Vaginal Urinary Calculi Formation Secondary to Vaginal Mesh Exposure with Urinary Incontinence

Background. Vaginal stones may form in the setting of mesh exposure with urinary incontinence. This report serves to help understand the presentation, evaluation, and management of vaginal urinary stones. Case. A 68-year-old female presented with a vaginal calculus. She had a history of anterior and posterior polypropylene mesh placement for prolapse 7 years earlier and urinary incontinence. The stone was identified on a portion of exposed mesh and removed in office. Pathology confirmed urinary etiology. The exposed mesh resolved with topical estrogen. Cystourethroscopy excluded urinary fistula and bladder mesh erosion. Conclusions. When identified, a vaginal calculus should be removed and evaluated for composition. Cystourethroscopy should be performed to assess potential urinary tract fistulas and mesh erosion. Additional imaging should be considered

The Pathophysiology of Pelvic Organ Prolapse

Objective: To summarize and review the current knowledge of the pathophysiology of pelvic organ prolapse. Methods: A review of the English language literature regarding the pathophysiology of pelvic organ prolapse. Results: A summary and discussion of the pathophysiology of pelvic organ prolapse is presented. Conclusions: Pelvic organ prolapse is a complex disease process with multifactorial etiology that affects thousands of women annually worldwide. A historical background of the understanding of prolapse, a review of normal pelvic support anatomy and physiology, and a discussion of the current knowledge of its pathophysiology is presented

The Pathophysiology of Pelvic Organ Prolapse

Objective: To summarize and review the current knowledge of the pathophysiology of pelvic organ prolapse. Methods: A review of the English language literature regarding the pathophysiology of pelvic organ prolapse. Results: A summary and discussion of the pathophysiology of pelvic organ prolapse is presented. Conclusions: Pelvic organ prolapse is a complex disease process with multifactorial etiology that affects thousands of women annually worldwide. A historical background of the understanding of prolapse, a review of normal pelvic support anatomy and physiology, and a discussion of the current knowledge of its pathophysiology is presented

Vaginal Urinary Calculi Formation Secondary to Vaginal Mesh Exposure with Urinary Incontinence

Background Vaginal stones may form in the setting of mesh exposure with urinary incontinence. This report serves to help understand the presentation, evaluation, and management of vaginal urinary stones. Case A 68-year-old female presented with a vaginal calculus. She had a history of anterior and posterior polypropylene mesh placement for prolapse 7 years earlier and urinary incontinence. The stone was identified on a portion of exposed mesh and removed in office. Pathology confirmed urinary etiology. The exposed mesh resolved with topical estrogen. Cystourethroscopy excluded urinary fistula and bladder mesh erosion. Conclusions When identified, a vaginal calculus should be removed and evaluated for composition. Cystourethroscopy should be performed to assess potential urinary tract fistulas and mesh erosion. Additional imaging should be considered

Vaginal Urinary Calculi Formation Secondary to Vaginal Mesh Exposure with Urinary Incontinence

Background Vaginal stones may form in the setting of mesh exposure with urinary incontinence. This report serves to help understand the presentation, evaluation, and management of vaginal urinary stones. Case A 68-year-old female presented with a vaginal calculus. She had a history of anterior and posterior polypropylene mesh placement for prolapse 7 years earlier and urinary incontinence. The stone was identified on a portion of exposed mesh and removed in office. Pathology confirmed urinary etiology. The exposed mesh resolved with topical estrogen. Cystourethroscopy excluded urinary fistula and bladder mesh erosion. Conclusions When identified, a vaginal calculus should be removed and evaluated for composition. Cystourethroscopy should be performed to assess potential urinary tract fistulas and mesh erosion. Additional imaging should be considered

Vaginal Urinary Calculi Formation Secondary to Vaginal Mesh Exposure with Urinary Incontinence

Background Vaginal stones may form in the setting of mesh exposure with urinary incontinence. This report serves to help understand the presentation, evaluation, and management of vaginal urinary stones. Case A 68-year-old female presented with a vaginal calculus. She had a history of anterior and posterior polypropylene mesh placement for prolapse 7 years earlier and urinary incontinence. The stone was identified on a portion of exposed mesh and removed in office. Pathology confirmed urinary etiology. The exposed mesh resolved with topical estrogen. Cystourethroscopy excluded urinary fistula and bladder mesh erosion. Conclusions When identified, a vaginal calculus should be removed and evaluated for composition. Cystourethroscopy should be performed to assess potential urinary tract fistulas and mesh erosion. Additional imaging should be considered

Selecting the Appropriate Technique for Vaginal Hysterectomy

Background There are many techniques for vaginal hysterectomies. Most of those performed in the United States are variations of the classic Heaney technique. The Döderlein technique of vaginal hysterectomy has not gained wide acceptance but offers advantages in selective cases. Methods The authors describe the Döderlein technique for vaginal hysterectomy and discuss the circumstances in which it offers advantages compared with the traditional Heaney technique. Conclusions The traditional Heaney technique of vaginal hysterectomy is preferred for the vaginal removal of the uterus with large anterior leiomyomata or a markedly elongated cervix and uteri weighing more than 200 g. The Döderlein technique offers advantages in the vaginal removal of the markedly prolapsed uterus, when uterine descensus is lacking, or for patients with shallow or scarred posterior vaginal fornices. Familiarity with both techniques affords the surgeon the option of using the method best suiting the patient, the disease process, and concomitant conditions to be addressed during the procedure

Selecting the Appropriate Technique for Vaginal Hysterectomy

Background There are many techniques for vaginal hysterectomies. Most of those performed in the United States are variations of the classic Heaney technique. The Döderlein technique of vaginal hysterectomy has not gained wide acceptance but offers advantages in selective cases. Methods The authors describe the Döderlein technique for vaginal hysterectomy and discuss the circumstances in which it offers advantages compared with the traditional Heaney technique. Conclusions The traditional Heaney technique of vaginal hysterectomy is preferred for the vaginal removal of the uterus with large anterior leiomyomata or a markedly elongated cervix and uteri weighing more than 200 g. The Döderlein technique offers advantages in the vaginal removal of the markedly prolapsed uterus, when uterine descensus is lacking, or for patients with shallow or scarred posterior vaginal fornices. Familiarity with both techniques affords the surgeon the option of using the method best suiting the patient, the disease process, and concomitant conditions to be addressed during the procedure