Anatomic and functional outcome of vaginal paravaginal repair in the correction of anterior vaginal wall prolapse.

Over a 2-year period 45 patients with bilateral paravaginal support defects underwent vaginal paravaginal repair. Postoperative evaluations were conducted and anatomic outcome was determined by vaginal examination, with grading of vaginal wall support. Functional outcome was assessed by a standardized quality of life questionnaire, voiding dairy and standing stress test with a full bladder. Thirty-five patients had long-term follow-up with a mean of 1.6 years (range 1-85). The recurrence rates for displacement cystocele, enterocele and rectocele were 3% (1/35), 20% (7/35) and 14% (5/35), respectively. In no patients did vault prolapse develop or recur. Subjective or objective evidence of persistent stress urinary incontinence was found in 57% of patients (12/21). Vaginal paravaginal repair is a safe and effective technique for the surgical correction of anterior vaginal wall prolapse but has limited applicability in the surgical correction of genuine stress incontinence.

Routine hematocrit after elective gynecologic surgery.

OBJECTIVE: To determine the clinical use and associated costs of routine postoperative hematocrit after elective gynecologic surgery. METHODS: We reviewed the charts of all women who had elective gynecologic surgery over 12 months at a community hospital. Demographic data, estimated blood loss at surgery, pre- and postoperative hematocrits, postoperative symptoms suggesting anemia, and incidence of transfusion were tabulated. Laboratory charges for hematocrit at the hospital were used to develop an economic assessment. Statistical analysis was done with Student t test, Mann-Whitney U test, and Fisher exact test. RESULTS: Among 1105 women who had elective surgery, a single postoperative hematocrit was done in 761 (69%) and two or more postoperative hematocrits (mean 2.4, range 2-6) were done in 201 (18%). The overall incidence of blood transfusion related to elective gynecologic surgery was 1.9% (21 of 1105). Five of those women needed preoperative transfusions, eight needed intraoperative transfusions, and the remaining eight had postoperative transfusions. All women who needed postoperative transfusion showed some sign or symptom of anemia. None received transfusions based solely on hematocrit. Risk factors for postoperative transfusion included low preoperative hematocrit and increased intraoperative blood loss. CONCLUSION: Routine postoperative hematocrit in asymptomatic women after uncomplicated elective gynecologic surgery did not improve outcome.