Many functional noncommunicating horns present during or after the third decade of life with acute obstetric uterine rupture. Surgical removal before pregnancy is recommended. Rates of prerupture diagnosis remain disappointingly low.

Objective To determine whether digital assessment of pelvic floor contraction strength is as reliable as Design A blinded, two-assessor protocol, prospectively testing a volunteer sample of women.Population Two hundred and sixty-three women (from a total of 278), aged 16-75 years, attending a general gynaecological clinic with nonurinary symptoms.Methods Participants answered a questionnaire regarding urinary symptoms and practice of pelvic floor exercises. History and examination was carried out by the clinician, and pelvic floor strength scored digitally using the Oxford Scale. Pelvic floor strength was then assessed by the physiotherapist, using a PFX perineometer. The physiotherapist was blinded to the woman's history, examination findings and digital assessment score. Both the clinician and physiotherapist were blinded to the questionnaire responses.Main outcome measures Digital pelvic floor contraction assessment, according to the Oxford Scale, was compared with perineometric assessment as the gold standard -examined against the background of the questionnaire findings.Results Of 263 patients, 53 were nulliparous (20%), and 210 parous (80%). Only 49 women carried out regular pelvic floor exercises (19%), and all were parous and admitted to troublesome urinary symptoms. Stress urinary incontinence was reported by 28% of all women (38.1% of parous women and 10.5% of nulliparous women). For both methods, there was no difference in the range of results when parity was taken into account. Concordance studies showed good agreement between digital and perineometric assessment of pelvic floor strength. The kappa value of 0.73 (95% confidence interval 0.67-0.79) indicated substantial agreement between the two methods.There is good agreement between digital assessment of pelvic floor contraction strength and vaginal perineometry. Assessment during gynaecological examination may help to identify women with fascial defects of the pelvic floor, as well as those at risk of genital prolapse or urinary symptoms.vaginal perineometry and to assess the practice of pelvic floor exercises by women. Conclusion

The use of Ligasure, a computer-controlled bipolar diathermy system is proven beneficial in a wide range of surgical procedures. This study was to evaluate its application to vaginal hysterectomy. Over forty patients underwent vaginal hysterectomy with (n = 32) or without (n = 12) Ligasure using standard surgical techniques. The main diagnoses, the age of patients, time for surgery, hospital stay and estimated blood loss during operation were compared. The average operating time was shorter in the Ligasure vaginal hysterectomy group (30 mins (24-48) P < 0.05), the estimated blood loss was less in the Ligasure hysterectomy group (39 mins (25-60) P < 0.05), and the hospital stay was shorter in the Ligasure hysterectomy group (1.2 days (1-2) vs 3 days (3-5) P < 0.05). There were no postoperative complications or re-admissions in either group. Vaginal hysterectomy using Ligasure reduced operating time and blood loss, and therefore shortened hospital stay.

To compare the safety and efficacy of the transobturator tape (Monarc) with the retropubic tape (tension-free vaginal tape, TVTR) for the treatment of urodynamic stress incontinence (USI) a prospective, single-blinded, multi-centre randomised clinical controlled trial was undertaken in four urogynaecology units in Australia. One hundred and eighty-seven women with USI were randomly allocated to undergo surgery with either the Monarc sling (n = 80) or TVT (n = 107). Outcome measures were intra-operative complications (especially bladder injury), as well as peri-operative complications, symptomatology, quality of life and urodynamic outcomes. At 3 months, data were available on 140 women, 82 (59%) TVT and 58 (42%) Monarc. The TVT group was significantly more likely to be complicated by bladder injury (7 TVT, 0 Monarc, p < 0.05). Blood loss and operative time were significantly less in the Monarc group, which was 49 mls (31) vs that of the TVT group, which was 64 mls (41) p < 0.05; 18.5 min (6.5) TVT vs 14.6 min (6) Monarc (p < 0.001). The subjective and objective stress incontinence cure rates were 86.6% (71) vs 72.4% (42) p = 0.77 and 79.3 vs 84.5%, p = 0.51 for the TVT and Monarc groups, respectively. Both groups reported similar improvement in incontinence impact and satisfaction with their operation, although return to activity was significantly quicker with the transobturator route (p = 0.029). The transobturator tape appears to be as effective as the retro-pubic tape in the short term, with a reduction in the risk of intra-operative bladder injury, shorter operating time, decreased blood loss, and quicker return to usual activities.

Despite reviewing 39 eligible trials, few firm conclusions could be reached because of the multiple comparisons considered, the small size of individual trials, and their low quality. Whether or not to use a particular policy is usually a trade-off between the risks of morbidity (especially infection) and risks of recatheterisation.

The objective is to study the long-term outcomes of posterior colporrhaphy with composite polyglactin 910-polypropylene mesh (Vypro 2, Ethicon, Somerville, NJ, USA) utilizing an overlay technique. Seventy-eight patients involved in our previous study were contacted 3 years after their initial operation for follow-up (Lim YN, Rane A, Muller R, Int Urogynecol J 16:126-131, 2005). Thirty-seven (47%) returned for follow-up and completed a standardized questionnaire survey, whereas a further 16 (20%) returned their postal questionnaires. Mean age was 61.3 (SD 10.8) years, and follow-up was 35.7 (SD 4.5) months. There were statistically significant improvements in vaginal lump sensation and constipation (p < 0.001) but no differences with defecatory difficulties or dyspareunia. De novo dyspareunia was reported in 27%. On examination, the incidences of mesh vaginal erosion and rectocele recurrence were 30% and 22%, respectively. It appears that posterior colporrhaphy incorporating Vypro 2 mesh with an overlay method is associated with unacceptably high incidence of complications.

All three slings appear quite successful for the treatment of stress incontinence. The SPARC tapes showed more sling protrusion complications and a trend towards lower objective cure rates; probably as a result of the insertion method used in this study which favoured a loose SPARC sling placement. The authors recommend that the SPARC slings be left tighter than TVT, or for the cough test to be carried out.

(odds ratio (OR), 2.24 (95% confidence interval (CI),). This finding was confirmed after adjusting for potential predictors of prolapse recurrence on multivariate logistic regression (OR, 2.13 (95% CI,; P = 0.04). ConclusionLevator avulsion doubles the risk of cystocele recurrence after anterior colporrhaphy with transobturator mesh.