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Pierluigi Benedetti Panici - One of the best experts on this subject based on the ideXlab platform.
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Treatment of the Mayer–Rokitansky–Küster–Hauser syndrome with autologous in vitro cultured Vaginal tissue: descriptive study of long‐term results and patient outcomes
BJOG : an international journal of obstetrics and gynaecology, 2018Co-Authors: Ilaria Sabatucci, Cinzia Marchese, Innocenza Palaia, Ludovico Muzii, C Della Morte, Margherita Giorgini, Angela Musella, Simona Ceccarelli, Enrica Vescarelli, Pierluigi Benedetti PaniciAbstract:OBJECTIVE Evaluating sexual function and quality of life (QoL) in patients treated with a modified Abbe-McIndoe technique using in vitro cultured autologous Vaginal mucosa. DESIGN Descriptive study. SETTING Policlinico Umberto I, Sapienza University of Rome. POPULATION From 2006 to 2016, 39 women affected by Mayer-Rokitansky-Kuster-Hauser syndrome (MRKHS) underwent vaginoplasty at our centre using a modified Abbe-McIndoe technique with in vitro cultured autologous Vaginal tissue. METHODS For each patient, Vaginal tissue was obtained by full-thickness biopsy of the Vaginal Vestibule. Following enzymatic dissociation, cells were cultured for 2-3 weeks before the transplant. MAIN OUTCOME MEASURES Each patient completed two validated questionnaires to quantify sexual function and QoL: the Female Sexual Function Index (FSFI), administered at 12, 36, and 60 months, and the Psychological General Well Being Index (PGWBI) administered at 0, 6, and 36 months after surgery. RESULTS Twelve months after surgery, 29 patients were engaging in regular sexual activity. The FSFI test results showed a satisfactory sexual function compared to the general population, with median values of 25.85 (range 4.6-30.5) at 12 months, 27.2 (range 4.4-33.6) at 36 months, and 29.6 (range 23.9-33.6) at 60 months. The PGWBI questionnaire showed a median score of 420.5 (range 108-540) before surgery, and 459 (range 252-533) at the 60-month follow-up. CONCLUSIONS Vaginoplasty performed with the use of autologous Vaginal tissue, besides ensuring a long-term satisfying sex life, helps in achieving an improvement in QoL that is maintained over time. TWEETABLE ABSTRACT Vaginoplasty using in vitro Vaginal tissue ensures a satisfactory sexual function and improves quality of life.
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Autologous in vitro cultured Vaginal tissue for vaginoplasty in women with Mayer-Rokitansky-Küster-Hauser syndrome: anatomic and functional results.
Journal of minimally invasive gynecology, 2014Co-Authors: Pierluigi Benedetti Panici, Ludovico Muzii, Simona Ceccarelli, Enrica Vescarelli, Diana Maffucci, Giorgia Perniola, Cinzia MarcheseAbstract:Abstract Study Objective To present the procedure and the results of a technique in which in vitro autologous cell cultures were used for the canal lining in patients with Mayer-Rokitansky-Kuster-Hauser syndrome (MRKHS) subjected to vaginoplasty with a modified Abbe-McIndoe technique. MRKHS is a rare anomaly characterized by Vaginal agenesis with variable mullerian duct abnormalities. The Abbe-McIndoe procedure is 1 of the most frequent surgical treatments adopted in these women. In the last decades, several modifications have been introduced by different authors, mostly changing the lining material, but no consensus has been reached on what material should be used for the neovagina canal wall lining. Design A pilot study (Canadian Task Force classification II-1). Setting Policlinico Umberto I, “Sapienza” University of Rome. Patients A consecutive series of 23 women with MRKHS underwent neovaginoplasty with autologous Vaginal tissue as the graft material between 2006 and 2013. Interventions Each patient with MRKHS was subjected to a full-thickness mucosal biopsy from the Vaginal Vestibule. After enzymatic dissociation, cells were inoculated onto collagen IV–coated plates and cultured for 2 to 3 weeks. The patients were subjected to vaginoplasty with a modified Abbe-McIndoe technique with autologous in vitro cultured Vaginal tissue. Patients underwent clinical follow-up visits at 1, 3, 6, and 12 months after surgery and every year thereafter. Anatomic, functional, and sexual results were assessed. Measurements and Main Results In all cases, the vagina appeared normal in length and depth. A Vaginal cytology and a Vaginal biopsy obtained at the 3-month follow-up visit revealed physiological Vaginal tissue. All 23 patients completed the Female Sexual Function Index questionnaire at 12 months after surgery. The results showed a total score of 27.2. These results indicate a satisfactory quality of sexual life. Conclusion The modified Abbe-McIndoe technique with autologous Vaginal tissue appears to be safe and feasible. This technique allows normal and satisfying sexual intercourse. Larger series with longer follow-ups will be necessary to confirm if this technique represents the ideal procedure for Vaginal agenesis.
