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Introduction: Radiofrequency (RF)-based stress urinary incontinence (SUI) treatment, which has quickly attracted attention, is administered in an office setting. This pilot-safety study assessed the efficacy of transvaginal RF treatment in the quality of life (QOL) and frequency of incontinence episodes in women with SUI.Methods: Twenty-eight women suffering from SUI were treated with an intravaginal quadric applicator while a grounding pad was attached in front of their pubes. The first phase is thermic, which will heat up the vaginal wall up to 40°C for 10 minutes. The second step is contraction to stimulate an aerobic exercise of pelvic floor muscles for 20 minutes (pulsed contractile RF at 20-40 watts and 1000-300 kHz with modulation of 1 to 300 Hz for muscle exercise). It was scheduled for one session per week for 3 sessions. Patients had follow-up visits before and 1, 6, and 12 months following the treatment for a one-day voiding diary, the Persian version of urinary incontinence QOL questionnaire (I-QOL), Q-tip test, 24 hours-pad test, and daily incontinence episodes’ number.Results: The patients’ mean age, duration of incontinence, and median vesical leak point pressure were 41.6±9.6 years, 5.48±6.84 years, and 140 cm H2 O respectively. Significant changes were observed in the mean I-QOL total score and the pad test. Also, a notable reduction was observed in the number of daily leakage episodes and the Q-tip test at any follow-up visit (P=0.001).Conclusion: Preliminary results suggest that transvaginal RF is a convenient method of SUI treatment. Significant changes were observed in the mean I-QOL total score and the pad test. Also, a notable reduction was observed in the number of daily leakage episodes. DOI: 10.34172/jlms.2021.56

Enteroceles and rectoceles are often identified as the cause of a vaginal mass and pelvic discomfort. The combination of a rectocele and an enterocele as pelvic organ prolapses is not infrequent; however, there are few reports on possible simultaneous treatments of these two conditions. We report a new and simple procedure for repairing an enterocele during a transvaginal anterior levatorplasty with posterior colporrhaphy for a rectocele repair. This technique involves making an excision in the peritoneal sac, with high ligation, and attaching the uterine cervix and/or cardinal ligament to the upper most part of the approximation of the levator muscles, to reinforce and lift the deep peritoneal sac. This procedure allows for transvaginal repair of both an enterocele and a rectocele. The enterocele is visualized by applying barium to the posterior vaginal wall during defecography.

Fibroblast to myofibroblast differentiation is a key feature of wound-healing in soft tissues, including the vagina. Vaginal fibroblasts maintain the integrity of the vaginal wall tissues, essential to keep pelvic organs in place and avoid pelvic organ prolapse (POP). The micro-environment of vaginal tissues in POP patients is stiffer and has different extracellular matrix (ECM) composition than healthy vaginal tissues. In this study, we employed a series of matrices with known stiffnesses, as well as vaginal ECMs, in combination with vaginal fibroblasts from POP and healthy tissues to investigate how matrix stiffness and composition regulate myofibroblast differentiation in vaginal fibroblasts. Stiffness was positively correlated to production of &alpha, smooth muscle actin (&alpha, SMA). Vaginal ECMs induced myofibroblast differentiation as both &alpha, SMA and collagen gene expressions were increased. This differentiation was more pronounced in cells seeded on POP-ECMs that were stiffer than those derived from healthy tissues and had higher collagen and elastin protein content. We showed that stiffness and ECM content regulate vaginal myofibroblast differentiation. We provide preliminary evidence that vaginal fibroblasts might recognize POP-ECMs as scar tissues that need to be remodeled. This is fundamentally important for tissue repair, and provides a rational basis for POP disease modelling and therapeutic innovations in vaginal reconstruction.

Surgical correction is considered in women with symptomatic pelvic organ prolapse (POP). There is an expected increase in the prevalence of surgical correction due to an aging population within the United States. Individuals with previous colorectal surgery present a unique challenge considering the changes in pelvic anatomy. This case discusses the challenges of posterior colporrhaphy in a patient with previous, remote J-pouch surgery. In traditional posterior colporrhaphy, randomized controlled trials have not shown any benefit of graft augmentation (Maher, 2016). However, the utilization of a biologic graft to improve anatomical correction is discussed in this unique case. Short term anatomical success was obtained without immediate complications in the postoperative period. In a patient with a history of ulcerative colitis with colorectal resection and a J-pouch, surgery can be challenging due to alterations of pelvic anatomy. Modification of the standard surgical approach may be required to achieve success.

A 23-year-old patient with an asymptomatic anterior vaginal wall cyst was referred to gynecology for evaluation and treatment. Preoperative assessment with physical examination and magnetic resonance (MR) imaging of the pelvis was most consistent with Gartner’s cyst. Following resection of the cyst wall, histologic evaluation demonstrated endometrial glands, hemosiderin-laden macrophages and inflammation, consistent with vaginal wall endometrioma. This case highlights challenges in the diagnosis of endometriosis in the vagina and in other rare locations, possible mechanisms of development, and proposed treatments., Highlights • Endometriosis implants can occur widely throughout the body, but rarely in the vagina. • Endometrioma is an atypical etiology of a vaginal lesion, and can be asymptomatic. • Preoperative magnetic resonance imaging and histologic evaluation are helpful to characterize the lesion. • Treatment of vaginal endometrioma is with surgical excision of the cyst wall, and recurrence is unlikely.

