Women with a preoperative genital hiatus 4 cm or greater that is not surgically normalized after native tissue vaginal vault suspension are at significantly increased odds of anatomic failure in all compartments.

Objectives To develop and test a method for measuring the relationship between the rise in intra-abdominal pressure and sagittal plane movements of the anterior and posterior vaginal walls during Valsalva in a pilot sample of women with and without prolapse. Methods Mid-sagittal MRI images were obtained during Valsalva while changes in intra-abdominal pressure were measured via a bladder catheter in 5 women with cystocele, 5 women with rectocele, and 5 controls. The regional compliance of the anterior and posterior vagina wall support systems were estimated from the ratio of displacement (mm) of equidistant points along the anterior and posterior vaginal walls to intra-abdominal pressure rise (mmHg). Results The compliance of both anterior and posterior vaginal wall support systems varied along different regions of vaginal wall for all three groups, with the highest compliance found near the vaginal apex and the lowest near the introitus. Women with cystocele had more compliant anterior and posterior vaginal wall support systems than women with rectocele. The movement direction differs between cystocele and rectocele. In cystocele, the anterior vaginal wall moves mostly toward the vaginal orifice in the upper vagina, but in a ventral direction in the lower vagina. In rectocele, the direction of the posterior vaginal wall movement is generally toward the vaginal orifice. Conclusions Movement of the vaginal wall and compliance of its support is quantifiable and was found to vary along the length of the vagina. Compliance was greatest in the upper vagina of all groups. Women with cystocele demonstrated the most compliant vaginal wall support.

Completion of vaginal uterosacral ligament suspension using only absorbable suture affords similar anatomic outcomes in the medium term as compared with suspension with additional permanent suture.

We present the case of Ruby, a 21-year-old hand-reared chimpanzee (Pan troglodytes) who had an obstetric history significant for a premature stillborn infant that was conceived while on oral contraceptive pills, followed by a full term healthy delivery complicated by neonatal demise attributed to inappropriate maternal care. She was recommended for permanent sterilization due to her history of conception while on oral contraceptives. She underwent uncomplicated laparoscopic bilateral tubal ligation. Due to the similar anatomy to humans, human OB/GYN surgical consultants were used. The objective of this case report is to describe a modern technique for approaching and employing laparoscopic surgery in primates. Minimally invasive surgery allows for faster recovery and fewer complications, and has become the preferred approach for surgical intervention in many animals. The information presented in this case report can be expanded to benefit not only Chimpanzees but other large primate species as well. However, subtle anatomical differences among species must be recognized in order to be carried out safely.