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Vaginoplasty using autologous in vitro cultured Vaginal tissue in a patient with Mayer–von-Rokitansky–Küster–Hauser syndrome
Human reproduction (Oxford England), 2007Co-Authors: Pierluigi Benedetti Panici, Filippo Bellati, Terenzio Boni, Federica Francescangeli, Luigi Frati, Cinzia MarcheseAbstract:Mayer-von-Rokitansky-Kiister-Hauser syndrome (MRKHS) is characterized by Vaginal agenesis with variable Miillerian duct abnormalities. The Abbe-McIndoe technique is considered a valid treatment option for vaginoplasty but no consensus has been reached on what material should be used for the neovagina canal wall lining. We report the first case of autologous Vaginal tissue transplantation in a 28-year-old women with MRKHS. The patient was subjected to a 1 cm 2 full-thickness mucosal biopsy from the Vaginal Vestibule. Following enzymatic dissociation, cells were inoculated onto collagen IV-coated plates and cultured for 2 weeks. The patient was subjected to a vaginoplasty with a modified Abbe-McIndoe vaginoplasty with 314 cm 2 autologous in vitro cultured Vaginal tissue for the canal lining. At 1 month from surgery, the vagina appeared normal in length and depth and a Vaginal biopsy revealed normal Vaginal tissue. The use of autologous in vitro cultured Vaginal tissue to create a neovagina appears as an easy, minimally invasive and useful method.
Cinzia Marchese - One of the best experts on this subject based on the ideXlab platform.
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Treatment of the Mayer–Rokitansky–Küster–Hauser syndrome with autologous in vitro cultured Vaginal tissue: descriptive study of long‐term results and patient outcomes
BJOG : an international journal of obstetrics and gynaecology, 2018Co-Authors: Ilaria Sabatucci, Cinzia Marchese, Innocenza Palaia, Ludovico Muzii, C Della Morte, Margherita Giorgini, Angela Musella, Simona Ceccarelli, Enrica Vescarelli, Pierluigi Benedetti PaniciAbstract:OBJECTIVE Evaluating sexual function and quality of life (QoL) in patients treated with a modified Abbe-McIndoe technique using in vitro cultured autologous Vaginal mucosa. DESIGN Descriptive study. SETTING Policlinico Umberto I, Sapienza University of Rome. POPULATION From 2006 to 2016, 39 women affected by Mayer-Rokitansky-Kuster-Hauser syndrome (MRKHS) underwent vaginoplasty at our centre using a modified Abbe-McIndoe technique with in vitro cultured autologous Vaginal tissue. METHODS For each patient, Vaginal tissue was obtained by full-thickness biopsy of the Vaginal Vestibule. Following enzymatic dissociation, cells were cultured for 2-3 weeks before the transplant. MAIN OUTCOME MEASURES Each patient completed two validated questionnaires to quantify sexual function and QoL: the Female Sexual Function Index (FSFI), administered at 12, 36, and 60 months, and the Psychological General Well Being Index (PGWBI) administered at 0, 6, and 36 months after surgery. RESULTS Twelve months after surgery, 29 patients were engaging in regular sexual activity. The FSFI test results showed a satisfactory sexual function compared to the general population, with median values of 25.85 (range 4.6-30.5) at 12 months, 27.2 (range 4.4-33.6) at 36 months, and 29.6 (range 23.9-33.6) at 60 months. The PGWBI questionnaire showed a median score of 420.5 (range 108-540) before surgery, and 459 (range 252-533) at the 60-month follow-up. CONCLUSIONS Vaginoplasty performed with the use of autologous Vaginal tissue, besides ensuring a long-term satisfying sex life, helps in achieving an improvement in QoL that is maintained over time. TWEETABLE ABSTRACT Vaginoplasty using in vitro Vaginal tissue ensures a satisfactory sexual function and improves quality of life.