Robot-assisted surgery is safe and effective to treat the complex pelvic organs prolapse (C-POP). The present study analyzes all the robotic procedures and their advantages in the treatment of C-POP performed in a Proctologic and Pelvic Floor Clinical Centre. All the patients affected by C-POP who had robot-assisted surgery were retrospective analyzed. The anatomical and functional outcomes were respectively evaluated through POP-Q grading system and Wexner score about constipation and incontinence. The satisfaction rate was investigated using a five-point scale. From September 2014 to December 2018, 229 women underwent robotic surgery. The follow-up was 12 months. There were no robot-related complications. One hematoma (4.5%) of the recto-vaginal space occurred after Robotic Ventral Rectopexy with Folded Mesh (R-VRP-FM). In the robotic assisted lateral suspension (R-ALS) group there was one case of anterior vaginal wall mesh exposure (0.9%). After the robotic ventral rectopexy (R-VRP) the recurrence rate of external rectal prolapse, internal rectal prolapse, rectocele and enterocele was respectively 6.6, 9.5, 7.4 and 9.5%. After R-VRP-FM only one cystocele (14%) and one partial rectal prolapse (25%) recurred. Vaginal bulge symptoms resolution rate was 95.4%. The mean Wexner constipation score significantly decreased after R-VRP and R-VRP-FM. Vaginal bulge symptoms improved in 98.3% of cases with any apical prolapse recurrence after robotic abdominal colposacropexy. Success rate after R-ALS was 99.1% and 96.4% for apical and anterior prolapse respectively. Robotic assistance makes some surgical steps easier and more precise and this may result in less morbidity and better results.

Background Determination of the phases of the estrous cycle and induction of estrus (heat) in experimental animals remains useful, especially in reproductive function research. Main body of the abstract This review provides a detailed description and discusses extensively the variations observed in different phases of the estrous cycle in laboratory animals using rats and mice as examples. It also illustrates how these phases can be determined and how to induce estrus ‘heat’ when required. The phases of the estrous cycle can be determined using various methods such as visual assessment, vaginal smear/cytology, histology of female reproductive organs (vagina, uterus and ovaries), vaginal wall impedance assessment and determination of urine biochemical parameters. Female animals can be artificially brought to estrus phase ‘heat’ to make them receptive to male counterparts. Conclusion Determination of the length and phases of the estrous cycle and induction of estrus are useful in teaching and research and evaluating the effects of drugs/chemicals on the reproductive functions.

True pelvic floor areas are uncommon conditions, but they can occur after extensive pelvic surgery including radical cystectomies or pelvic exenteration. We present the case of a patient with a persistent hernia that failed a native tissue repair and required a prosthetic mesh implant as definitive surgical treatment.

It is reported that almost one in five women will need some form of pelvic organ prolapse surgery in their lifetime, with anterior wall repair accounting for nearly half of these. Cystoceles occur secondary to defect(s) in one or more of the vaginal wall support mechanisms, including its lateral paravaginal attachments. Paravaginal defects are very common in women presenting with cystocele, thus highlighting the importance of paravaginal defect repair for optimal cystocele correction in the majority of cases. Although there are several paravaginal defect repair procedures, some entail complex techniques, whereas others rely on the use of transvaginal mesh, which is currently not permitted in many countries. In this video article we present a novel trans-obturator native tissue paravaginal defect repair for the management of cystocele. This procedure has the advantages of avoiding complex transabdominal paravaginal defect repair, the controversial use of transvaginal mesh, or a single-point fixation to an arcus tendineus fasciae pelvis that might be difficult to identify. We believe that the trans-obturator cystocele repair procedure offers several advantages over existing paravaginal defect repair alternatives.

To determine the association of opening the paravesical space in relation to its occurrence of de novo SUI in an animal model. Thirty five female Sprague Dawley rats were divided into 5 groups of 7 rats each: Control group, Sham groups(F, H), and Study groups(MF, MH). Groups labeled with “F” had the paravesical space opened, “H” had tissue dissection with no opening of the space, and “M” had mesh implanted inside the vaginal wall. Urodynamic studies, immunohistochemical analysis, and western blot were done at day 40. The mean weight and age of 35 rats were 302.1 ± 25.1 grams and 12.8 ± 1.2 weeks old. No significant differences were noted among the control, Sham F, Sham H, Study MF, and Study MH on the voiding pressure and voided volume. The Sham F and Study MF (opened paravesical space) groups had significantly lower values on leak point pressures (LPP) (p = 0.026; p

Summary Introduction The innovation of robotic surgery has transformed many specialties across the surgical field. Plastic surgeons work jointly with many disciplines to provide reconstructive services. Hence, it is important to embrace this novel technology and be familiar with it. We present our experience of vaginal reconstruction with robotic assisted flap inset. To our knowledge, this is the first report of using this technique in perineal reconstruction. Methods A retrospective chart review of two patients who underwent robot assisted perineal reconstruction utilising the Singapore flap was conducted. Data collection included patient demographics, type of tumour, size of resection and defect, and operative technique. Results Two patients diagnosed with bladder neck tumours were managed with robotic partial cystectomy, urethrectomy and excision of anterior vaginal wall with subsequent vaginal reconstruction utilizing the Singapore flap in both cases. The flap was raised through a standard open approach. The inset of flap was carried out utilising the Da Vinci Robot allowing the surgeon to obtain access to the proximal vagina in the retroperitoneum. This technique of flap inset did not add to the total operative time. At follow up both patients had healed well with no flap complications. Conclusion This report highlights our experience using robotic assisted techniques to augment flap inset in a narrow operative field. This technique is now routinely used in our unit for cases undergoing robotic surgery in conjunction with the urology team. It allows good access and relative ease of suturing in what was previously a difficult and slow procedure.

BACKGROUND The FIGO Working Group (FWG) in Pelvic Floor Medicine and Reconstructive Surgery (2012-2015) established a consensus among international opinion leaders in evaluating current evidence and providing practice recommendations. OBJECTIVES To provide an update of the previous clinical opinion report on conservative and surgical treatment of posterior compartment prolapse. SEARCH STRATEGY Search of evidence was performed using Pubmed, Embase, and Cochrane Library databases up to August 2018. SELECTION CRITERIA Controlled trials on posterior colporrhaphy, site-specific defect, transanal, abdominal, laparoscopic, and mesh repair. DATA COLLECTION AND ANALYSIS Collective consensus on surgical outcomes was based on a decision-making process during meetings and multiple group consultations. MAIN RESULTS Basic evaluation and conservative treatment precede surgical management. Surgical techniques are performed by vaginal, transperineal, transanal, abdominal, or laparoscopic approach. The transvaginal surgical route without mesh appears superior to the transanal route. No conclusions can be drawn based on clinical studies or randomized controlled trials of posterior colporrhaphy and laparoscopic rectopexy. CONCLUSIONS Management of rectocele should include patients' history, quality of life questionnaires, and, in case of complex anorectal symptoms, imaging and functional studies. Evidence on the best type of posterior vaginal wall repair is still scarce. Randomized controlled trials are needed to determine the best approach to achieve safe, effective, and long-term anatomical and functional outcomes.

