Sentinel node biopsy in vulvar and vaginal melanoma: presentation of six cases and a literature review

Background Urogenital melanoma is a rare neoplasm with poor prognosis. Its management in the past involved radical vulvectomy and complete bilateral inguinofemoral lymphadenectomy. Sentinel lymph node biopsy is an accurate low-morbidity procedure when used in the context of cutaneous melanoma. However, prophylactic lymphadenectomy has not been shown to improve survival of melanoma patients. We wanted to determine the feasibility of sentinel lymph node biopsy in patients with female urogenital melanoma as a staging procedure. Methods Six patients with vulvar or vaginal melanomas underwent preoperative lymphatic mapping with^99mTc-labeled sulfur colloid followed by sentinel lymphadenectomy. In addition, we reviewed the literature on the application of sentinel lymph node biopsy in urogenital tract melanomas. Results One or more sentinel nodes were identified in all six patients by lymphoscintigraphy. All patients underwent sentinel lymphadenectomy, except for one patient with a deep vaginal melanoma that drained to pelvic nodes. The five successful cases had unilateral drainage patterns. None of the sentinel lymph nodes excised had tumor invasion. Combined with five other patients from the published literature, the success rate of localizing sentinel lymph nodes in the patients with urogenital melanoma approaches 100%. Conclusions This experience, plus reports of a small number of patients from three similar studies, supports the impression that sentinel lymph node biopsy is feasible for vulvar and vaginal melanoma.     

Vaginal vault suspension and enterocele repair by Richardson-Saye laparoscopic technique: description of training technique and results.

OBJECTIVES: To describe the Richardson-Saye technique for laparoscopic vaginal vault suspension and enterocele repair (vaginal apex reconstruction) and the appropriate training needed for performance of this technique. METHODS: Before using this technique, Drs Carter, Winter, and Mendelsohn first received training by observation of skilled surgeons performing the procedure, attending courses, and finally being tutored and proctored by Dr Saye on the appropriate performance of the technique. They then used this technique to surgically treat eight patients, 42 to 85 years of age, mean age 62 years, between March and September of 1999. RESULTS: We included eight patients in this study who underwent the Saye-Richardson vaginal vault suspension and enterocele repair (apical vaginal vault reconstruction) by the suture technique. In all patients at six-month follow-up, the vaginal apex remains intact and well supported. We describe here the entire vaginal vault suspension and enterocele repair procedure with all its relevant details. CONCLUSION: Laparoscopic reconstruction of the disrupted vaginal apex followed by reattachment to the previously broken uterosacral ligament with the use of permanent suture provides a secure and anatomically correct vault suspension. Before performing this technique, physicians should undergo proper training, including observation, courses, tutoring, and proctorship by a surgeon experienced in performing this technique.     

改良的阴道紧缩术治疗阴道松弛临床观察

目的探讨更安全有效的治疗阴道松弛的阴道紧缩手术方法。方法对132例因阴道松弛导致性生活质量下降,要求行阴道紧缩手术的患者进行改良的阴道缩紧术。手术对松弛的阴道前壁和后壁的肌肉及筋膜进行切实有效修复,同时修复会阴裂伤。对合并张力性尿失禁的患者,根据尿道中断吊床学说理论,在修复前壁时于尿道中段加强缝合肌肉筋膜1针;对合并便秘患者,在后壁修复时加强缝合肛提肌3针;前后壁修复时最大限度保护阴道黏膜。结果术后2～7年,随访118例对术后改善性生活满意度、张力性尿失禁、便秘及阴道排气4项内容进行问卷调查,收到满意的临床效果。结论手术方法设计专业,疗效确切,患者满意度高,适合有经验的专科医师采用。     

Rectus fascia colpopexy in posthysterectomy vaginal prolapse: Analysis of 18 cases

Posthysterectomy prolapse of the vaginal vault is a complicated and uncommon occurrence in gynecology. The treatment is surgical and may be either vaginal or abdominal. The great variety of techniques described indicates that there is disagreement about the ideal route or technique to be used. The authors present their experience in surgical correction using colpopexy with rectus abdominal muscle fascia.Editorial Comment: This surgical procedure was originally described by Te Linde in 1962 and later modified by Alves de Lima and Valente. The value of this study is in the relatively long follow-up of 3 years. The authors document minimal complications and good results. It is actually surprising that they did not see postprocedure enteroceles owing to the markedly anterior placement of the vaginal axis.     

