A case of laparoscopic excision of a rudimentary horn is presented. The anatomical features of this case are contrasted with others in the published literature. A 23 year old nulligravida presented with severe dysmenorrhoea and a pelvic mass. At laparoscopy a unicornuate uterus with a rudimentary horn was identified. The patient had stage III endometriosis. The rudimentary horn was attached to the unicornuate uterus by a band of tissue. The blood supply was identified within this band of tissue. The rudimentary horn was removed laparoscopically with no complications. There are two anatomical variations in the attachment of the rudimentary horn to the unicornuate uterus. Knowledge of both types is important to avoid complications such as bleeding and possible compromise of myometrial wall thickness.
Objective To compare the long‐term efficacy of laparoscopic Burch colposuspension with tension‐free vaginal tape (TVT) for the treatment of urodynamic stress urinary incontinence (SUI). Design Long‐term follow up from a prospective randomised trial. Setting Academic tertiary referral centre. Sample Seventy‐two women with urodynamic SUI from two institutions. Methods Subjects were randomised to either laparoscopic Burch or TVT from August 1999 to August 2002. Follow‐up evaluations occurred 6 months, 1 year, 2 years, and 4–8 years after surgery. Main outcome measures Subjects completed the Incontinence Severity Index, Urogenital Distress Inventory 6 (UDI‐6), Incontinence Impact Questionnaire (IIQ‐7), and Patient Global Impression of Improvement (PGI‐I) scales. Results Median follow‐up duration was 65 months (range 12–88 months) with 92% completing at least one follow‐up visit. Seventy‐four percent of subjects had long‐term (4–8 years) follow up. Fifty‐eight percent of subjects receiving laparoscopic Burch compared with 48% of TVT subjects reported any urinary incontinence 4–8 years after surgery (Relative Risk (RR):1.19; 95% CI: 0.71–2.0) with no significant difference between groups. Bothersome SUI symptoms were seen in 11 and 8%, respectively, 4–8 years after surgery (P= 0.26). There was significant improvement in the postoperative UDI‐6 and IIQ‐7 scores in both groups at 1–2 years that were maintained throughout follow up with no significant differences between the groups. Conclusions TVT has similar long‐term efficacy to laparoscopic Burch for the treatment of SUI. A substantial proportion of subjects have some degree of urinary incontinence 4–8 years after surgery; however, the majority of incontinence is not bothersome.
OBJECTIVE:We sought to describe perioperative and postoperative adverse events associated with uterosacral colpopexy, to describe the rate of recurrent pelvic organ prolapse (POP) associated with uterosacral colpopexy, and to determine whether surgeon technique and suture choice are associated with these rates. STUDY DESIGN:This was a retrospective chart review of women who underwent uterosacral colpopexy for POP from January 2006 through December 2011 at a single tertiary care center. The electronic medical record was queried for demographic, intraoperative, and postoperative data. Strict definitions were used for all clinically relevant adverse events. Recurrent POP was defined as the following: symptomatic vaginal bulge, prolapse to or beyond the hymen, or any retreatment for POP. RESULTS:In all, 983 subjects met study inclusion criteria. The overall adverse event rate was 31.2% (95% confidence interval [CI], 29.2e38.6), which included 20.3% (95% CI, 17.9e23.6) of subjects with postoperative urinary tract infections. Of all adverse events, 3.4% were attributed to a preexisting medical condition, while all other events were ascribed to the surgical intervention. Vaginal hysterectomy, age, and operative time were not significantly associated with any adverse event. The intraoperative bladder injury rate was 1% (95% CI, 0.6e1.9) and there were no intraoperative ureteral injuries; 4.5% (95% CI, 3.4e6.0) of cases were complicated by ureteral kinking requiring suture removal. The rates of pulmonary and cardiac complications were 2.3% (95% CI, 1.6e3.5) and 0.8% (95% CI, 0.4e1.6); and the rates of postoperative ileus and small bowel obstruction were 0.1% (95% CI, 0.02e0.6) and 0.8% (95% CI, 0.4e1.6). The composite recurrent POP rate was 14.4% (95% CI, 12.4e16.8): 10.6% (95% CI, 8.8e12.7) of patients experienced vaginal bulge symptoms, 11% (95% CI, 9.2e13.1) presented with prolapse to or beyond the hymen, and 3.4% (95% CI, 2.4e4.7) required retreatment. Number and type of suture used were not associated with a higher rate of recurrence. Of the subjects who required unilateral removal of sutures to resolve ureteral kinking, 63.6% did not undergo suture replacement; this was not associated with a higher rate of POP recurrence. CONCLUSION:Perioperative and postoperative complication rates associated with severe morbidity after uterosacral colpopexy appear to be low. Uterosacral colpopexy remains a safe option for the treatment of vaginal vault prolapse. P elvic organ prolapse (POP) is a common problem in women and is associated with considerable morbidity and a decreased quality of life. In the United States, the prevalence of POP is approximately 2.9% 1 and nearly 300,000 women undergo surgery annually for prolapse. 2 As a result, the estimated direct cost of POP surgery is >$1 billion per year. 3,4 Transvaginal and abdominal procedures exist to treat symptomatic POP. Uterosacral colpopexy is a common transvaginal procedure for vaginal prolapse and can be performed at the time of vaginal hysterectomy or for posthysterec...
Laparoscopy has been applied to all aspects of gynecologic surgery, but few investigators have reported the repair of vaginal apex prolapse, enterocele and rectocele via the laparoscopic route. This article reviews the indications, anatomy, operative technique, clinical results and complications of laparoscopic culdeplasty, enterocele repair, posterior repair, sacral colpopexy and vaginal vault-uterosacral ligament suspension.
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