Rectoceles involve herniation of the anterior rectal wall through the rectovaginal septum and into the posterior vaginal wall. They are often found in females, rarely in men, and may or may not be related to evacuatory disorders. Since the immediate cause of rectoceles is not completely known, the baseline prevalence has not been well established, and due to the concurrence of both vaginal and rectal symptomatology, cases are under the care of either gynecologists, colorectal surgeons, or both. Rectoceles are often asymptomatic, but when symptoms do arise, it can be debilitating, affecting daily life. A working knowledge of anatomy, symptomatology, medical therapies, and surgical options are necessary in the proper diagnosis and treatment of a rectocele. The ultimate goal in any surgery is restoration of function; techniques for accomplishing this will be discussed.

Sexual crimes are serious crimes and evidence of violations of Human Rights (HAM). Based on data from the National Commission on Violence Against Women in 2018 in 2019 it appears that violence against women has increased by 406,178 cases, up about 14% compared to the previous year. Sexual crime is an event that is difficult to prove even though the case has been carried out an examination and collection of complete evidence. The following is a case report of a 29-year-old woman suspected of having been raped coming with the investigator bringing SPVR number: VER / A / 144 / VIII / 2019 / SPKT to the Emergency Hospital Installation Dr. Soetomo Surabaya on Friday, Agst 09, 2019. In the results of the examination of intercourse burrows were found long rips to the bottom at one, five and seven o’clock. Examination of irrigation preparations and vaginal wall swabs found spermatozoa. Sexual crime most often involves the act of intercourse that is marked by the penetration of male genital organs (penis) into the female genetal organs (vagina). In an effort to prove that intercourse has taken place, Forensic Medicine has an important role in proving efforts to obtain an explanation of events that occur medically. A clear proof that there has been a medical intercourse is getting spermatozoa in the woman’s intercourse in question. The article relating to this case is the Criminal Code Article 280,281,289 and 290.

Vaginally assisted laparoscopic sacrocolpopexy (VALS) is a combined vaginal and laparoscopic surgical approach that has been described for the treatment of women with a uterus who suffer from severe multicompartmental pelvic organ prolapse (POP). The aim of this study is to evaluate the long-term anatomical and functional outcomes and report the long-term mesh-related complications. This was a single-center prospective study of women with advanced POP who underwent VALS with at least 3 years of follow-up. The primary outcome was “composite surgical success” defined as: (1) no descent of the vaginal apex (point C) more than one-third into the vaginal canal and no anterior or posterior vaginal wall beyond the hymen (Ba and Bp

Objective The aim of this study was to analyze quantified displacements of the posterior vaginal wall (PVW) on dynamic magnetic resonance imaging (MRI), which may generate hypotheses for the detailed mechanisms that underlie the development of posterior vaginal prolapse. Methods Pelvic dynamic MRI scans were obtained for 12 women with normal vaginal structure (stage 0) and 62 women with 4 consecutive stages (1-4) of posterior vaginal prolapse. Structural locations (apex vagina, distal vagina, and mid-perineal body [PB]) and equidistant points along the PVW (points 4-6 were considered as midvagina) were identified, and PVW length, straight distance of PVW, levator ani parameters (levator hiatus length [LHL], levator hiatus width [LHW], levator plate angle, anorectal angle, and M line [ML]), urogenital hiatus, and prolapse diameter were measured at rest and maximal Valsalva, respectively. The displacement of these measurements was obtained. Results From stage 0 to 2, the variables LHL, LHW, levator plate angle, anorectal angle, and ML increased gradually, but midvagina, distal vagina, and mid-PB were the opposite. From stage 2 to 3, apex vagina, midvagina, distal vaginal, mid-PB, LHL, LHW, and ML raised rapidly and peaked at stage 3, then declined at stage 4. In addition, the correlation coefficients between each measurement from stage 2 to 3 were statistically higher than those from stage 0 to 2. Conclusions Quantified displacements of the PVW and its supporting structure were shown on dynamic MRI, and the mechanical mechanisms were hypothesized regarding the interaction between pressure and the support force contributing to the deformation of the PVW and the supporting structures.

This study is to evaluate the efficacy and safety of vaginoscopic incision of oblique vaginal septum in adolescents with Obstructed hemi-vagina and ipsilateral renal agenesis (OHVIRA) syndrome. It is about Fourteen adolescents with OHVIRA syndrome managed by vaginoscopic incision of the oblique vaginal septum using a “No-touch” technique over an 8-year period. In all fourteen adolescents with OHVIRA the oblique vaginal septum was incised successfully without any intraoperative complications. Postoperative pain was unremarkable and each patient’s symptoms resolved postoperatively. The 3-month postoperative follow up office vaginoscopy revealed that the vaginal septum had not reformed nor was any vaginal stenosis noted. Vaginoscopic incision of the oblique vaginal septum using a “No-Touch” technique is a safe, minimally invasive, and effective approach for treating OHVIRA syndrome in adolescents with hematocolpos. This technique may be utilized to minimize disruption to the undeveloped vaginal wall and postoperative pain while providing excellent surgical visualization throughout the procedure.

