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Vaginal invagination: definition, clinical presentation and surgical management

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Abstract

Introduction and hypothesis

The objective of this observational study is to define vaginal invagination identified at vaginal prolapse surgery and to report the prevalence and risk factors for its development.

Methods

All women undergoing vaginal prolapse surgery between January and December 2010 were prospectively evaluated intraoperatively for invagination of the vagina. The preoperative details and characteristics of the invagination were recorded and the area of vaginal mucosa released was quantified in square centimetres. Vaginal topography was evaluated using the Pelvic Organ Prolapse Quantification system.

Results

Intraoperative assessment demonstrated that vaginal invagination occurred in 8 % (25/295) and was characterized by a tight, fixed and tethered portion of vaginal mucosa at the vault which was bilateral in 14 (56 %) women. Prior gynaecological surgery with hysterectomy being the most common surgery and vaginal route the most frequent approach were identified as overall risk factors. The gain (mean  ± SD) of vaginal mucosa after releasing entrapped tissue was 3.5 ± 0.63 cm2.

Conclusions

Vaginal invagination is diagnosed intraoperatively as a fixed and tight area of vaginal mucosa at the vault. The identification and release of the invaginated vagina ensures a safer access to the pelvic sidewall and increases vaginal mucosal area.

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References

  1. Abramov Y, Gandhi S, Botros SM, Goldberg RP, Sherman W, Rurak M, Sand PK (2005) Do alterations in vaginal dimensions after reconstructive pelvic surgeries affect the risk for dyspareunia? Am J Obstet Gynecol 192(5):1573–1577

    Article  PubMed  Google Scholar 

  2. Tan JS, Lukacz ES, Menefee SA, Luber KM, Albo ME, Nager CW (2006) Determinants of vaginal length. Am J Obstet Gynecol 195:1846–1850

    Article  PubMed  Google Scholar 

  3. Given FT Jr, Muhlendorf IK, Browning GM (1993) Vaginal length and sexual function after colpopexy for complete uterovaginal eversion. Am J Obstet Gynecol 169(2 Pt 1):284–287

    PubMed  Google Scholar 

  4. Occhino JA, Trabuco EC, Heisler CA, Klingele CJ, Gebhart JB (2011) Changes in vaginal anatomy and sexual function after vaginal surgery. Int Urogynecol J 22(7):799–804. Epub 2011 Mar 17

    Article  PubMed  Google Scholar 

  5. Bump RC, Mattiasson A, Bø K et al (1996) The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction. Am J Obstet Gynecol 175:10–17

    Article  PubMed  CAS  Google Scholar 

  6. Baessler K, O’Neill SM, Maher CF, Battistutta D (2010) A validated self-administered female pelvic floor questionnaire. Int Urogynecol J 21(2):163–172

    Article  PubMed  Google Scholar 

  7. Srikrishna S, Robinson D, Cardozo L (2010) Validation of the Patient Global Impression of Improvement (PGI-I) for urogenital prolapse. Int Urogynecol J 21(5):523–528

    Article  PubMed  Google Scholar 

  8. Yamamoto R, Okamoto K, Ebina Y, Shirato H, Sakuragi N, Fujimoto S (2000) Prevention of vaginal shortening following radical hysterectomy. BJOG 107(7):841–845

    Article  PubMed  CAS  Google Scholar 

  9. Kwon CH, Culligan PJ, Koduri S, Goldberg RP, Sand PK (2003) The development of pelvic organ prolapse following isolated Burch retropubic urethropexy. Int Urogynecol J Pelvic Floor Dysfunct 14(5):321–325, discussion 325. Epub 2003 Sep 30

    Article  PubMed  Google Scholar 

  10. Ward KL, Hilton P, UK and Ireland TVT Trial Group (2008) Tension-free vaginal tape versus colposuspension for primary urodynamic stress incontinence: 5-year follow up. BJOG 115(2):226–233. Epub 2007 Oct 25

    Article  PubMed  CAS  Google Scholar 

  11. Maher CF, Qatawneh AM, Dwyer PL, Carey MP, Cornish A, Schluter PJ (2004) Abdominal sacral colpopexy or vaginal sacrospinous colpopexy for vaginal vault prolapse: a prospective randomized study. Am J Obstet Gynecol 190(1):20–26

    Article  PubMed  Google Scholar 

  12. Paraiso MF, Ballard LA, Walters MD, Lee JC, Mitchinson AR (1996) Pelvic support defects and visceral and sexual function in women treated with sacrospinous ligament suspension and pelvic reconstruction. Am J Obstet Gynecol 175(6):1423–1430, discussion 1430-1

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Royal Brisbane & Women’s Hospital, Urogynaecology, Butterfield Street, Herston, QLD, 4029, Australia

    Corina Schmid & Christopher Maher

  2. Queensland Institute of Medical Research, Brisbane, Australia

    Peter O’Rourke

Authors
  1. Corina Schmid
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  2. Peter O’Rourke
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  3. Christopher Maher
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Corresponding author

Correspondence to Corina Schmid.

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Schmid, C., O’Rourke, P. & Maher, C. Vaginal invagination: definition, clinical presentation and surgical management. Int Urogynecol J 24, 313–317 (2013). https://doi.org/10.1007/s00192-012-1838-4

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  • DOI: https://doi.org/10.1007/s00192-012-1838-4

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