Dr. John Miklos and Dr. Robert Moore – Bladder Fistula Surgeons
Internationally Renowned Vaginal and Laparoscopic Surgeons
Located in Atlanta, GA – Patients from 47 States and 45 Countries
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Case Study #1
Davydov Neovagina Case Study
Symptoms/Sign: 19 year old with MRKH and short (agenesis) vagina
State of Residency: Maryland
Previous evaluations: 1) National Institute of Health (NIH) – Bethesda Maryland 2) Urogynecologists – Sacramento California
Surgery: Davydov Neovagina
This patient is a 19-year-old female, accompanied by her mother, who presented with complaints of vaginal agenesis and MRKH and is inquiring about a neovagina. She was first diagnosed with vaginal agenesis at the age of 16. She was recently seen in Maryland at the famous National Institute of Health (NIH) and was scheduled for surgery specifically the McIndoe procedure. Her mother had found Dr Miklos &Moore at Atlanta Urogynecology on line. Based on what the patient and her mother had read about the Davydov procedure they scheduled an appointment for her here in Atlanta. She contacted the NIH again and asked about doing the Davydov as an alternative and they told her they didn’t have anyone who could do the procedure.
The patient then went to Sacramento to see a Urogynecologist and who does the Veccietti procedure and based on the surgeons evaluation, recommended the patient come to Atlanta for the Davydov procedure, neither the NIH or Sacramento specialists did the less invasive Davydov procedure.
The patient presented for evaluation and an exam was performed. The patient has been using vaginal dilators for stretching for over a year and was capable of stretching her vagina from 2.5 cm to 5.0 cm (1 inch = 2.5 cm). She and her mother were consulted and they decided to proceed with surgery the very next day. The surgery was performed in less than 1 hour and the patient did fabulously.
Steps of the operative procedure are seen below:
Figure 1 – Laparoscopic incisions are made for the surgery
Figure 2 – Ovaries (normal) are seen inside the patient (photo 4)
Figure 3- A metal probe is placed in the short vagina and an incision is made (photo 5)
Figure 4 – The surgeons fingertips are seen at the top of the
short vagina that is seen through the newly made incision (photo 6)
Figure 5 – The peritoneum is suture secured to the edge
of the cut vaginal apex
Figure 6 – Making of the new apex of the vagina by “pursestringing” the peritoneum
Figure 7 – Pursestring suturing which has completed the new apex of
the vagina in turn has lengthened the vagina to 11.5 cm (Photo 19)