Aims Sacrocolpopexy (SCP) is an extensively studied and highly efficacious treatment for female pelvic organ prolapse (POP). We aimed to analyze the technical steps for performance of a SCP among all RCTs in the literature that compared it with different procedures, or that studied different routes for performing SCP. Methods Systematic review searching electronic databases for RCTs only. We extracted data for 13 points of interest; main outcomes were procedure standardization; depth of vaginal dissection; number of sutures in the vaginal wall; type of suture in the vaginal wall; type of mesh fixation to the sacrum; and type and shape of mesh used. Results Twenty-two RCTs were included. Most of them did not provide a full standardized description of the procedure steps. There was great heterogeneity in almost all steps of the operation, including the choice of materials for attaching the mesh to the vagina and sacrum-with both absorbable and non-absorbable sutures being used-and the extent of vaginal dissection for mesh fixation, with some studies dissecting only the apex, superficially, while others performed a full-length dissection. Choice of mesh material was more consensual, with polypropylene mesh being the most commonly used. Conclusions SCP is a highly unstandardized procedure in the literature, albeit being used as a major comparator. Various RCTs compared alternative procedures with SCP, but the technical aspects have varied greatly, and studied outcomes could have been potentially influenced by these technical choices.

Objective The aim of our study is to reveal the correlation between the posterior vaginal wall and apex in pelvic organ prolapse. Methods We retrospectively reviewed the records of all new patient visits to a urogynecology clinic between January 2013 and December 2015. Results Four hundred five cases were enrolled in our study. When all POP stages were included, the Bp (pelvic organ prolapse quantification point) had a moderate correlation with the C (Pearson's r=0.419; P

During vaginal hysterectomy, extraperitoneal uterosacral ligament suspension (ULS) bites can be taken before removing the uterus. We evaluated this modified extraperitoneal ULS for vault prolapse prevention. Study period was 3.5 years. Fifty-one women with third- and fourth-degree prolapse were enrolled. An inverted V incision was made on the anterior vaginal wall and continued as a semicircular incision on the posterior vaginal wall. Lateral vaginal mucosa was pushed up to expose the cardinal–uterosacral ligament complex. The first ULS suture, using polypropylene no. 1, was taken in the upper-most exposed area of the uterosacral ligament. The second suture, using polyglactin no. 1 or 0, was taken 0.5–1 cm below the first suture. During placement of both sutures, traction on the cervix was maintained. The cardinal–uterosacral ligament complex was clamped, dissected, and ligated 1 cm below the second suture. Vaginal hysterectomy was completed. Ends of the ULS suture were fastened to the vault via vesicovaginal and rectovaginal septum using polypropylene within and polyglactin outside vaginal mucosa. Prolapse stage was 3 in 42 cases and 4 in nine. Duration of operation ranged from 60 to 120 min. Blood loss was 100–300 ml. During follow-up (average 2.3 years) four (8.3%), cases had stage 1 pelvic organ prolapse (POP), three were lost to follow-up, and 44 (91.6%) had no POP. Using the cervix as a traction device is a good option when performing extraperitoneal ULS during vaginal hysterectomy to prevent vault prolapse.

Objective To evaluate the impact of repair of uterovaginal prolapse using sacrospinous hysteropexy and vaginal wall repair on the bladder function. Study design The study was conducted at the urogynecology clinic of Suez Canal University Hospitals, Ismailia from January 2014 to March 2016. This study included women with a diagnosis of uterovaginal prolapse and wishing to preserve their uteri. Bladder function was evaluated through assessment of urological symptoms using a standardized questionnaire – the urogenital distress inventory (UDI-6) – in addition to urodynamic studies just before and six-months after the sacrospinous hysteropexy ± associated vaginal wall repair operation. Results Twenty-seven patients completed the study with a mean age of 36.5 ± 4 years. Only 3 women had sacrospinous hysteropexy with no additional procedures. Other procedures included anterior colporrhaphy (12), posterior colporrhaphy (9) and perineorrhaphy (15). Based on UDI-6, there was no significant difference between the pre- and post-operative symptoms of stress urinary incontinence (SUI) [8/27 (29.6%) vs. 9/27 (33.3%) respectively; p value = 0.7]. The pre- and post-operative symptoms of urge urinary incontinence were also insignificantly different [13/27 (48.1%) vs. 15/27 (55.5%); p value = 0.5]. The total score of UDI-6 increased from 24.5 ± (14.2) to 32.8 ± (29.4) which was not statistically significant ( p value = 0.12). Urodynamically, voiding dysfunction was found less frequently after the operation, however the difference was statistically insignificant [9/27 (33.3%) vs. 8/27 (29.6%); p value = 0.7]. Conclusion Sacrospinous hysteropexy and associated vaginal wall repair do not affect the bladder function either subjectively or objectively.

Rectovaginal fistula caused by a tension-free vaginal mesh (TVM) is a rare condition. Moreover, a rectovaginal fistula is a challenging issue to address for surgeons regardless of causes. Due to a low rate of occurrence, treatment modality for a rectovaginal fistula caused by a TVM has previously received little attention. A successful surgery using several key techniques to address a rectovaginal fistula caused by a TVM is herein reported. A 78-year-old woman who underwent a TVM for a rectocele three months ago was referred to our hospital with a two-month history of anal bleeding. Mesh protruding into both the vagina and the rectum was confirmed. The patient was operated on under diagnosis of a rectovaginal fistula caused by TVM. TVM was removed by transvaginal dissection of the rectovaginal septum with division of both anterior and posterior arms of the TVM. Layer-to-layer sutures of rectal and vaginal walls were crossly performed with a drain placed in the rectovaginal septum after saline irrigation followed by a covering sigmoid colostomy. The wound healed without infection after surgery, and a water-soluble contrast enema demonstrated the healing of the rectovaginal fistula two months after surgery. No recurrent fistula was confirmed 15 months after stoma closure.

