Abdominal Key

Fig. 7.1 Grade II uterine prolapse (Baden-Walker), Grade III cystocele As planned, she returned for fluoroscopic urodynamic studies (FUDS) with and without vaginal packing. Post void residuals were high with…

Fig. 6.1 Anterior vaginal wall prolapse with loss of rugal folds, more consistent with a midline defect The objective of the anterior colporrhaphy is to fold and tighten the layers…

Fig. 17.1 (a) Fistula exposure. (b) Foley catheter within fistula can apply traction. Note the inverted T incision Fistula closure— Define the fistula by blue dye test if not done…

Fig. 9.1 Prolapse everted to identify the leading edge of the apex. Dimples marked The vaginal epithelium is hydrodissected away from the underlying enterocele, pubocervical and rectovaginal fascia at the…

General considerations Vaginal surgery considerations Health and ability to tolerate anaesthetic Enemas to clear the rectum Jehovah’s Witness with refusal of blood and blood products Antibiotic douches to decrease vaginal…

Fig. 5.1 VCUG: Demonstrating leakage with straining Urodynamics (UDS) The urodynamic study demonstrated adequate bladder capacity of 300 ml with normal compliance, stress incontinence, and a differential valsalva leak point…

Fig. 10.1 Pelvic diaphragm. The pelvic diaphragm is made up of (1) the coccygeus muscle and (2) the levator ani: the puborectalis pubococcygeus (or pubovisceral) and iliococcygeus muscles. Additional structures…

Fig. 8.1 Voiding cystogram confirming presence of moderate cystocele (a) and incomplete emptying (b) The patient and the family desired a native tissue repair option for her prolapse from which…

Fig. 13.1 Field preparation – O’Connor rectal shield secured with silk sutures and Lone Star® self-retaining retractor for vaginal exposure Mark out the mucocutaneous junction at the posterior vaginal fourchette…

Fig. 11.1 START OF PROCEDURE. (a) Vault and anterior compartment prolapse (b) Marking sutures placed on each side at site where the vaginal cuff (dimples) was once secured to the…