To assess the value of transrectal biplane high-frequency ultrasound in evaluating artificial vagina in patients with Mayer-Rokitansky-Küster-Hauser syndrome (MRKH) after peritoneal vaginoplasty.

Eighty-two preoperative patients with MRKH syndrome (preoperative group), 30 normal reproductive women (normal control group), and 85 patients with MRKH syndrome after operation at Luohu District People's Hospital of Shenzhen were enrolled as the research participants from January 2021 to March 2022. Among the 85 postoperative patients with MRKH syndrome, 69 who underwent reexamination within one month after surgery were included in postoperative group A, and 16 who were reexamined more than 1 month after surgery were included in postoperative group B. The morphological and structural changes in the urethra and bladder posteriorly and the rectum anteriorly in the four groups were observed by transrectal biplanar high-frequency ultrasound in sagittal and cross-sectional sections, and the thickness of the gaps at the level of the urethral orifice was measured and compared by the Kruskal-Wallis H test.

In the 82 patients in the preoperative group, only hypoechoic connective tissue was seen between the urethra and bladder posteriorly and the rectum anteriorly in sagittal and cross-sectional sections, the thickness of the gap was about 3.01 (2.33, 3.52) mm, and color Doppler flow imaging (CDFI) revealed a little blood flow signal in the gap. The vagina showed "three lines and two zones" between the urethra and bladder posteriorly and the rectum anteriorly in sagittal and cross-sectional sections in 30 women in the normal control group, CDFI revealed that there were abundant blood flow signals in the vaginal wall, and the average thickness of the vaginal wall was about (10.07±2.93) mm. The artificial vagina could be seen between the urethra and bladder posteriorly and the rectum anteriorly in sagittal and cross-sectional sections and showed "one line and two areas" in 69 patients in the postoperative group A, CDFI revealed abundant blood flow signals in the deformed area of artificial vagina, and the average thickness of the artificial vaginal wall was (13.25±3.06) mm. The artificial vagina could also be seen between the urethra and bladder posteriorly and the rectum anteriorly in sagittal and cross-sectional sections and showed "one line and two areas" in 16 patients in the postoperative group B, CDFI revealed abundant blood flow signals in the deformed area of artificial vagina, and the average thickness of the artificial vaginal wall was (11.03±3.26) mm. The Kruskal-Wallis H test showed that there was a significant difference in the thickness between the urethra and bladder posteriorly and the rectum anteriorly at the level of the urethral orifice among the four groups (H=150.301, P<0.001).

Transrectal biplanar high-frequency ultrasound provides a direct and reliable imaging tool for the assessment of morphological and structural changes between the urethra and bladder posteriorly and the rectum anteriorly in patients with MRKH syndrome before and after peritoneal vaginoplasty, and it could also provide the sonoimagedata characteristics of the postoperative artificial vagina from formation to maturity.