Native tissue vaginal repairs are associated with relatively high levels of recurrence. Systematic reviews have noted that preoperative pelvic floor muscle strength was associated with increased risk of recurrence in the short term. This is a retrospective review of patients who underwent a primary reconstructive surgery for anterior compartment vaginal prolapse between 2001 and 2015. Patients were divided into “absent,” “weak” and “good” preoperative PFM strength (aPFM, wPFM and gPFM, respectively) based on a modified Oxford scale. Failure rates were determined by a composite of subjective and objective anatomic outcomes. Subjects who underwent re-operations or procedures for recurrent prolapse of the anterior compartment were considered failures. A p value < 0.05 was considered statistically significant. Two hundred ninety-nine patients were included. The aPFM (n = 36), wPFM (n = 115) and gPFM (n = 148) groups had similar descriptive statistics, except subjects in the aPFM and wPFM groups were significantly older than the gPFM group (p = 0.008). All groups underwent similar reconstructive surgeries. Average length of follow-up of 143.9 weeks (41 to 717 weeks) was similar among the three groups (p = 0.472). For the primary outcome of composite failure, aPFM had significantly more anterior vaginal wall recurrences than both the wPFM and gPFM groups, 13.89% vs. 3.48% and 4.05%, respectively (p = 0.033). Patients with preoperative absent pelvic floor muscle strength (nonfunctioning PFM) had a significantly higher anterior vaginal wall recurrence rate than those with weak or good pelvic floor muscle strength.

Minimally invasive platforms have afforded women undergoing hysterectomy the advantages of improved postoperative pain control, reduced complication rates, and shorter inpatient recovery time. In patients where malignancy has been confirmed or suspected, the necessity for uterine delivery per vagina is imperative to maintain these advantages without compromising oncological outcome.A previously unreported technique of enlarging the apical circumference of the vagina during robotic hysterectomy facilitates intact uterine passage after extended reflection of the bladder and/or rectum. Significant increases in vault circumference can be gained through even small midline incisions of the vaginal wall, with an additional 5-cm incision almost doubling the apical aperture in certain cases.We present our series of 21 cases that support this safe, reliable, and simple method for intact uterine delivery during robotic hysterectomy in minimally invasive gynecological oncology practice.

Aims: To evaluate smooth muscle cells (SMCs) proliferation and elastin and collagen production after heat exposure (65°C). Methods: Samples were taken from the anterior vaginal wall, SMCs were cultured, and heated to 65°C for 30 and 60 s. Cell proliferation was assessed; tropoelastin and collagen production was measured. Results: Heat does not affect SMC proliferation at 65°C neither at 30 nor at 60 s. Surface-deposited elastin level was significantly increased after heat exposure (mean ± SD, 30 s 155 ± 5% of control [p < 0.01] and 60 s 516 ± 40% of control [p < 0.01]). Tropoelastin levels in the culture media were significantly lower after 60 s of heat exposure (mean ± SD, 30 s 102 ± 5% of control [p = ns] and 60 s 70 ± 2% of control [p = 0.04]). Significant increase in surface-deposited collagen production was found (mean ± SD, 30 s 170 ± 6% of control [p < 0.01] and 60 s 123 ± 6% of control [p < 0.01]), but no such elevation was measured in the media after heat exposure (mean ± SD, 30 s 120 ± 20% of control [p = ns] and 60 s 100 ± 20% of control [p = ns]). Conclusion: When SMCs are exposed to heat there is significant elevation in collagen and elastin production. Changes in the composition of the extracellular matrix after heat exposure may contribute to vaginal wall remodeling.

This study aimed to investigate the dynamics of the vaginal wall dose for interstitial brachytherapy (ISBT). A patient undergoing ISBT was selected as the patient case. The phantom case was generated to simulate the patient case in all regards with the exception of parallel needle positions. The vaginal wall was contoured as a 0.5-cm expansion around the vaginal surface of the obturator. The prescribed ISBT dose was 20 Gy in 4 fractions. Six treatment plans were generated by modifying relative dwell times and needle positions (DTNP). The volume of the vaginal wall receiving > 150% of prescription dose (V > 150% ) and D 2cc of the vaginal wall were compared among plans. The V > 150% was much larger in the patient case (49.3%) due to unparallel needles compared with the phantom case (14.3%) without modification (plan 1). Among the 6 plans, reduced dwell time (plan 3) and no dwell time (plans 5 and 6) on the vaginal surface needles had the lowest vaginal wall doses with the use of a central obturator needle in both cases. In comparison of patient case plans 1, 3, 5, and 6, V 150% was 49.2%, 19.0%, 21.3%, and 28.7%, respectively, and D 2cc was 41.15 Gy, 33.10 Gy, 36.51 Gy, and 34.37 Gy, respectively, which was limited around each loaded needle. Modification of DTNP is able to reduce the vaginal wall volume exceeding 150% of the prescription dose in the patient case. Understanding these dynamics of the vaginal wall dose will improve dose optimization of ISBT and may reduce vaginal morbidities.

Background Female urethral stricture is a rare condition. Different types of urethroplasty have been described. However, high quality studies are sparse. The most common technique used—the Blandy's technique—has resulted in our cases in a retrusive meatus and an inward urinary stream. Objective To show the efficacy and safety of an alternative vaginal wall flap urethroplasty. Design, setting, and participants A cross-sectional observational study was undertaken in a single University Hospital. Nine female patients previously diagnosed with urethral stricture at our institution underwent open surgery from 1993 to 2015. They were contacted and agreed to undergo a medical examination. Surgical procedure A ventral lateral-based anterior vaginal wall flap urethroplasty inspired by the Orandi technique for male urethroplasty was performed. Measurements A chart review was performed. Results and limitations The mean age was 56 yr (41–78 yr). The mean follow-up was 80.7 mo (12–198). All patients had relief of symptoms. The meatus of all patients stayed in an orthotopic position without any impact on the direction of the urinary stream. The average caliber of the urethra increased from 10.8 Fr (6–18 Fr) to ≥20 Fr. Peak flow improved from a mean of 6.8ml/s (3–11ml/s) to 21ml/s (14–35ml/s). No patient developed stricture recurrence or de novo stress urinary incontinence. There were no other immediate or delayed complications. All patients achieved a better score on the Patient Global Impression of Improvement questionnaire. Conclusions Our study, with the same limitations that the few studies published in this field had, that is the few patients included, demonstrates that lateral anterior vaginal wall flap urethroplasty is an effective technique, offering durable results without apparent complications. Patient summary We studied an alternative surgical technique for the treatment of female urethral stricture. We conclude that it is safe and effective with no apparent complications and good long-term results.

