Effectiveness of transvaginal colporrhaphy with porcine acellular collagen matrix in the treatment of moderate to severe cystoceles

PURPOSE

The aim of this study was to determine the effectiveness of transvaginal anterior colporrhaphy with the use of porcine acellular collagen matrix in the treatment of moderate to severe cystocele.

MATERIALS AND METHODS

This retrospective study included 95 patients who underwent anterior colporrhaphy with the use of porcine dermus from September 2003 through March 2008 at the Gynaecological Department of University General Hospital of Alexandroupolis in Greece. The inclusion criterion was a grade 2-4 cystocele by the Baden-Walker halfway system. Postoperatively patients were evaluated at one, six and 12 months. Objective cure was defined as no or grade 1 cystocele with an asymptomatic patient at 12 months postoperatively. Improved outcome was considered as an asymptomatic patient with a grade 2 cystocele and failure symptomatic patients or with grade 3 or 4 cystocele.

RESULTS

All of the patients had a 12-month postoperative follow-up or were noted as a failure prior to the 12-month assessment. The majority of the women were menopausal (88.4%) and overweight (mean BMI 26.1). The overall cure rate was 81.1%, the improvement of the cystocele was 10.5% while the failure rate was 8.4%. The complications we noted were vaginal erosion in 2.01% and graft extrusion in 1.05% of the patients.

CONCLUSION

Transvaginal anterior colporrhaphy using porcine dermal in the treatment of moderate to severe cystocele is simple, safe, easily learned and performed with a high success rate and low morbidity.

Abdominal rectus muscle sheath abscess after spontaneous vaginal delivery. A case report

Postpartum infections cause severe morbidity of the mother. Abdominal wound infection and abscess formation are common complications after cesarean delivery. We report a case with abscess formation inside the abdominal rectus muscle sheath after normal, spontaneous vaginal delivery. A 32-year-old woman, para 2, had a normal vaginal delivery at term. The second postpartum day she complained of lower abdominal pain and was unable to stand up or walk. The fourth day, cellulitis of the skin of the lower abdomen developed and was treated with broad-spectrum intravenous antibiotics. The seventh day the patient developed septic fever and an abdominal rectus muscle sheath abscess was diagnosed. The abscess was treated with incisions and evacuation and the patient was discharged the 12th postoperative day. The abscess in this case, as hematoma formation was not preceded, was referred to ascending contamination via the lymphatic vessels.

Evaluation during early puerperium of the low transverse incision after cesarean section through vaginal ultrasonography

OBJECTIVE

This study was designed in order to determine the criteria of the natural healing of the low transverse cesarean incision through vaginal ultrasonography.

METHODS

The uterine wound was examined with a vaginal scanner (5.5-7 MHz) in 75 asymptomatic patients with a normal postoperative course three days after the cesarean section. We compared our findings with those obtained in 21 patients with a complicated post-cesarean course.

RESULTS

The uterine incision was identified as an oval, centrally located region between the bladder and the uterus. In 18 of the 75 cases, a hypoechoic area with indistinct limits, almost rounded and with a diameter of smaller than 1.5 cm in all cases was determined in the incision site. Possibly all these cases represented small hematomas or serous collections, with no clinical importance. Four of the 21 symptomatic patients had bladder flap or uterine incision hematomas. These were large (> 2 cm in all cases) hypoechoic areas inside or around the transverse incision site.

CONCLUSION

The low transverse cesarean incision in the uterus can be visualized sonographically with a vaginal scanner and normal postoperative changes can be recognized.