Pediatrics Double mucosal flap for the reconstruction of transverse vaginal septum e A novel surgical approach using the vaginal septal tissue Amitay Lorber a, * , Dvora Bauman b , Katya Chapchay c , Mordechai Duvdevani a , Dov Pode a , Ofer N. Gofrit a , Ezekiel H. Landau a , Guy Hidas a a Urology Department, Hadassah Medical Center, Israel b Obstetrics and Gynecology Department, Hadassah Medical Center, Israel c Plastic Surgery Department, Hadassah Medical Center, Israel article info Article history: Received 18 September 2017 Received in revised form 28 October 2017 Accepted 12 November 2017 Available online 16 November 2017 1. Introduction Transverse vaginal septum is a congenital anomaly typically undiagnosed until menarche. Although the majority of such septa occur at the junction of the middle and upper thirds of the vagina, transverse vaginal septum may be found at any vaginal level (Fig. 1). A complete transverse septum will block menstrual flow and is a cause of primary amenorrhea and hematocolpus accompanied with cyclic abdominal pain, tubo-ovarian abscess, urinary tract infection and endometriosis. Some transverse septa are incomplete and may cause dyspar- eunia or obstruction in labor. 1 Transperineal, transrectal, and abdominal ultrasonography will show distended upper vagina and may be beneficial in establishing the diagnosis and for determination of the location and thickness of a transverse vaginal septum. MRI is the gold standard for a precise diagnosis of the anomaly, determination of the depth of the vagina, identification of the thickness of the septum and the extent of the distension of the vagina, cervix, and uterus or tubes. 2 Common surgical technique used to repair transverse septum is resection followed by primary end-to-end anastomosis of the lower and upper vaginal mucosa. The major drawbacks of this technique are the high rate of ring scarring, which may lead to vaginal stenosis and obliteration, extensive scaring resulting in vaginal shortening and dyspareunia. 3 High complication rate following resection of thick transverse septum mandates the need for alternative surgical technique to overcome these obstacles. In this paper we present a novel surgical technique. The principle behind this technique is Fig. 1. Low transverse vaginal septum. * Corresponding author. Urology Department, Hadassah Medical Center, POB:12000, Jerusalem, Israel. E-mail address: amitayavigal@gmail.com (A. Lorber). Contents lists available at ScienceDirect Urology Case Reports journal homepage: www.elsevier.com/locate/eucr https://doi.org/10.1016/j.eucr.2017.11.002 2214-4420/© 2017 The Authors. Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). Urology Case Reports 16 (2018) 92e94