Characteristics of patients with vaginal rupture and evisceration.

OBJECTIVE: To characterize vaginal rupture and evisceration. METHODS: We reviewed medical records (1970-2001) for use of the diagnostic terms "vaginal rupture," "vaginal evisceration," and "ruptured enterocele." RESULTS: Twelve clinical cases were identified. Patients usually presented with pain, vaginal bleeding, and abdominal pressure. In 9 of 12 women, rupture was primarily associated with postmenopausal prolapse and a history of pelvic surgery. Women with a history of abdominal hysterectomy tended to rupture through the vaginal cuff, and those with a history of vaginal hysterectomy tended to rupture through a posterior enterocele. Premenopausal rupture in 1 woman occurred postcoitally and involved the posterior fornix. Prolapse recurrence after repair was limited to 1 woman. CONCLUSIONS: Vaginal rupture and evisceration should be considered in women presenting with acute vaginal bleeding and pelvic pain. Evaluation is especially important in postmenopausal women with a history of pelvic surgery. In some cases, surveillance after pelvic surgery may prevent rupture, evisceration, and incarceration. LEVEL OF EVIDENCE: II-3

Needle tip control and its effect in reducing intraoperative complications during tension-free vaginal tape placement.

Tactile needle tip control was used to aid perforation during standard tension-free vaginal tape (TVT) placement to treat urinary incontinence. The success and complications of this novel method were compared retrospectively with the reported results of the standard technique. One hundred nine patients had TVT placement between 1998 and 2001, with follow-up continuing into 2002. Preoperatively, the severity of urinary incontinence was assessed objectively. Postoperatively, TVT effectiveness was assessed subjectively by standardized questionnaire, completed by 78 of the 109 patients (72%). Objective 2-year rates for continence or improvement and most complication rates were similar to previously reported results. Needle tip control was helpful in lowering the occurrence of bladder perforation. Longer postoperative recovery times associated with postoperative dysuria or obstruction did not decrease patient satisfaction if the patient experienced a marked improvement in leakage.

Therapeutic strategies for vaginal Müllerian agenesis.

Mayer-Rokitansky-Kuster-Hauser syndrome is challenging to diagnose and manage. A multisystem approach serves patients best. Appropriate treatment successfully improves patient self-image and sexual satisfaction.

McIndoe procedure for vaginal agenesis: long-term outcome and effect on quality of life.

OBJECTIVE: The purpose of this study was to evaluate quality of life, sexual function, and long-term outcome in women after undergoing the McIndoe procedure for vaginal agenesis. STUDY DESIGN: This was a retrospective descriptive study of patients who were treated with the McIndoe procedure for vaginal agenesis. Participants answered a structured questionnaire to describe self-reported outcomes in quality of life, sexual function and satisfaction, and body image after the McIndoe procedure. Patient characteristics along with short- and long-term findings were abstracted from the medical record. RESULTS: Eighty-six patients responded to the questionnaire. Average age (+/-SD) at surgery was 21+/-6 years (range, 12-49 years). The mean number of years (+/-SD) since surgery was 23+/-12 (range, 2-50 years). Seventy-nine percent of the respondents stated that the McIndoe procedure improved their quality of life. Ninety-one percent of the respondents were sexually active, with 75% able to achieve orgasm. Reported self-image was improved in 55% of the women. CONCLUSION: The McIndoe procedure improves quality of life and sexual satisfaction and provides a functional vagina with minimal complications.

Factors that are associated with clinically overt postpartum urinary retention after vaginal delivery.

OBJECTIVE: This study was undertaken to determine the incidence of clinically overt postpartum urinary retention after vaginal delivery and to examine what maternal, fetal, and obstetric factors are associated with this problem. STUDY DESIGN: This was a retrospective case-controlled study of women who had overt postpartum urinary retention after vaginal delivery from August 1992 through April 2000. RESULTS: Fifty-one of 11,332 (0.45%) vaginal deliveries were complicated by clinically overt postpartum urinary retention. In most cases (80.4%), the problem had resolved before hospital dismissal. Persons with urinary retention were more likely than control subjects to be primiparous (66.7% vs 40.0%; P <.001), to have had an instrument-assisted delivery (47.1% vs 12.4%; P <.001), to have received regional analgesia (98.0% vs 68.8%; P <.001), and to have had a mediolateral episiotomy (39.2% vs 12.5%; P <.001). On multivariate logistic regression analysis, of these 4 variables, only instrument-assisted delivery and regional analgesia were significant independent risk factors. CONCLUSION: Clinically overt postpartum urinary retention complicates approximately 1 in 200 vaginal deliveries, with most resolving before hospital dismissal. Factors that are independently associated with its occurrence include instrument-assisted delivery and regional analgesia.