Vaginal delivery following vaginal inlay grafting

We report the case of a 30-year-old woman with acquired vaginal stenosis secondary to relapsing vaginitis, who became pregnant after partial split-thickness skin graft vaginoplasty. She had a normal pregnancy except for two episodes of vaginitis caused byH. influenzae, which is an uncommon infection during pregnancy, and a normal vaginal delivery. To our knowledge there is only one additional report of vaginal delivery following this kind of surgery. Nevertheless, these isolated cases probably do not demonstrate the suitability of a totally reconstructed vagina by split skin serving as a potentially expansile conduit for normal delivery.     

球海绵体肌瓣重叠法阴道缩窄术治疗产后阴道松弛

目的：探讨一种有效的阴道缩窄整形术的方法。方法：经阴道口皮肤黏膜交界处切开．剥离阴道黏膜，分离出撕裂的球海绵体肌．形成肌瓣。将肌瓣折叠缝合，然后纵行缝合阴道黏膜，并形成阴道黏膜隆突。结果：本组11例患者均采用球海绵体肌重叠缝合法行阴道缩窄术，9例患者术后随访3个月至2年，夫妻性生活的质量均有明显提高，效果满意。结论：经此手术后可以矫正阴道松弛，提高患者性生活质量，效果确切。     

Transverse retubularized ileal vaginoplasty: a new application of the Monti principle--preliminary report

OBJECTIVE: The surgical management of the absence of the vagina is a complex problem and constitutes a significant technical challenge. Herein we present our successful experience with vaginal reconstruction by the use of a modified ileal segment according to the Monti principle. METHODS: Six patients aged from 23 to 41 years (mean 33 years) were referred to our institution for vaginal stenosis. In our series, ileum has been used to create the neovagina: the isolated segment has been longitudinally detubularized and transversally retubularized in order to configure the roof of the neovagina. RESULTS: The mean operating time was 220 min. No intra-operative complication occurred. The mean follow-up of this series was 16 months. At the latest follow-up, all patients had patent moist neovaginas, but excessive vaginal mucous was not a problem in any patient in our series. CONCLUSIONS: Neovaginal creation using isolated ileal segments according to the Monti channel principle provide excellent tissue for vaginal replacement, providing excellent patient satisfaction and relatively low morbidity. Cosmetic, functional and anatomical results were encouraging. In our opinion our technique may be indicated for all cases of vaginal absence: congenital abnormalities in the pediatric population, vaginal stenosis after treatment of pelvic tumors, severe vaginal scarring secondary to chronic inflammatory disease or in case of secondary correction after failure gender surgery.     

A case of laparoscopy-assisted vaginal cuff suturing for vaginal cuff dehiscence after total laparoscopic hysterectomy

IntroductionVaginal cuff dehiscence after hysterectomy is a rare complication and occurs in less than 1% of patients. It can present with serious complications, such as bowel evisceration and peritonitis.Presentation of caseA 51-year-old multigravida Korean woman underwent total laparoscopic hysterectomy for leiomyoma. Six months later, she reported lower abdominal pain and vaginal bleeding. Physical examination revealed rebound tenderness in the lower abdomen, and pelvic examination showed a small amount of vaginal bleeding with an evisceration of the small intestine through the vagina that exhibited healthy peristalsis. The eviscerated bowel, which seemed to be a part of the ileum, was carefully manually reduced transvaginally into the abdominal cavity. Laparoscopic observation revealed adhesions between the omentum, small intestine, and the peritoneum. Specifically, the small intestine was adhered around the vaginal cuff. An abdominal abscess was found in the left lower abdominal cavity. An adhesiotomy was performed and the abdominal abscess was removed and irrigated. Complete separation of the anterior and posterior vaginal cuff edges was obtained. The vaginal cuff was closed with interrupted 0-polydioxanone absorbable sutures without bowel injury. A 6-month follow-up examination revealed complete healing of the vaginal cuff.DiscussionIn this case, we were able to make use of both laparoscopic and transvaginal methods to perform a successful repair with a minimally invasive and safe technique.ConclusionLaparoscopically assisted vaginal cuff suturing for vaginal cuff dehiscence after total laparoscopic hysterectomy was found to be effective, safe, and minimally invasive.     

