Vaginal hysterectomy fulfills the evidence-based requirements as the preferred route of hysterectomy for benign gynecologic disease. Despite proven safety and effectiveness, the vaginal approach for hysterectomy has been and remains underused in surgical practice. Factors associated with underuse of vaginal hysterectomy include challenges during residency training, decreasing case numbers among practicing gynecologists, and lack of awareness of evidence supporting vaginal hysterectomy. Strategies to improve resident training and promote collaboration and referral among practicing physicians and increasing awareness of evidence supporting vaginal hysterectomy can improve the primary use of this hysterectomy approach.

We identified bleeding complications at the time of mesh implantation as a risk factor for mesh exposure requiring reoperation. Despite being one of the largest studies on this topic, our data were inconclusive regarding the impact of other possible factors on mesh exposure.

BackgroundVulvar mucinous cysts are rare, benign, noninvasive masses. They can be mistaken for cysts of Bartholin gland, Skene gland, vestibular, or canal of Nuck. Generally, they may be left untreated, but observed. However, if symptomatic, they may require surgical removal.CaseWe report a large vulvar mucinous cyst in a 29-year-old woman with no contributory medical history. Excision of the mass was performed because its size had begun to cause symptoms. The diagnosis of a mucinous cyst was based on radiological and clinicopathologic features. The patient developed a post-operative vulvar hematoma and was discharged 2 days after the surgery with a Foley catheter in place. Continued follow-up was maintained for the hematoma, which drained spontaneously and resolved without incident. There has been no recurrence of the cyst after completion of short-term surgical follow-up.ConclusionVulvar mucinous cysts are rare masses. We present the diagnosis and treatment of a large vulvar mucinous cyst. The cyst was completely removed during surgery, but long-term surveillance for recurrence is currently being conducted.

Transperineal sonography (TPS) affords dynamic evaluation of suburethral slings using tensionless vaginal tape and mesh implants used to treat complications associated with surgical procedures of the pelvic floor. This review describes and illustrates the TPS findings in postoperative complications such as recurrent prolapse, cystocele, enterocele, and rectocele. The potential use of live 3-dimensional TPS to delineate the dynamics aspects of pelvic floor disorder is also mentioned.

In this study, bladder trabeculations were associated with stage IV prolapse in the anterior compartment as well as with detrusor overactivity and UUI.

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