OJOG  Vol.2 No.1 , March 2012
Modified Vecchietti’s vaginoplasty with Remeex® system in patient with chronic graft-versus-host disease
Abstract: We present a case report of a chronic graft-versus-host disease manifestation in 33-year-old patient with an unusual complication of vaginal stenosis with complete obstruction after allogeneic bone marrow transplantation for myelocytic leukemia. The patient complained on a progressive dyspareunia and sexual intercourse inability. She has received hormone replacement therapy due to the ovarian failure after the chemotherapy treatment. The hormonal treatment was used in continuous combined manner and hematocolpos wasn’t seen during an abdominal ultrasound examination. The reconstructive surgery was performed by the modified Vecchietti’s neovagina technique with a Remeex® system after histological confirmation of main diagnosis. The immediate postoperative course was uneventful with gradual normalization of sexual function.
Cite this paper: Vidales Laura, M. , Muñiz Mar, M. and Padro Javier, S. (2012) Modified Vecchietti’s vaginoplasty with Remeex® system in patient with chronic graft-versus-host disease. Open Journal of Obstetrics and Gynecology, 2, 85-88. doi: 10.4236/ojog.2012.21017.

[1]   Atkinson, K.A. (1990) Chronic graft-versus-host disease (review). Bone Marrow Transplant, 5, 69-82.

[2]   Spinelli, S., Chiodi, S., Costantini, S., Van Lint, M.T., Raiola, A.M., Ravera, G.B., et al. (2003) Female genital tract graft-versus-host disease following allogeneic bone marrow transplantation. Haematologica, 88, 1163-1168.

[3]   Akpek, G., Zahurak, M. and Piantadosi, S. (2001) Development of a prognostic model for grading chronic graft versus host disease. Blood, 97, 1219-1226. doi:10.1182/blood.V97.5.1219

[4]   Basara, N., Blau, I.W. and Willenbacher, W. (2000) New strategies in the treatment of graft versus host disease. Bone Marrow Transplant, 25, S12-S15. doi:10.1038/sj.bmt.1702345

[5]   Williams, D.A. (2001) Inflammatory cytokines and mucosal injury. Journal of the National Cancer Institute Monographs, 29, 26-30. doi:10.1093/oxfordjournals.jncimonographs.a003435

[6]   Yanai, N., Shufaro, Y., Or, R. and Meirow, D. (1999) Vaginal outflow tract obstruction by graft-versus-host- reaction. Bone Marrow Transplant, 24, 811-812. doi:10.1038/sj.bmt.1701973

[7]   Eisen, D., Essell, J. and Broun, E.R. (1997) Oral cavity complications of bone marrow transplantation. Seminars in Cutaneous Medicine and Surgery, 16, 265-272. doi:10.1016/S1085-5629(97)80015-6

[8]   Cutler, C., Li, S., Kim, H.T., Laglenne, P., Szeto, K.C., Hoffmeister, L., et al. (2005) Mucositis after allogeneic hematopoietic stem cell transplantation: A cohort study of methotrexate and non-methotrexate-containing graft-versus-host disease prophylaxis regimens. Biology of Blood and Marrow Transplantation, 11, 383-388. doi:10.1016/j.bbmt.2005.02.006

[9]   Gossett, D.R., Montz, F.J. and Bristol, R.E. (2002) Cystic paracervical mass as an unusual sequel of graft-versus-host disease. A case report. Journal of Reproductive Medicine, 47, 600-602.

[10]   Eggleston, T.I., Ziccardi, V.B. and Lumerman, H. (1998) Graft-versus-host disease. Case report and discussion. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology and Endodontology, 86, 692-696. doi:10.1016/S1079-2104(98)90206-2

[11]   Lee, S.J., Klein, J.P. and Barret, A.J. (2002) Severity of chronic graft-versus-host disease: Association with treatment-related mortality and relapse. Blood, 100, 406-414. doi:10.1182/blood.V100.2.406

[12]   Balleari, E., Garre, S. and Van Lint, M.T. (2002) Hormonal replacement therapy and chronic graft-versus-host disease activity in women treated with bone marrow transplantation for hematological malignancies. Annals of the New York Academy of Sciences, 966, 187-192. doi:10.1111/j.1749-6632.2002.tb04214.x

[13]   Robien, K., Schubert, M.M., Bruemmer, B., Lloid, M.E., Potter, J.D. and Ulrich, C.M. (2004) Predictors of oral mucositis in patients receiving hematopoietic cell transplants for chronic myelogenous leukemia. Journal of Clinical Oncology, 22, 1268-1275. doi:10.1200/JCO.2004.05.147

[14]   Corson, S.L., Sullivan, K., Batzer, F., August, C., Storb, R. and Thomas, E.D. (1982) Gynecologic manifestations of chronic graft-versus-host disease. Obstetrics & Gynecology, 60, 488-492.

[15]   Spiryda, L.B., Laufer, M.R., Soiffer, R.J. and Antin, J.A. (2003) Graft-versus-host disease of the vulva and/or vagina: Diagnosis and treatment. Biology of Blood and Marrow Transplantation, 9, 760-765. doi:10.1016/j.bbmt.2003.08.001

[16]   DeLord, C., Treleaven, J., Shepherd, J., Saso, R. and Ponles, R.L. (1999) Vaginal stenosis following allogeneic bone marrow transplantation for acute myeloid leukaemia. Bone Marrow Transplant, 23, 523-525. doi:10.1038/sj.bmt.1701603

[17]   Anguenot, J.L., Ibecheole, V., Helg, C., Piacenza, J.M., Dumps, P. and Bonnefoi, H. (2002) Vaginal stenosis with hematocolpometra, complicating chronic graft versus host disease. European Journal of Obstetrics & Gynecology and Reproductive Biology, 103, 185-187. doi:10.1016/S0301-2115(02)00032-5

[18]   Hayes, E.C. and Rock, J.A. (2002) Treatment of vaginal agglutination associated with chronic graft-versus-host disease. Fertility and Sterility, 78, 1125-1126. doi:10.1016/S0015-0282(02)03380-0

[19]   Carpenter, P.A. (2008) Late effects of chronic graft-versus-host disease. Best practice and Research Clinical Haematology, 21, 309-331. doi:10.1016/j.beha.2008.02.016

[20]   Couriel, D., Carpenter, P.A. and Cutter, C. (2006) Ancillary therapy and supportive care of chronic GVHD: National institutes of health consensus development project on criteria for clinical trials in cGVHD: Ancillary Therapy and Supportive Care Working Group Report. Biology of Blood Marrow Transplantation, 12, 375-396. doi:10.1016/j.bbmt.2006.02.003

[21]   Vanrell, J.A., Martínez Roman, S. and Castelo-Branco, C. (2001) Neovagina por laparoscopia. Nueva modificacion a la tecnica de Vecchietti. Toko-Ginecologia Practica, 60, 195-199.

[22]   Veronikis, D.K., McClure, G.B. and Nichols, D.H. (1997) The Vecchietti operation for constructing a neovagina: Indications, instrumentation and techniques. Obstetrics & Gynecology, 90, 301-304. doi:10.1016/S0029-7844(97)00231-7

[23]   Zantomio, D., Grigg, A.P., MacGregor, L., Panek-Hudson, Y., Szer, J. and Ayton, R. (2006) Female genital tract graft-versus-host disease: Incidence, risk factors and recommendations for management. Bone Marrow Transplantation, 38, 567-572. doi:10.1038/sj.bmt.1705487