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Autologous in vitro cultured Vaginal tissue for vaginoplasty in women with Mayer-Rokitansky-Küster-Hauser syndrome: anatomic and functional results.
Journal of minimally invasive gynecology, 2014Co-Authors: Pierluigi Benedetti Panici, Ludovico Muzii, Simona Ceccarelli, Enrica Vescarelli, Diana Maffucci, Giorgia Perniola, Cinzia MarcheseAbstract:Abstract Study Objective To present the procedure and the results of a technique in which in vitro autologous cell cultures were used for the canal lining in patients with Mayer-Rokitansky-Kuster-Hauser syndrome (MRKHS) subjected to vaginoplasty with a modified Abbe-McIndoe technique. MRKHS is a rare anomaly characterized by Vaginal agenesis with variable mullerian duct abnormalities. The Abbe-McIndoe procedure is 1 of the most frequent surgical treatments adopted in these women. In the last decades, several modifications have been introduced by different authors, mostly changing the lining material, but no consensus has been reached on what material should be used for the neovagina canal wall lining. Design A pilot study (Canadian Task Force classification II-1). Setting Policlinico Umberto I, “Sapienza” University of Rome. Patients A consecutive series of 23 women with MRKHS underwent neovaginoplasty with autologous Vaginal tissue as the graft material between 2006 and 2013. Interventions Each patient with MRKHS was subjected to a full-thickness mucosal biopsy from the Vaginal Vestibule. After enzymatic dissociation, cells were inoculated onto collagen IV–coated plates and cultured for 2 to 3 weeks. The patients were subjected to vaginoplasty with a modified Abbe-McIndoe technique with autologous in vitro cultured Vaginal tissue. Patients underwent clinical follow-up visits at 1, 3, 6, and 12 months after surgery and every year thereafter. Anatomic, functional, and sexual results were assessed. Measurements and Main Results In all cases, the vagina appeared normal in length and depth. A Vaginal cytology and a Vaginal biopsy obtained at the 3-month follow-up visit revealed physiological Vaginal tissue. All 23 patients completed the Female Sexual Function Index questionnaire at 12 months after surgery. The results showed a total score of 27.2. These results indicate a satisfactory quality of sexual life. Conclusion The modified Abbe-McIndoe technique with autologous Vaginal tissue appears to be safe and feasible. This technique allows normal and satisfying sexual intercourse. Larger series with longer follow-ups will be necessary to confirm if this technique represents the ideal procedure for Vaginal agenesis.
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Vaginoplasty using autologous in vitro cultured Vaginal tissue in a patient with Mayer–von-Rokitansky–Küster–Hauser syndrome
Human reproduction (Oxford England), 2007Co-Authors: Pierluigi Benedetti Panici, Filippo Bellati, Terenzio Boni, Federica Francescangeli, Luigi Frati, Cinzia MarcheseAbstract:Mayer-von-Rokitansky-Kiister-Hauser syndrome (MRKHS) is characterized by Vaginal agenesis with variable Miillerian duct abnormalities. The Abbe-McIndoe technique is considered a valid treatment option for vaginoplasty but no consensus has been reached on what material should be used for the neovagina canal wall lining. We report the first case of autologous Vaginal tissue transplantation in a 28-year-old women with MRKHS. The patient was subjected to a 1 cm 2 full-thickness mucosal biopsy from the Vaginal Vestibule. Following enzymatic dissociation, cells were inoculated onto collagen IV-coated plates and cultured for 2 weeks. The patient was subjected to a vaginoplasty with a modified Abbe-McIndoe vaginoplasty with 314 cm 2 autologous in vitro cultured Vaginal tissue for the canal lining. At 1 month from surgery, the vagina appeared normal in length and depth and a Vaginal biopsy revealed normal Vaginal tissue. The use of autologous in vitro cultured Vaginal tissue to create a neovagina appears as an easy, minimally invasive and useful method.
Lior Lowenstein - One of the best experts on this subject based on the ideXlab platform.
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The Vaginal Vestibule.