Vaginal hysterectomy in non-prolapsed uteruses: “no scar hysterectomy”

Introduction and hypothesis  Traditionally, vaginal hysterectomy (VH) has been limited to cases of uterine prolapse, despite the fact that vast worldwide literature has demonstrated its applicability in other common benign diseases, such as uterine fibromatosis and abnormal uterine bleeding, with excellent outcomes. Methods  Such outstanding results have made this procedure one of the most useful and advantageous alternatives when compared to the abdominal and laparoscopic routes. Results  Currently, VH (an ancient procedure) does not represent a first-line alternative. Conclusion  Therefore, the main goal of this paper is to describe some of the advantages of the vaginal route in order to help vaginal surgery schools to re-establish the leading role of this approach as a part of the minimally invasive gynecological surgery trend.     

Vaginal calculi secondary to urethrovaginal fistula with vaginal stenosis in a 14-year-old girl

The author reports a case of vaginal calculi secondary to urethrovaginal fistula with vaginal stenosis in a 14-year-old girl. The initial urethrovaginal fistula and vaginal stenosis resulted from pelvic trauma after a traffic accident, with subsequent surgical urethral realignment and anterior colporrhaphy without success. The patient had continuous urinary incontinence for a duration of 11 years after surgery, and was finally diagnosed with urethrovaginal fistula with primary multiple vaginal calculi in our hospital. Surgeries were performed to remove the stones and repair the urethrovaginal fistula. Colpoplasty was also given by an obstetrician–gynecologist to solve the vaginal stenosis. After the procedure, the girl urinated normally. At her 3-month follow-up, the patient had no sign of urine leakage.     

A new needle suspension procedure for genuine stress incontinence and anterior vaginal wall prolapse

A new suspension method was developed for the correction of anterior vaginal wall relaxation and genuine stress incontinence. This procedure suspends the anterior vaginal wall to the anterior rectus fascia, and in doing so gives support to the bladder neck, anterior vaginal wall and vaginal apex. The procedure is performed at the time of vaginal hysterectomy or correction of anterior vaginal wall relaxation. The authors present their experience with this technique in 31 patients.Editorial Comment: Numerous types of surgery for the simultaneous correction of stress incontinence and cystocele and/or procidentia have been described in the literature. Some have proved more efficient for the correction of stress incontinence and others for the correction of disturbed pelvic support. The authors use the known method of needle suspension for the correction of stress incontinence, but for the new purpose of correction of cystocele/procidentia and stress incontinence. If necessary, vaginal hysterectomy can be performed with the originally planned intervention. As the criterion of an efficient outcome for the correction of genital statics, the author uses a vaginal depth of greater than 5 cm, which is less than normal. The successful correction of genital statics after 24 months was reported to be 93%, which is an extremely favorable result, resembling the success rate achieved by much more complicated surgeries (e.g. sacrospinous vault fixation or fixation of the vagina to the sacrum). The successful correction of stress incontinence in 82% of patients after 24 months is also favorable, and comparable to the results achieved by other surgical methods of needle suspension for the correction of stress incontinence.     

Reconstruction of vaginal agenesis by Singapore flap

Summary Various surgical methods for reconstruction of vaginal agenesis have been described in the past. One of these is the neurovascular pudendal thigh flap described by Wee and Joseph [20] after they studied the blood and nerve supply of upper thigh skin, medial groin, and perineum in fresh cadavers. This technique involves elevation of two flaps extending laterally to labia majora in the groin crease and suturing them to each other in the midline after bringing them through tunnels formed under the labia majora, thus, creating a new vagina. In our clinic, 24 cases of vaginal agenesis have been reconstructed with neurovascular pudendal thigh flaps in a period of 33 months. The patients were observed for eight months to three years following the operation, and only in three cases did necrosis of the distal flaps occur; hair grew in the vagina in five cases, and shrinkage was observed in only one case. This rather easy technique is the ideal reconstructive method in the vaginal agenesis. However, hair growth in the vagina must be prevented, since this is the main patient complaint.Presented at the 7th Congress of the European Section of the International Confederation for Plastic and Reconstructive Surgery, Berlin, Germany, June 2–5, 1993     

