A Rare Case of Prolapse Uterus.

Prolapse is the commonest complaint in elderly females. We present herein a case of procidentia with more than 200 stones in bladder of varying size, treated with vaginal hysterectomy and vesical calculi removal through bladder (abdominally).

Anterior bladder flap neo urethra as treatment for stress urinary incontinence due to developmental urogenital anomaly

Congenital anomalies that involve the distal segment of urogenital sinus [giving rise to female urethra and vagina] may lead to abnormal urethral development ranging from absent to markedly deficient urethra. The abnormal division may also cause a short and patulous urethra. Sphincteric defects are likely to be associated and when combined with the short urethral length is a cause for severe urinary incontinence. Urinary incontinence due to a congenital cause requiring repeated urethral reconstruction to relieve symptoms is presented. A 15 year old girl was referred for bothersome urinary incontinence due to a short, wide, patulous urethra with defective sphincteric mechanism as part of urogenital sinus developmental anomaly. She was initially managed by reconstruction of bladder neck and proximal urethra with sphincter augmentation using autologous pubovaginal sling. Persistent urinary incontinence demanded a second urethral reconstruction using tubularised anterior bladder flap [modified Tanagho]. Surgical reconstruction of the urethra achieved socially acceptable continence.

Recurrent Urovaginal Fistula: A Sequel of Missed Ureteral Involvement.

A 44-year-old multipara presented with continuous urinary leakage per vagina of 15 months duration despite abdominal vesicovaginal fistula repair. Intravenous urography revealed normal upper urinary tract. Methylene blue test was positive but no fistula was detected on cystoscopy. Failure to cystoscopically visualize the catheter, which was easily introduced through the vaginal end of fistulous tract warranted a fistulogram that simulated retrograde ureteropyelogram and showed contrast in the bladder confirming ureterovesicovaginal fistula. Patient underwent transvesical ureteroneocystostomy with closure of bladder communication and remains continent at six months follow-up. Recurrence of urovaginal fistulae after vesicovaginal fistula repair may be attributable to undiagnosed ureteral involvement despite normal upper tract imaging. Simple procedures like cystoscopic visualization of catheter along with fistulogram can clinch the diagnosis in such cases.

Multiple Developmental Urogenital Anomalies: A Therapeutic Challenge.

Case report: In cases of atretic lower vagina, drainage of hematocolpos per se is inadequate as recurrent hematocolpos from re-stenosis is common. Surgical reconstruction in these cases should be directed to relieve obstruction and ensure continued vaginal patency. A 14-year-old girl reported with primary amenorrhea and recurrence of cyclical lower abdominal pain due to re-stenosis following a primary intervention for hematocolpos. Evaluation identified an atretic lower vagina and multiple associated urinary tract anomalies like unascended right kidney, malrotated left duplex collection system, ureteric diverticula and bladder diverticulum with left ureter opening into it. Though associated Grade IV vesicoureteral reflux (VUR) posed a management dilemma, drainage of hematocolpos and restoration of vaginal continuity by pull through of the proximal vagina and approximating its edges to fourchette relieved the patient of pain, restored menstruation, resolved the VUR and obviated the need for extensive urinary reconstructive procedures. Conclusion: In case of atretic lower vagina, drainage of hematocolpos per se is inadequate as recurrent hematocolpos from re-stenosis is common and surgical reconstruction should be directed to relieve obstruction and ensure continued vaginal patency. Coexisting developmental urinary tract anomalies may not require immediate surgical intervention.

Trans-vaginal repair of gynecological supratrigonal vesicovaginal fistulae: a worthy option!

To determine the appropriateness of vaginal approach for gynecological supratrigonal vesicovaginal fistulae. Retrospective review of consecutive women with gynecological supratrigonal Vesico Vaginal Fistulae [VVF] repaired at the fistula unit of Urogynecology department between 1996 and 2011 was done.Out of 48 cases of supratrigonal VVF of gynecological origin identified; 34 [70.8%] cases were repaired vaginally and 14 [36.8%] abdominally with a mean follow-up period of 52.8 [2-132] months. Overall 95.8% were successfully cured at first attempt. The success rate of vaginal repair [94.8%] at first attempt was comparable to that of abdominal repair [100%] [P value = 0.8946]. Amongst two failed vaginal repairs, one was successfully cured by subsequent vaginal repair and other by abdominal repair. Three fourth gynecological supratrigonal VVF can be repaired vaginally in first attempt with success rate comparable to abdominal approach. On the basis of this study we postulate that vaginal approach should be preferred over abdominal approach for repair of all vaginally accessible supratrigonal VVF of gynecological origin