Neovaginoplasty using Nile Tilapia Fish Skin as a new biological graft in patients with Mayer-Rokitansky-Küster-Hauser syndrome

ABSTRACT Mayer–Rokitansky–Kuster–Hauser syndrome is the second most common cause of primary amenorrhea, trailing only gonadal dysgenesis. In patients who failed dilation therapy, neovaginoplasty is an appropriate treatment option. Several biomaterials have been used in this procedure, including peritoneum, amnion, skin grafts and myocutaneous flaps. Nile Tilapia Fish Skin has non-infectious microbiota, morphological structure comparable to human skin, and high in vivo bioresorption. In addition, it showed good outcomes when used as a xenograft for burn treatment. Thus, we suggest it as a new biological graft for vaginal agenesis management. In this descriptive study (Canadian Task Force classification III), neovaginoplasty using Nile Tilapia Fish Skin offered three patients an anatomical and functional neovagina via a simple method with potential long-term effectiveness. When postsurgical dilation was performed correctly, a vaginal length greater than 6 cm was maintained at 180 days follow-up. Histological and immunohistochemical analyses revealed presence of stratified squamous epithelium with high expression of cytokeratins and fibroblast growth factor, matching the characteristics of normal adult vaginal tissue. We believe that further studies will allow Nile Tilapia Fish Skin to firm itself as a relevant option in the therapeutic arsenal of Mayer–Rokitansky–Kuster–Hauser syndrome.