Visualization of the endopelvic fascia by transrectal three-dimensional ultrasound

The aim of our pilot study was to explore the feasibility of visualizing the endopelvic fascia by transrectal three-dimensional (3D) ultrasound. Transrectal 3D ultrasound was performed in 12 nulliparous women and 11 women with a history of vaginal delivery. A 6–10 MHz volume probe was used to examine the suburethral anterior vaginal wall. In all women, an echogenic layer was identified at an average of 3–5 mm from the vaginal surface. This echogenic layer was found to be contiguous to the lateral pelvic sidewall and uninterrupted in 10 of 12 nulliparous women, whereas gaps in this layer were identified in all 11 parous women. We hypothesize that this echogenic layer may represent the suburethral component of the endopelvic fascia. Depending on the number and localization of the interruptions in this echogenic layer, the mechanical support of the pelvic floor seems to be weakened corresponding to a higher incidence of descensus of the anterior vaginal wall, which frequently was associated with urinary incontinence.     

Use of synthetic mesh to prevent recurrent vaginal evisceration: a case report

Vaginal evisceration of the bowel is a rare and life-threatening complication of gynecologic surgery; recurrence is even more rare. Most cases in the literature discuss primary closure of the dehisced vaginal cuff with delayed absorbable sutures via a vaginal, abdominal, or laparoscopic approach. The case presented here is of a patient who had a history of recurrent vaginal evisceration treated with an abdominal sacrocolpopexy utilizing synthetic mesh. Further recurrence, to date, has been prevented.     

Neo-vaginal construction with subcutaneously based gluteal-fold flaps: a case report

A 16-year-old girl with vaginal aplasia had a 1-cm long vaginal pouch and complete absence of uterus. Bilateral subcutaneous based flaps were raised horizontally from the gluteal folds and transposed into the created vaginal cavity. At 12 months follow-up, she had successfully engaged in intercourse and at no time had been mechanically using dilation. At clinical examination, the neo-vagina maintained both adequate length and width.     

PLLA 在老年性阴道炎患者中的应用效果

目的 探讨聚左旋乳酸（PLLA）在老年性阴道炎患者中的应用效果。方法 选取2021年4月-2022年 3月南昌添润医疗美容门诊部收治的50例老年性阴道炎患者作为研究对象，选用PLLA作为干预因素，采用阴 道黏膜下多点注射，术后3个月观察患者阴道健康指数、阴道症状指数及阴道内pH变化。结果 治疗后阴道健 康评分为（9.84±1.69）分，高于治疗前的（6.06±2.14）分，差异有统计学意义（P＜0.05）；治疗后阴道症 状评分为（5.92±1.75）分，低于治疗前的（8.08±1.95）分，差异有统计学意义（P＜0.05）；治疗前后阴道 内pH值比较，差异无统计学意义（P＞0.05）。结论 PLLA可以改善老年性阴道炎阴道黏膜老化症状，提高阴 道健康状况，改善阴道内环境，在阴道年轻化中具有较高的临床应用价值。     

提肛肌肌瓣对合重叠缝合法治疗产后阴道松弛

目的 探讨一种有效治疗产后阴道松弛的手术方法。方法 经阴道口皮肤黏膜交界处切开，剥离阴道黏膜，分离出撕裂的提肛肌，形成两个肌瓣。将两肌瓣对合重叠拉紧缝合后缝合阴道黏膜，并形成阴道黏膜隆突。结果 1998年6月至2002年6月将此法用于2l例产后阴道松弛的患者，术后随访16例，随访3个月至2年，患者均感手术后提高了性生活质量。结论 此方法可以提高患者性生活质量，效果确切。     

