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SBA Questions
Published in Justin C. Konje, Complete Revision Guide for MRCOG Part 2, 2019
A 70-year-old, frail and diabetic obese woman presents with troublesome procidentia. She is not sexually active and has been assessed to be fit to withstand prolonged surgery. A colpocleisis is therefore offered as the treatment of choice. What is the main disadvantage of this procedure?A high recurrent rareLess patient satisfaction than with corrective surgeryLoss of access to the cervix and uterusLoss of sexual functionThe need to have drainage channels for the passage of vaginal and cervical secretions
Fistula repair
Published in J. Richard Smith, Giuseppe Del Priore, Robert L. Coleman, John M. Monaghan, An Atlas of Gynecologic Oncology, 2018
Radiation fistulas present particular problems in that the area of devitalized tissue is usually considerably larger than the fistula itself. Mobilization is often impossible, and if repair in layers is attempted the flaps are likely to slough. For patients in whom sexual activity is not required, closure by colpocleisis may be the most effective means of achieving continence (Figure 31.17). Some have advocated total closure of the vagina, although it may be preferable to avoid dissection in the devitalized tissue entirely and to perform a lower partial colpocleisis, essentially converting the upper vagina into a diverticulum of the bladder. It is usually necessary to fill the dead space below this with an interposition graft (Figures 31.18, 31.19).
Complications and clinical outcomes of laparoscopic sacrocolpopexy for pelvic organ prolapse
Published in Journal of Obstetrics and Gynaecology, 2021
Hirotaka Sato, Hirokazu Abe, Atsushi Ikeda, Tomoaki Miyagawa, Katsuhiko Sato
This study had several limitations. As patients were identified retrospectively, selection bias was a concern. Furthermore, an objective evaluation of LUTS was not completed, which is necessary in urodynamic studies. The small sample size should also be mentioned as a limitation. The deep vesicovaginal space dissection technique is different from traditional LSC, and assessment of patients from a single centre who underwent treatment by a single surgeon may cause outcomes that cannot be generalised to other studies. We recommend that prospective studies be performed with larger sample sizes to further verify the efficacy of LSC. It is important to preoperatively inform patients about its postoperative complications, even though they are rare and may not be severe, and secure their informed consent. Patients should also be preoperatively informed of alternative treatment options including reconstructive surgery, i.e., native tissue repair or colpocleisis.
Staged repair of concomitant rectovaginal fistula and pelvic organ prolapse after removal of a neglected pessary
Published in Baylor University Medical Center Proceedings, 2020
Stacy Mathews, Shaked Laks, Carola LaFollette, T. Ignacio Montoya, Pedro A. Maldonado
There is a paucity of information to guide treatment with colpopexy using mesh at the time of a rectovaginal fistula repair. Sacrocolpopexy with mesh implant can raise concerns for mesh erosion through the rectum if the mesh is placed adjacent to the fistula repair. Instead, we propose that colpopexy with mesh be considered as a delayed repair after the fistula repair has healed, or as a concomitant repair with minimal posterior vaginal wall mesh application and a margin away from the fistula repair. In elderly patients with procidentia or advanced posthysterectomy prolapse who are no longer sexually active, colpocleisis can be considered either at the time of fistula repair or after the fistula has healed.6 Isolated posterior vaginal wall prolapse can pose more of a challenge. Delayed prolapse repair such as posterior colporrhaphy with or without enterocele repair or apical suspension should be entertained to allow for adequate fistula healing.
Update on vesicovaginal fistula: A systematic review
Published in Arab Journal of Urology, 2019
Ahmed S. El-Azab, Hassan A. Abolella, Mahmoud Farouk
Most VVFs are accessible via a transvaginal approach. The vaginal approach is associated with less morbidity, less blood loss, less burdensome for patients, and lesser hospital stay than the abdominal approach. Through the anterior vaginal wall, the vagina is dissected off of the bladder followed by a multilayer closure. Before we start the procedure we insert a ureteric catheter. To ensure bladder drainage, we place both a urethral and suprapubic catheter. We usually use only a wide-bore urethral catheter in cases of straightforward obstetric VVFs [28]. An alternative approach is the Latzko technique. The Latzko technique may be typically indicated for proximal post-hysterectomy VVF. The technique consists of a circumferential ellipsoid incision around the VVF, with wide mobilisation of the vaginal epithelium in all directions. The vaginal epithelium around the VVF site is excised and the fistulous tract is closed. The repair is reinforced by a layer derived from the perivesical tissue. A modified colpocleisis is performed, with several layers of absorbable sutures from the anterior to posterior vaginal wall obliterating the upper vagina. The Latzko partial colpocleisis procedure is an alternative technique to traditional vaginal repair. Shortening of the vaginal canal can occur but rarely affects sexual function. However, caution should be exercised when considering it in sexually active females [29].