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Transgender reassignment surgeries have become a major topic of interest within the last decade. Although there are numerous surgical techniques for male-to-female reassignment, a physician must assess each patient's anatomy and past medical history to determine the most suitable technique. Additionally, patient preference is important. The neovaginal constructive technique most commonly used in male-to-female reassignment surgery is penile skin inversion, but various other techniques and tissues can also be used including pelvic peritoneum, buccal mucosa, and bowel. Surgical text descriptions were enhanced by creating new anatomical illustrations. Donor and recipient site anatomies, and the surgical technique leading to creation of the neovagina, are demonstrated in detail with relevant illustrations. A review of the literature concerning the anatomy, procedure development, and outcomes is presented. The pelvic peritoneum was originally used in neovaginal construction for females with vaginal agenesis as a result of MRKH syndrome. The use of this technique to create a neovagina in male-to-female transgender reassignment surgery has become appealing owing to the relative ease of the procedure, low complication rates, and overall high patient satisfaction. This technique offers a potential new choice for transgender male-to-female neovaginal construction, but further studies are needed to confirm its successful use in transgender surgery. Clin. Anat. 31:175-180, 2018. © 2017 Wiley Periodicals, Inc.

Key content Congenital anomalies of the genital tract are uncommon. Embryological knowledge is essential in diagnosis and management. Mayer–Rokitansky–Kuster–Hauser (MRKH) syndrome is best managed in tertiary centres by a multidisciplinary team. The more complex the obstructive disorder, the more specialist care is required. Ultrasound imaging is usually all that is required. Learning objectives To understand the relationship between embryology and congenital abnormalities. To gain ability to recognise those problems that need specialist care. To understand the need for a holistic approach to care in MRKH syndrome. Ethical issues Is failure to provide a multidisciplinary holistic approach acceptable medical care?

Many types of operations are described to create a neovagina in a patient with Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome, that sometimes result in injury of the surrounding organs. Many trials are detailed in the literature to avoid these complications. Our goal was to examine the benefit of 'endovaginal' sonography during a laparoscopy-assisted Vecchietti operation to avoid bladder injuries.A neovagina was created in 15 women with MRKH syndrome by the method of Vecchietti assisted by laparoscopy. The method was modified with the use of‘endovaginal' sonography, in order to reduce bladder and rectal injuries. The vaginal ultrasound transducer, placed in front of the vaginal dimple, can guide penetration from the perineum into the peritoneal cavity. With this technique, the narrow space between the bladder and rectum can be well identified.All operations were successful, without any complication, forming a well-functioning 8-10 cm long neovagina, allowing easy introduction of two fingers in all cases, and with good quality of sexual life for the couples.Creation of a neovagina by any method in MRKH syndrome may sometimes result in injury of the bladder or rectum due to the narrow space between the bladder and rectum. The placement of the endovaginal ultrasound transducer in front of the vaginal dimple seems to be a promising method to avoid these complications during a laparoscopy-assisted Vecchietti operation.

Objective To report a case of laparoscopic resection of bilateral rudimentary horns in a patient with a variant of Mayer–Rokitansky–Kuster–Hauser (MRKH) syndrome. Methods The clinical records of the patient were reviewed. Results Laparoscopy was undertaken in our patient for diagnosis of suspicious adnexal masses which had been observed on ultrasound examination. Laparoscopy disclosed two Mullerian remnants (bilateral rudimentary horns) on each pelvic sidewall and a simple paraovarian cyst 3–4 cm in size. These remnants did not communicate with each other and cervical agenesis was identified. It was decided to undertake bilateral laparoscopic horn resection since our patient complained of a cyclic pelvic pain and suspicious endometriotic implants on the right ovary and fallopian tube were observed; this was performed without complication. The resected horns and paraovarian cyst were removed by use of an endobag with extension of the left 5-mm trocar incision. The patient was completely free of symptoms at the 1- and 6-months follow-up examinations. Conclusion Laparoscopic resection was used safely for the treatment of a variant of MRKH syndrome with bilateral rudimentary horns.

Objective To evaluate the effect of a group programme on psychological distress in women with the Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome. Setting Gynaecologic outpatient clinic. Sample Seventeen women with MRKH syndrome participated in this study. Method A semi-structured programme of seven sessions was offered dealing with themes of the MRKH syndrome. Psychological distress was measured at the first visit 3–6 month before the group programme was started (pre-test-0), at the first (pre-test) and then at the last group session (post-test). Main outcome measure The Symptom Check List-90 was used to assess feelings of psychological distress. Results The post-test subscale scores for anxiety, depression, interpersonal sensitivity and the total score for psychological distress were significantly lower than the pre-test-0 and pre-test scores (P < 0.05). No significant differences were found between the pre-test-0 and pre-test subscale scores and total score. Conclusion A semi-structured group programme seems valuable in helping women with the MRKH syndrome to deal with their psychological stress.

Both yolk sac tumor and Mayer–Rokitansky–Kustner–Hauser syndrome (MRKH) are uncommon disorders. We describe a rare combination of yolk sac tumor of the ovary and MRKH syndrome that was diagnosed us...