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Purpose/Objective(s) Tissue spacers, including vaginal wall spacers, are used in a number of cancer diagnoses including soft tissue sarcomas, prostate cancer, cervical and uterine cancers. In proton therapy, the benefit of tissue spacers can be even greater as the device can serve as a beam stopper where protons reach their end of range in the material of the spacer instead of adjacent tissues. Materials/Methods Commercially available hollow vaginal spacers which come in sizes ranging from 1.46 cm to 3.65 cm in diameter were filled with air-free silicone in a custom-made vacuum chamber. Two adolescent patients with pelvic soft tissue sarcomas receiving proton therapy were CT-simulated with and without a vaginal spacer. The relative stopping power of silicone was measured in a water tank to estimate the water equivalent thickness from 1.56 cm to 3.91 cm used in the treatment planning system for dosimetric comparisons. The dosimetric advantages of the silicone-filled vaginal spacer were investigated in three different dosimetric scenarios: (1) no vaginal spacer, (2) hollow vaginal spacer, (3) silicone-filled vaginal spacer in terms of plan quality and sparing of contralateral vaginal wall during primary and boost phases for two patients. Results While the target coverages remained comparable for the phase I (CTV, Rx = 36 Gy) and the phase II (GTV, Rx = 59.4 Gy), the dose distributions of ipsilateral and contralateral vaginal walls varied across these scenarios. After the phase II, the dosimetric sparing of contralateral vaginal wall was chiefly achieved in the patient A as the mean dose was 8.4 Gy with the silicone-filled spacer, and 17.1 Gy with hollow spacer, and 30.8 Gy with no spacer. However, due to the size and location of the tumor relative to the vagina, the sparing of contralateral vaginal was not observed in the patient B. While the patient A had a unilateral tumor with smaller GTV volume (23.3 cc) irradiated by straight lateral and posterior beams, the patient B had bilaterally located larger GTV volume (342.2 cc) covered by two posterior oblique beams. Conclusion The study suggested that when the vagina is adjacent but located distal to the tumor, a significant dose reduction can be achieved with the insertion of a silicon-filled vaginal spacer.

The incidence of pelvic organ prolapse (POP) is increasing in our aging society. We aimed to evaluate the clinical usefulness of translabial ultrasound (TLUS) by comparing the findings of POP-Q examination and TLUS in advanced POP patients and we also aimed to evaluate the prevalence of rectocele and enterocele on the TLUS. We analyzed the TLUS and POP-Q exam findings of 363 symptomatic POP patients who visited our clinic from March 2019 to April 2021. We excluded three patients who had conditions mimicking POP, as revealed by the TLUS. The most common POP type was anterior compartment POP (68.61%), followed by apical compartment (38.61%) and posterior compartment (16.11%) POP. Agreement between the POP-Q exam and TLUS was tested using Cohen’s kappa (κ). p values &lt, 0.05 were considered statistically significant. The incidence of rectocele or enterocele was only 1.67% (6/360) and there was no rectocele or enterocele in most patients (246/252, 96.63%) when the POP-Q exam revealed posterior compartment POP, suggesting that they only had posterior vaginal wall relaxation. The positive predictive value of the POP-Q exam for detecting rectocele or enterocele (as revealed by TLUS) was only 2.38%, whereas the negative predictive value was 100%. In conclusion, the application of TLUS is useful in the diagnosis of POP, especially for differentiation of true POP from conditions mimicking POP. The correlation between the POP-Q exam and TLUS is low, especially in posterior compartment POP, and therefore, patients with POP-Q exam findings suggesting posterior compartment POP should undergo TLUS to check for rectocele or enterocele. The use of TLUS in the diagnosis of POP patients can improve the accuracy of the diagnosis of POP patients in conjunction with a POP-Q exam.

Introduction The G-spot, a putative erogenous area in the anterior vaginal wall, is a widely accepted concept in the mainstream media, but controversial in medical literature. Aim Review of the scientific data concerning the existence, location, and size of the G-spot. Methods Search on Pubmed, Pubmed Central, Cochrane, clinicaltrials.gov and Google Scholar from inception to November 2020 of studies on G-spot's existence, location and nature. Surveys, clinical, physiological, imaging, histological and anatomic studies were included. Main Outcome Measure Existence, location, and nature of the G-spot. Results In total, 31 eligible studies were identified: 6 surveys, 5 clinical, 1 neurophysiological, 9 imaging, 8 histological/anatomical, and 2 combined clinical and histological. Most women (62.9%) reported having a G-spot and it was identified in most clinical studies (55.4% of women); in 2 studies it was not identified in any women. Imaging studies had contradictory results in terms of its existence and nature. Some showed a descending of the anterior vaginal wall, that led to the concept of clitourethrovaginal complex. In anatomic studies, one author could systematically identify the G-spot, while another group did not find it. Studies on innervation of the vaginal walls did not systematically identify an area with richer innervation. Conclusion The different studies did systematically agree on the existence of the G-spot. Among the studies in which it was considered to exist, there was no agreement on its location, size, or nature. The existence of this structure remains unproved. Vieira-Baptista P, Lima-Silva J, Preti M, et al. G-spot: Fact or Fiction?: A Systematic Review. Sex Med 2021;9:100435.

