Cryptomenorrhea with cervicovaginal aplasia: endoscopic transfundal development of the lower genital tract

The current case series was done to evaluate the feasibility of transfundal hysteroscopy (TFH) in helping the development of new cervical canal in cases with cervical aplasia. Five cases with obstructive cervicovaginal agenesis with hematometra were included in this report. Laparoscopic-guided TFH was done in conjunction with endoscopic canalization to all cases. Additional retropubic balloon vaginoplasty (BV) was needed in three cases with associated vaginal aplasia. The hysteroscope was passed through the uterine fundus. After complete washing, the endometrial lining was inspected, and a properly located intrauterine catheter coming out from the vagina or vaginal dimple was used to drain the uterine cavity and maintain the cervical tract. The procedure was done successfully in all cases with adequate drainage of hematometria. Additional time needed for TFH was between 4 to 15 min. Second-look hysteroscopy revealed adequate canalization in all cases. The five cases had regular menstrual cycles up to the sixth postoperative month. In conclusion, TFH is a safe and feasible procedure as a harmonizing technique during endoscopic canalization of cervical atresia with or without BV in cases of obstructive Müllerian anomalies. The procedure accelerates the drainage of uterine contents and localizes the correct site of draining catheter.