Primary Amenorrhea due to Mayer-Rokitansky-Küster-Hauser Syndrome Managed with Laparoscopic Davydov Procedure: A Case Report.

Abstract

Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome is a congenital Müllerian anomaly characterized by uterovag-inal agenesis in phenotypic females with normal second-ary sexual characteristics and preserved ovarian function. Vaginal reconstruction may be required to allow satisfac-tory sexual function, particularly when nonsurgical dilation is declined, not tolerated, or not preferred. Laparoscopic Davydov vaginoplasty uses autologous peritoneum to line the neovaginal canal and may provide favorable anatomical outcomes when postoperative dilation is performed consis-tently. We report the case of an 18-year-old phenotypic female who presented with primary amenorrhea and nor-mal pubertal development. Examination showed normal external genitalia with a shallow vaginal dimple measuring approximately 3 cm. Pelvic ultrasonography demonstrated absence of the uterus with normal ovaries, and karyotype was 46,XX. Endocrine evaluation showed normal gonado-tropins, estradiol within the expected range, normal pro-lactin, and normal thyroid function tests. Renal evaluation revealed no abnormalities, supporting the diagnosis of MRKH type I. The patient underwent laparoscopic Davy-dov vaginoplasty, with detailed operative steps, trocar placement, injury-prevention strategies, and perioperative management described. A structured postoperative dila-tion protocol was implemented. At 2 months, the neovag-inal canal remained patent, with an approximate length of 8 cm; Hegar 30 was tolerated, and no early postoper-ative complications were observed. Laparoscopic Davydov vaginoplasty is a feasible surgical option for vaginal re-construction in MRKH syndrome, provided that diagnostic confirmation, reproducible operative and perioperative de-tails, and a structured postoperative dilation protocol are carefully established.