A externalização de órgãos internos em peixes tem sido registrada ao longo do tempo na literatura científica. Grande parte dos registros está relacionada à eversão ou protrusão do estômago e/ou intestino, devido principalmente ao barotrauma. Porém uma pequena parcela dos registros é referente a diversas causas naturais. O presente estudo teve como objetivo registrar a ocorrência de um raro evento de eversão vaginal na raia anã espinhosa Psammobatis rutrum. Em 15/06/2020 três exemplares (2 fêmeas e 1 macho) foram capturados como fauna acompanhante da pesca de parelha nas proximidades da Barra de Santos SP, com profundidade média de 27 metros. Dentre eles, uma exemplar fêmea apresentava uma protrusão via abertura cloacal. Através de necropsia, avaliação comparativa e estudo das vias reprodutivas foi identificado que o órgão externalizado era a parede vaginal. Embora existam muitos registros de externalização de órgãos de Elasmobranchii, principalmente relacionados ao comportamento natural de eversão do estômago e intestino, apenas um registro deste tipo de evento foi reportado para órgão reprodutivo. Não foi possível identificar a causa da eversão vaginal, porém tal evento está associado a um quadro de prolapso pélvico, que pode ter sido intensificado por causas naturais ou devido a captura.

In this study, the reproducibility and validity of an automated artificial finger for evaluating properties of vaginal wall tissue was assessed. The effect of angle and rate of indentation on displacing the anterior vaginal wall (AVW) was studied in control and prolapse patients. Following IRB approval, an automated artificial finger equipped with a calibrated piezoresistive sensor at its tip was used to induce 3-second AVW deformation sequences (10°, 15°, and 20° indentation). Measurements were taken in patients in supine position, either awake in clinic or under anesthesia in the operating room (OR). The real time voltage output of a sensor (linearly proportional to the reaction force) was recorded for each motion profile to calculate key parameters: baseline voltages, amplitude changes over indentation intervals, and slopes of indentation curves. 23 women (9 controls and 14 prolapse) were studied, 6 in clinic and 17 in OR. No differences in mean reproducibility was noted across groups. There was a significant difference in sensor output based on selected motion profile parameters between different degrees of indentation for all women (p 0.001) and in baseline voltage between age-matched and non-age-matched controls (p 0.02). From these findings, we can conclude that indentation reaction properties of prolapsed and non-prolapsed AVW can be objectively measured using an operator-independent artificial finger with significant differences between patient groups.

For examining pig ovaries, which have complex structures, laparoscopy is a useful technique, but requires general anesthesia; therefore, it cannot be performed repeatedly within a short period of time. We report a transvaginal endoscopy-based technique for conducting ovarian examinations without general anesthesia. Sows were sedated in pig stalls. Using a colonoscope, the vaginal wall was punctured with a trocar. To avoid the trocar being caught in the broad ligament of the uterus or the connective tissue around the vagina, the trocar was inserted close to the external uterine os and between the 2:00 and 3:00 or the 9:00 and 10:00 positions (in a clockwise direction). Then, a urethroscope was inserted into the abdomen, and an examination was carried out after the ovaries had been moved towards the urethroscope camera via rectal palpation. This less invasive procedure may allow repeated examinations and will increase our understanding of ovarian dynamics in pigs.

BACKGROUND The vaginal wall like the endometrium of the uterus shows variations in wall thickness in response to oestrogen levels.1,2 Postmenopausal decline in vaginal thickness has been documented in myriad studies.2 Limited published work exists, however, that documents ultrasound assessment of vault thickness.3,4 The aim of the study is to evaluate and compare the vaginal mucosal and wall thickness in postmenarcheal adolescents, newly wed and postmenopausal female subjects by transabdominal sonography. MATERIALS AND METHODS Ultrasound findings of 188 female subjects with regard to vaginal wall and mucosal thickness (VWT and VMT, respectively), who underwent abdominal ultrasonography for trivial abdominal symptoms or as a routine/baseline study over a three month period were analysed. RESULTS A total of 188 female subjects were examined. 48 of these were postmenarcheal adolescents in the 12-15 years age group, 66 were recently wedded young adult subjects in the 20-25 years age group and 74 were postmenopausal females in the 50-75 years age group. Statistically significant differences in VWT and VMT were noted between the three groups. VMT and VVT for postmenarcheal adolescents were 0.8-1.5 mm and 6.2-8.1 mm, respectively. VMT and VVT for recently wedded female subjects were 0.9-2.5 mm and 7.8-21.4 mm, respectively. VMT and VVT for postmenopausal subjects were 0.4-0.8 mm and 4.4-6.8 mm, respectively. CONCLUSION The study suggests that mucosal and wall thickness are maximal in early adult life, minimal in the postmenopausal period and intermediate in early adolescence. A variety of factors are probably responsible, viz. the role of oestrogens and other hormones, vaginal blood flow and mucosal congestion. The variations between wall thickness in young newly-married females and the other two groups suggests that sexual activity has a aetiologic role in the increase in wall and mucosal thickness in this age group.

Objective As life expectancy increases, the number of women reporting adverse genito-urinary symptoms (genitourinary syndrome of menopause; GSM) from menopause, including vaginal dryness and sexual pain, also will increase. Current objective measurements of vaginal atrophy such as maturation index require vaginal swabs and are invasive; at present, no minimally invasive measurements exist. The purpose of this study was to assess whether total vaginal wall thickness (TVT) and total vaginal mucosa thickness (TMT) as measured by transabdominal ultrasound could qualify as additional objective markers of vaginal wall thinning which could be related to menopausal status. Design Women presenting for pelvic ultrasound had a transabdominal ultrasound scan performed to measure TVT and TMT at the level of the bladder trigone. In addition, a transvaginal endometrial lining thickness was measured. Results The ultrasound measurement data from 76 participants showed that there was a significant difference in the mean value for TVT and endometrial lining between pre- and post-menopausal women. The same difference in mean was not observed for TMT. Conclusion TVT may be a reliable measure of vaginal thinning, which worsens with estrogen decline. These preliminary data also suggest that TMT does not have the same correlation as the TVT measurement. A larger sample is needed to further assess the usefulness and sensitivity of these measures and whether there is clinical and/or research usefulness in obtaining vaginal wall measurements by transabdominal ultrasound.

