A Novel Approach to Resection of a Vaginal Septum

Abstract

Background: Tethered cord syndrome (TCS) is caused by abnormal tissue attachments of the spinal cord that limit its movement in the canal and produce stretching of the cord. Tethered cord syndrome encompasses a clinical spectrum of signs and symptoms including urinary and bowel incontinence, gait abnormalities, lower extremity or pelvic pain and weakness, and various motor and sensory defects.Cases: Although tethered cord syndrome is uncommonly diagnosed in pediatric adolescent gynecology, we have diagnosed five young women in the last two years in our practice. The majority of our patients subsequently diagnosed with TCS did not present with a chief complaint of incontinence or leg weakness but instead presented with subtle findings of incontinence elucidated on review of systems (ROS). Our original patient seen for a chief complaint of primary amenorrhea was noted on ROS to have scoliosis and incontinence with valsalva that was progressively worsening. She was referred to orthopedic surgery when an MRI was performed, which diagnosed TCS. This patient has now undergone an untethering procedure and has seen improvement in her urinary incontinence.Comments: In the pediatric or adolescent patient, it is important to maintain a high index of suspicion for tethered cord syndrome in patients with unexplained urinary incontinence, pelvic pain or gait abnormalities that are refractory to other medical therapy. As the disease is believed to be mediated by oxidative metabolic changes and local ischemia to the cord, early diagnosis is crucial to halt the progression of symptoms. Appropriate initial evaluation includes a lumbosacral MRI followed by a neurosurgery consult if a tethered cord is discovered. Finally, an orthopedic surgery referral is also necessary if there is concomitant scoliosis.Background: We describe the resection of a vaginal septum using the Harmonic ScalpelÒ. The innovative method was utilized in order to minimize blood loss and operative time in a patient with a history of deep venous thrombosis and anti-thrombin III deficiency

Complete longitudinal vaginal septum resection. Description of a bloodless new technique

“…Vaginal septum resection using a harmonic scalpel has been described in the past [8]. However, the fact that additional sutures were used in that particular case report, may suggest that coaptive coagulation is less effective for hemostasis than diathermy.…”