membrane, facilitating the safe, straightforward resection of all obstructing tissue.