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The present study was undertaken to evaluate effect of traditional anterior repair versus site specific anterior repair in reduction of urinary symptoms in women with Pelvic organ Prolapse. During the study period of 2 years 140 women belonging to reproductive, peri-menopausal and postmenopausal age groups were included in the study. Employing past literature, the sample size calculated was 140. All women were assessed pre-operatively by the assessment method – Pelvic organ prolapse quantification (POP-Q) system. 70 women belonging to Group A were treated according to vaginal hysterectomy with traditional anterior repair and 70 women belonged to Group B who were treated according to vaginal hysterectomy with site specific anterior repair. Post-operatively, all women were followed up till 7th post-operative day and were assessed for anatomical and functional improvement to determine a better method for repair in reduction of urinary symptoms in women with pelvic organ prolapse. Our study shows functional and anatomical outcomes of traditional anterior repair and site specific anterior repair. 48 of 70 women (68.2%) who were subjected to traditional anterior repair and 52 of 70 women (73.4%) who were subjected to site specific anterior repair had marked functional improvement after surgery. 58 of 70 women (83.2%) belonging to traditional anterior repair group and 67 of 70women (95.3%) belonging to Site specific anterior repair group had considerable anatomical improvement post-operatively. This impresses the role of site specific anterior repair in women with pelvic organ prolapse for attaining better functional and anatomical outcome. Keywords: Pelvic organ prolapse, Traditional repair, Site specific repair, Vaginal hysterectomy, POP-Q, Urinary symptoms

Background Pelvic organ prolapse (POP) is a common health problem affecting 40% multiparous women above 35 years of age. Lifetime risk of women requiring surgery for recurrence is 10%. The POP is intricious due to complex pelvic anatomy, and difficulty increases due to tissue weakness, lack of evidence-based surgical guidelines, and lack of standardized definition for surgical success, which results in highly variable estimates of success. Aim To compare the effectiveness of traditional anteroposterior repair with site-specific repair with concomitant vaginal hysterectomy with respect to anatomical considerations by POP-Q and functional or symptomatic considerations, complications, duration of surgery, and recurrence. Materials and methods This hospital-based randomized controlled trial was carried out at a tertiary care hospital from January 1, 2013 to December 31, 2015 over a period of 3 years after obtaining ethical committee approval. All women attending the gynecological outpatient department having symptoms of mass coming out of vagina were subjected to detailed history and examination and 51 women underwent traditional anterior and posterior repair and 44 women underwent site-specific repair with concomitant hysterectomy, with random sampling according to computerized sheet. The effectiveness of both the surgeries was assessed and compared. Observations There was statistically significant improvement in all the sites of POP-Q points using traditional repair and site-specific repair. When compared, site-specific repair by POP-Q was better than traditional method. Conclusion Site-specific repair of decussated natural tissue has great curative potential, and success is attributable to site-specific repair, rather than nonspecific scar formation by traditional method. Thus, it is important to properly quantify the repair to be done, whether anterior or posterior, and perform site-specific repair. How to cite this article Bhalerao AV, Vora A, Bhalerao K, Garg R. To Compare the Effectiveness of Traditional Anterior Colporrhaphy, Posterior Colpoperineorrhaphy with Site-specific Anterior and Posterior Repair for Pelvic Organ Prolapse. J South Asian Feder Menopause Soc 2017;5(2):92-98.

Introduction Vaginal vault prolapse can be prevented by supporting the vaginal cuff, which is an essential part of hysterectomy, whether done abdominally or vaginally. The American Association of Gynecologic Laparoscopists (AAGL) has recommended for future research, specifically, a randomized trial comparing McCall's culdoplasty (with uterosacral ligament plication) with vaginal high uterosacral ligament suspension (HUSLS) (without plication), since both procedures are accessible to gynecological surgeons without urologic background. Hence, this study was carried out. Aim To compare both anatomic and functional outcomes of patients undergoing vaginal HUSLS or McCall's culdoplasty at the time of vaginal hysterectomy. Materials and methods This hospital-based prospective comparative study was carried out at a tertiary care hospital from January 1, 2013 to December 31, 2015 over a period of 3 years after obtaining Ethical Committee approval. All women attending gynecological outpatient department having symptom of mass coming out of vagina were subjected to detailed history, examination, and later underwent either HUSLS (43) or McCall's culdoplasty (42), for vault suspension with concomitant hysterectomy. The effectiveness of both the procedures was assessed by preoperative and postoperative pelvic organ prolapse quantification (POP-Q) and both were compared. Observations There was statistically significant improvement in all the sites of POP-Q points by HUSLS and McCall's culdoplasty as a method of vault suspension except in total vaginal length (TVL). Vault suspension by HUSLS is better than McCall's culdoplasty. All the points of POP-Q showed better results but the point C was significantly placed at a higher level by HUSLS (p = 0.000) as compared with McCall's culdoplasty. The time required for HUSLS was statistically more as compared with repair by McCall's culdoplasty (81.55/74.53 minutes, T: 1.981, p: 0.05). Complications, such as hemorrhage and ureteric injuries were more in HUSLS (2/43, 4.8%) as compared with McCall's culdoplasty (0/42); this is statistically significant. Conclusion High uterosacral ligament suspension provides excellent suspensory support to vaginal vault. Vagina is suspended over the levator ani with normal axis toward sacrum. By doing HUSLS, the vagina is symmetrically supported directed toward the hollow of sacrum. High uterosacral ligament suspension is highly recommended for young women with POP as vaginal length is not altered at all and so is the quality of life. How to cite this article Bhalerao AV, Bhalerao K, Garg R. To Compare the Effectiveness of Vaginal High Uterosacral Ligament Suspension and McCall's Culdoplasty during Vaginal Hysterectomy for Pelvic Organ Prolapse. J South Asian Feder Menopause Soc 2017;5(2):81-86.

In developing countries most of the fistulas occur as a catastrophic complication of obstructed labor in young women. Constant dribbling, wetness, and stink lead to social outcasting of patients of vesico-vaginal fistula (VVF) making their life miserable. In most of the cases, timely surgery taking all required precautions is successful. In small number of cases, fistula is irreparable. Under such circumstances urinary diversion helps. Very few cases are reported in literature, where patients have endured fistula for more than 40 years. A case report of a patient of VVF, who suffered for 45 years without seeking any treatment because of prevailing circumstances is presented here. The fistula was irreparable. Urinary diversion was the only option available. She was successfully managed by urinary diversion with an ileal conduit. Now patient is leading a contented life.

Today vaginal hysterectomy is the most commonly performed gynecological surgery for prolapsed uteri and for other conditions, like fibroid, dysfunctional uterine bleeding, cervical intraepithelial neoplasia, etc. Vaginal hysterectomy has least incidence of complications. Complications like hemorrhage, infection, bladder injury, etc. are known. This prospective study was carried out at a tertiary hospital to analyze the complications and find measures to prevent or decrease complications. Primary hemorrhage was the most common complication, followed by bladder injury and infection. Thus proper selection of cases, preoperatively prepare for any eventuality and intraoperative proficiency can decrease vaginal hysterectomy complications.