Endoscopic ablation of longitudinal vaginal septa in prepubertal girls: a minimally invasive alternative to open resection.

Background: Vaginal septation is a congenital defect seen in patients with persistent cloaca, urogenital sinus and disorders of Müllerian duct aplasia. Rarely, these patients present with symptoms in infancy and childhood with the exception of hydrocolpos. Treatment traditionally consists of surgical excision of the vaginal septum. We present our experience with minimally invasive endoscopic ablation of vaginal septa.

Methods: We reviewed retrospectively the management of four patients with vaginal septae: Herlyn-Werner-Wunderlich syndrome (1), cloacal malformations (2), and urogenital sinus (1). All were prepubertal (aged 2-9 years). The first patient presented with hydrocolpos. The others were asymptomatic and identified during definitive reconstruction. All four underwent endoscopic ablation in ≤30 min, using a pediatric resectoscope.

Results: One of the cloacal patients developed a postoperative perineal/vestibular infection leading to urethral stenosis and currently requires intermittent catheterization. There were no other complications. Endoscopic examination under anesthesia at 6 months in all patients revealed no septal scarring or vaginal stenosis.

Conclusions: The advantage of endoscopic ablation over traditional open repair is that it is minimally invasive and can be easily performed as an outpatient procedure or at the time of definitive reconstruction. Our results suggest that endoscopic ablation should be considered as the primary approach for correction of vaginal septa.