SummaryBackground and objective Vaginal childbirth, natural process of aging, congenital factors, and surgical interventions are considered the main causes of vulvo-vaginal laxity driven by changes in collagen and elastin fibers. This causes a loss of strength and flexibility within the vaginal wall. As a result, women may experience lack of sensation and stress urinary incontinence (SUI)—the condition of involuntary loss of urine associated with activities that cause an increase in intra-abdominal pressure (eg, sneezing, coughing, and lifting). Both vaginal laxity and urinary incontinence significantly affect patients' quality of life (QoL). The aim of this study was to evaluate efficacy and safety of a noninvasive radiofrequency device when used to treat SUI and vulvo-vaginal laxity through its heating effect which stimulates collagen and elastin fibers. Methods Twenty-seven women (average age 44.78±10.04 years) with indications of mild/moderate SUI as well as vulvo-vaginal laxity were treated with a monopolar radiofrequency device. The treatment course consisted of three once-a-week sessions. Each session included intravaginal treatment followed by treatment of labia majora and the perineum. Improvement in the SUI condition was evaluated by applying the International Consultation on Incontinence Questionnaire - Urinary Incontinence Short Form (ICIQ-UI SF). Data were collected at the baseline, after the last treatment and at 1-month follow-up visit. Vaginal laxity was assessed by subjective vulvo-vaginal laxity questionnaire (VVLQ). Data were collected before the 1st treatment and during the 1-month follow-up visit. Patient's satisfaction was recorded using a satisfaction questionnaire. Data were collected after the last treatment and at the 1-month follow-up visit. Any adverse events related to the treatments were monitored. Results On a scale of 0 to 5, the average frequency of urine leak improved from “2-3 times a week” (2.15±1.03 points prior to treatment) to “once a week” (1.00±0.78 points post-treatment), and on to “never” (0.44±0.51 points at the 1-month follow-up visit). Sixteen subjects (59.3%) reported decrease in the amount of leakage, with 15 women (55.6%) becoming completely leak-free at the 1-month follow-up. At the 1-month follow-up visit, 24 subjects (88.9%) expressed their condition's interference with everyday life decreased and 17 patients (62.9%) said the condition did not interfere with their everyday life at all as a result of the treatment. All results are statistically significant (P

Pelvic organ prolapse is a fairly common condition that imposes significant symptoms, diminished quality of life, social burden, financial expense, and surgical risk on women. As evidence supporting the benefit of pelvic-floor muscle training in nonsurgical management of pelvic organ prolapse grows, physical therapists are becoming a provider of choice interacting with women affected by pelvic organ prolapse. This perspective article will review recent research on tissue characteristics of 3 key components of pelvic organ support: skeletal muscle, ligament, and vaginal wall. This information will be summarized as implications for physical therapists. An improved understanding of pelvic-floor tissue in women with and without pelvic organ prolapse will provide a more comprehensive appreciation of the interaction of multiple systems in the disorder.

Gynecologist and plastic surgeons pioneered the application of lasers in medicine and surgery almost 5 decades ago, initially used to treat cervical and vaginal pathologies. Ever since, energy-based devices have been deployed to treat pelvic pathologies and improve fertility. Recent technological developments triggered an unprecedented wave of publications, assessing the efficacy of fractional laser, and radiofrequency on the vaginal wall in reversing natural aging processes. Studies have shown that a certain degree of thermal energy deposited on the vaginal wall stimulates proliferation of the glycogen-enriched epithelium, neovascularization, and collagen formation in the lamina propria, and improves natural lubrication and control of urination. This review aimed to review such data and to guide future research. A unique assembly of experts from around the globe, compiled and edited this manuscript based on a thorough literature review and personal experience. Lasers Surg. Med. 49:137-159, 2017. © 2017 Wiley Periodicals, Inc.

The aim of this paper is to present the new laser technology using erbium laser JAG various minimally invasive, non-surgical procedures in gynecology. The laserhas its effect through photothermal action, leading to reconstructtion and stimulation of new collagen synthesis in the vaginal walls and fascia of the pelvic floor muscles. This results into hardening and tightening of the vaginal walls, which contributes to better leverage of the bladder and urine retention. In gynecology this laser treatment is used for treatment of vaginal walls failure, stress urinary incontinence, pelvic organ prolapse and vaginal atrophy. From 2010 to 2014 several clinical studies were conducted, all of them about the use of laser in the treatment of these 4 conditions and the aim was to confirm the efficacy and safety of this technology. The results showed that SMOOTH mode erbium laser is an effective and safe method for treatment of vaginal walls weakness, stress urinary incontinence, pelvic organ prolapse and vaginal atrophy.

On the basis of a comprehensive study of the clinical and laboratory parameters of a comparative assessment of the effectiveness of operations subtotal hysterectomy with excision of muco-muscular cervical flap by using transvaginal mortsellyator and total hysterectomy about benign combined pathology of the cervix and uterine body. Depending on the extent of surgical treatment 2 groups of women were formed, who have had total hysterectomy and subtotal hysterectomy with excision of muco-muscular cervical flap by using transvaginal mortsellyator. As a result of further examination revealed the benefits of subtotal hysterectomy with excision of muco-muscular cervical flap: the duration of the operation, blood loss, and drop in hemoglobin levels after surgery. Preserving the anatomical relationship of the pelvic organ, saving ligament apparatus and cervical innervations save vaginal integrity, reduce the risk of complications in the form of descent and prolapse of the vaginal walls in the late postoperative period, which will undoubtedly improve the quality of life of women.

Sarcophaga disputata Lehrer, 1967 is a poorly known Central European species. A detailed redescription of the male with a morphological study of the genitalia using light and electron microscopy was carried out. A terminology of different structures of the phallosome of Sarcophagini is discussed. A hypothesis is proposed suggesting that specific areas near the base of the gonites, which are covered with numerous yellow microtrichiae, are important points of contact with the vaginal wall; and that juxtal lateral spaces with apical openings serve to guide the lateral styli during copulation.