Journal of lower genital tract disease, 2004Co-Authors: Michael Friedman, Ephraim Siegler, Lior LowensteinAbstract:OBJECTIVES: Vulvar Vestibule is a common term in the medical nomenclature. In our view, this term is inaccurate. MATERIALS AND METHODS: Herein, we provide evidence from embryologic, anatomic, and architectonic textbooks that shows the links between the Vestibule and vagina. RESULTS: Our research proves that the term vulvar Vestibule does injustice to the area it describes. CONCLUSIONS: The correct term for vulvar Vestibule actually is Vaginal Vestibule.
William J. Ledger - One of the best experts on this subject based on the ideXlab platform.
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Decreased concentration of protease inhibitors: possible contributors to allodynia and hyperalgesia in women with vestibulodynia.
American journal of obstetrics and gynecology, 2014Co-Authors: Aswathi Jayaram, Faith Esbrand, Georgios Dulaveris, T. Orfanelli, Ryan Sobel, William J. Ledger, Steven S. WitkinAbstract:Objective Women with vestibulodynia exhibit increased pain sensitivity to contact with the Vaginal Vestibule as well as with Vaginal penetration. The mechanism(s) responsible for this effect remains incompletely defined. Based on reports of a possible role for proteases in induction of pain, we compared levels of proteases and protease inhibitors in Vaginal secretions from women with vestibulodynia and controls. Study Design Vaginal secretions from 76 women with vestibulodynia and from 41 control women were assayed by an enzyme-linked immunosorbent assay for the protease inhibitors, secretory leukocyte protease inhibitor (SLPI) and human epididymis protein-4 (HE-4), and the proteases, kallikrein-5 and cathepsins B and S. Concentrations between subjects and controls were compared and levels related to clinical and demographic variables. Results Concentrations of HE-4 and SLPI were markedly reduced in Vaginal samples from women with vestibulodynia compared with controls ( P ≤ .006). All other compounds were similar in both groups. HE-4 ( P = .0195) and SLPI ( P = .0033) were lower in women with secondary, but not primary, vestibulodynia than in controls. Subjects who had constant vulvar pain had lower levels of HE-4 and SLPI than did healthy control women ( P ≤ .006) or women who experienced vulvar pain only during sexual intercourse ( P ≤ .0191). There were no associations between HE-4 or SLPI levels and event associated with symptom onset, duration of symptoms, age, number of lifetime sexual partners, or age at sex initiation. Conclusion Insufficient Vaginal protease inhibitor production may contribute to increased pain sensitivity in an undefined subset of women with secondary vestibulodynia who experience constant vulvar pain.
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Differential characterization of women with vulvar vestibulitis syndrome
American journal of obstetrics and gynecology, 2002Co-Authors: Steven S. Witkin, Stefan Gerber, William J. LedgerAbstract:Abstract Objective: We differentiated women with vulvar vestibulitis syndrome into subgroups on the basis of the time of symptom onset, a history of recurrent vulvoVaginal candidiasis, and the interleukin-1 receptor antagonist gene polymorphism. Study Design: One hundred sixty-two consecutive patients with strictly defined vulvar vestibulitis syndrome were asked to fill out a questionnaire with the assistance of their gynecologist. A buccal sample was collected from each subject for the analysis of interleukin-1 receptor antagonist gene polymorphism; Vaginal and vestibular microbial investigations were performed. Results: Symptoms began with the first act of coitus in 20.4% of patients. A history of a recurrent Candida vulvoVaginal infection was reported in 42.6% of patients; 25.9% of the patients were positive for the homozygous interleukin-1 receptor antagonist 2,2 genotype. Women with primary vulvar vestibulitis syndrome differed from women with secondary vulvar vestibulitis syndrome; women with primary vulvar vestibulitis syndrome were younger at the time of the onset of the symptoms (23.8 vs 31.2 years, P P Candida vulvovaginitis differed from the other subjects by having a higher frequency of constant vestibular pain (40.6% vs 20.4%, P =.005), a Vaginal discharge (79.7% vs 45.2%, P P =.0001). Women who were homozygous for interleukin-1 receptor antagonist 2,2 genotype had an earlier onset of symptoms (26 years) than did women who were allele 1 homozygotes (31.3 years, P P P =.002). Human papillomavirus in the Vaginal Vestibule occurred at a greater frequency in women who were homozygous for interleukin-1 receptor antagonist 2,2 genotype. Conclusion: Subgroups of women with vulvar vestibulitis syndrome may be differentiated by symptomatic and genetic variables. (Am J Obstet Gynecol 2002;187:589-94.)
