Neovaginoplastia com pele de tilápia: novo enxerto biológico para síndrome de Mayer-Rokitansky-Küster-Hauser

Abstract

Mayer-Rokitansky-Küster-Hauser syndrome (MRKHS) is the second most common cause of primary amenorrhea, trailing only to gonadal dysgenesis. It is characterized by complete or partial aplasia of the fallopian tubes, uterus and upper two thirds of the vagina, and may be associated with extragenital malformations. Neovaginoplasty is an appropriate treatment option for vaginal agenesis in those patients who have failed dilation therapy. Several biomaterials have been used in this procedure, including peritoneum, amnion, skin grafts, and myocutaneous flaps. Nile Tilapia Fish Skin (NTFS) has noninfectious microbiota, morphologic structure comparable to human skin, and high in vivo bioresorption. NTFS is suggested as a new biological graft for the management of vaginal agenesis. The aim of this work is to describe a new surgical technique for vaginal agenesis in patients with MRKHS. This is a descriptive study, in which three patients with MRKHS were followed up and submitted a neovaginoplasty using Nile Tilapia Fish Skin. NTFS sterilization process goes through a chemical step and another through ionizing radiation with gamma rays. Postoperative outpatient follow-up was performed at 30, 60, 90 and 180 days. When postsurgical dilation was performed correctly, a vaginal length greater than 7 cm was maintained at 180 days follow-up. Histologic and immunohistochemical analyses revealed the presence of stratified squamous epithelium with high expression of cytokeratins and fibroblast growth factor, matching the characteristics of normal adult vaginal tissue. Neovaginoplasty using Nile Tilapia Fish Skin offered three patients an anatomic and functional neovagina via a simple method, safe and minimally invasive. More studies will show Nile Tilapia Fish Skin to be a relevant option in the therapeutic arsenal for vaginal agenesis of Mayer-Rokitansky-Küster-Hauser syndrome.