Management of congenital absence of the vagina.

The management of congenital absence of the vagina is facilitated where there is knowledge and understanding of any associated genetic, metabolic, and morphologic anomalies. Although the McIndoe split-thickness graft operation was the most commonly used method (15 patients), other surgical and nonsurgical alternatives were selectively utilized. In 10 women where a functioning uterus was present, laparotomy was necessary in six because of obstruction to uterine drainage. In the choice of treatment method to establish a functioning vagina, individualization is important, but certain guiding principles found to be useful are discussed.

Marlex gauze hammock sling operation with Cooper's ligament attachment in the management of recurrent urinary stress incontinence.

In 1970 Morgan described an operation designed to meet the problem created by scarring and fibrosis resulting from previous operative procedures to the urethra and bladder neck. In the method, a 2 cm wide polypropylene (Marlex) mesh is placed as a broad hammock to elevate and support the urethrovesical junction with lateral attachment at Cooper's ligament. Sixty-nine women operated upon by Morgan's technique have been followed up for 6 months to 8 years. In those with unmixed stress incontinence, 90% were dry at follow-up, whereas in those with a mixture of stress incontinence and symptoms of detrusor disturbance, only 50% were benefited.