Nile tilapia skin graft as a new treatment for vaginal agenesis in androgen insensitivity syndrome: a case series.

INTRODUCTION

Androgen insensitivity syndrome (AIS) is a genetic disorder affecting 46 XY individuals, leading to varied degrees of incomplete development of sexual characteristics. In patients with vaginal agenesis who wish to engage in sexual activity, surgical interventions, such as neovaginoplasty, may be required. While traditional approaches pose drawbacks, the emergence of Nile tilapia fish skin (NTFS) for vaginal agenesis management offers a promising, cost-effective alternative. This study aims to evaluate morphofunctional outcomes in AIS patients who underwent neovaginoplasty using NTFS.

METHODS

In this case series, five patients diagnosed with AIS underwent modified McIndoe vaginoplasty using NTFS. Outpatient consultations at 30, 90, and 180 days assessed neovagina aesthetics and functionality. Sexual function was evaluated using the Female Sexual Function Index (FSFI), and genital self-image was assessed with the Female Genital Self-Image Scale (FGSIS). Tissue sampling at 30 and 180 days post-surgery involved histopathological analysis of the vaginal wall.

RESULTS

Surgeries were conducted to form vaginal canals measuring 9-10 cm, with no intraoperative complications. Three patients experienced difficulties during sexual intercourse within the six months following surgery, while one reported successful sexual activity. An average FSFI score of 18.7 and an FGSIS score of 14.6 were observed. Histopathological analysis of vaginal wall samples at 1 and 6 months post-surgery indicated the presence of fibrovascular connective tissue and inflammatory response.

CONCLUSION

Neovaginoplasty with NTFS emerges as a cost-efficient approach with minimal complications. Epithelial tissue formation was not observed at 6 months post-surgery. The study underscores challenges in achieving morphofunctional outcomes in AIS individuals, emphasizing the need for hormonal considerations and psychological factors.