Steven S. Witkin - One of the best experts on this subject based on the ideXlab platform.
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Decreased concentration of protease inhibitors: possible contributors to allodynia and hyperalgesia in women with vestibulodynia.
American journal of obstetrics and gynecology, 2014Co-Authors: Aswathi Jayaram, Faith Esbrand, Georgios Dulaveris, T. Orfanelli, Ryan Sobel, William J. Ledger, Steven S. WitkinAbstract:Objective Women with vestibulodynia exhibit increased pain sensitivity to contact with the Vaginal Vestibule as well as with Vaginal penetration. The mechanism(s) responsible for this effect remains incompletely defined. Based on reports of a possible role for proteases in induction of pain, we compared levels of proteases and protease inhibitors in Vaginal secretions from women with vestibulodynia and controls. Study Design Vaginal secretions from 76 women with vestibulodynia and from 41 control women were assayed by an enzyme-linked immunosorbent assay for the protease inhibitors, secretory leukocyte protease inhibitor (SLPI) and human epididymis protein-4 (HE-4), and the proteases, kallikrein-5 and cathepsins B and S. Concentrations between subjects and controls were compared and levels related to clinical and demographic variables. Results Concentrations of HE-4 and SLPI were markedly reduced in Vaginal samples from women with vestibulodynia compared with controls ( P ≤ .006). All other compounds were similar in both groups. HE-4 ( P = .0195) and SLPI ( P = .0033) were lower in women with secondary, but not primary, vestibulodynia than in controls. Subjects who had constant vulvar pain had lower levels of HE-4 and SLPI than did healthy control women ( P ≤ .006) or women who experienced vulvar pain only during sexual intercourse ( P ≤ .0191). There were no associations between HE-4 or SLPI levels and event associated with symptom onset, duration of symptoms, age, number of lifetime sexual partners, or age at sex initiation. Conclusion Insufficient Vaginal protease inhibitor production may contribute to increased pain sensitivity in an undefined subset of women with secondary vestibulodynia who experience constant vulvar pain.
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Differential characterization of women with vulvar vestibulitis syndrome
American journal of obstetrics and gynecology, 2002Co-Authors: Steven S. Witkin, Stefan Gerber, William J. LedgerAbstract:Abstract Objective: We differentiated women with vulvar vestibulitis syndrome into subgroups on the basis of the time of symptom onset, a history of recurrent vulvoVaginal candidiasis, and the interleukin-1 receptor antagonist gene polymorphism. Study Design: One hundred sixty-two consecutive patients with strictly defined vulvar vestibulitis syndrome were asked to fill out a questionnaire with the assistance of their gynecologist. A buccal sample was collected from each subject for the analysis of interleukin-1 receptor antagonist gene polymorphism; Vaginal and vestibular microbial investigations were performed. Results: Symptoms began with the first act of coitus in 20.4% of patients. A history of a recurrent Candida vulvoVaginal infection was reported in 42.6% of patients; 25.9% of the patients were positive for the homozygous interleukin-1 receptor antagonist 2,2 genotype. Women with primary vulvar vestibulitis syndrome differed from women with secondary vulvar vestibulitis syndrome; women with primary vulvar vestibulitis syndrome were younger at the time of the onset of the symptoms (23.8 vs 31.2 years, P P Candida vulvovaginitis differed from the other subjects by having a higher frequency of constant vestibular pain (40.6% vs 20.4%, P =.005), a Vaginal discharge (79.7% vs 45.2%, P P =.0001). Women who were homozygous for interleukin-1 receptor antagonist 2,2 genotype had an earlier onset of symptoms (26 years) than did women who were allele 1 homozygotes (31.3 years, P P P =.002). Human papillomavirus in the Vaginal Vestibule occurred at a greater frequency in women who were homozygous for interleukin-1 receptor antagonist 2,2 genotype. Conclusion: Subgroups of women with vulvar vestibulitis syndrome may be differentiated by symptomatic and genetic variables. (Am J Obstet Gynecol 2002;187:589-94.)