机器人带血管蒂回肠段移植阴道成形术：病例报告并文献复习

目的：初步探讨应用机器人带血管蒂回肠段移植阴道成形术的临床疗效。方法回顾性分析1例应用机器人带血管蒂回肠段移植阴道成形术病例,并复习相关文献进行讨论。结果机器人带血管蒂回肠段移植阴道成形术失血量较少,再造的阴道可达到足够的深度和宽敞度,阴道壁柔软、滑润、有弹性,合乎生理需求,有感觉且稳定不挛缩,手术创伤小,可作为治疗先天无阴道的一种手术方式。结论机器人带血管蒂回肠段移植阴道成形术治疗先天阴道发育不全,观察手术疗效满意,有一定的优势,具有临床应用前景。     

Anatomical and functional results of McCall culdoplasty in the prevention of enteroceles and vaginal vault prolapse after vaginal hysterectomy

The objective of the study is to evaluate the anatomical and functional results of the McCall culdoplasty in the treatment of moderate hysterocele and the prevention of enterocele and vaginal vault prolapse after vaginal hysterectomy. Using a modified McCall procedure, 185 patients underwent vaginal hysterectomy for mild or moderate uterine prolapse. Pre- and post-operative assessments were carried out using the International Continence Society staging system. The 24-month follow-up showed stable 89.2% incidence of stage 0 vaginal vault prolapse (point C) and a 10% incidence of stage 1 vaginal vault prolapse that was well tolerated and did not require revision surgery. Functional analysis showed satisfactory sexual function at 24 months post-surgery for 81.2% of patients. The McCall culdoplasty did not lead to a disruption of the vaginal axis and gave excellent anatomical and functional results in maintaining support after vaginal hysterectomy, especially in sexually active patients.     

In vitro functional responses of isolated human vaginal tissue to selective phosphodiesterase inhibitors

Only little is known as to the significance of the cyclic nucleotide-mediated signal transduction in the control of the function of human vaginal smooth musculature. Recently, the presence of the phosphodiesterase (PDE) isoenzymes 4 (cAMP-PDE) and 5 (cGMP-PDE) in the human vagina was reported. Thus, it was the aim of the study to elucidate the effects of some PDE inhibitors on the tension induced by endothelin 1 (ET-1), as well as on levels of cGMP and cAMP in isolated human vaginal wall tissue. Using the organ bath technique, the ability of norepinephrine (NE), carbachol, serotonin (5-HT), oxytocin and ET-1 to contract isolated vaginal wall muscle strips was evaluated. In another set-up, the effects of the PDE4 inhibitor rolipram and PDE5 inhibitors sildenafil and vardenafil (1 nM–10 μM) on the tension induced by 0.1 μM ET-1 of human vaginal wall tissue strips were investigated. In order to measure drug effects on tissue levels of cGMP and cAMP, vaginal tissue was exposed to different concentrations (0.1, 1 and 10 μM) of the compounds and the accumulation of cyclic nucleotides was determined. The adenylyl cyclase stimulating agents forskolin and nitric oxide donor sodium nitroprusside (SNP) (0.01, 0.1 and 1 μM) were used as reference compounds. While NE, carbachol and oxytocin failed to contract the vaginal tissue, ET-1 and, to a certain degree, 5-HT elicited contractile responses of the isolated strip preparations. The tension induced by 0.1 μM ET-1 was dose-dependently reversed by the drugs. The rank order of efficacy was sildenafil > forskolin > rolipram ≥ vardenafil > SNP. R _max values ranged from 24% (SNP) to 50% (sildenafil). With sildenafil being the only exception, none of the compounds reached an EC₅₀ value. The relaxing effects of the drugs were paralleled by a fourfold to tenfold increase in tissue levels of cGMP and/or cAMP. Our results demonstrate that PDE inhibitors can relax human vaginal tissue and increase levels of cyclic nucleoside monophosphates. The findings with regard to the PDE5 inhibitors may indicate that the NO–cGMP pathway is, to a certain degree, involved in the control of vaginal smooth muscle tone. This might be of significance with regard to the pharmacological treatment of disorders connected with female sexual arousal and the ability to achieve orgasm.