Management of trans-vaginal extrusion of the distal ventriculoperitoneal shunt catheter: a systematic literature review from 1973 to 2021

Trans-vaginal extrusion of the distal ventriculoperitoneal shunt (VPS) catheter is a rare complication of VPS insertion done for the treatment of hydrocephalus. The primary purpose was to review the demographics. The secondary objectives were to review the clinical presentation, operative intervention executed, and outcome of the cases published on trans-vaginal extrusion of the distal VPS catheter. The literature and case reports were retrieved from 1973 to September 30, 2021. This literature review included (n=19) cases of the above-mentioned VPS complication. The mean age of 15 children at the time of diagnosis of the complication was 18.13 months and ranged from 2 to 72 months. For the entire case, the interval from the initial VPS insertion/VPS revision to the clinical diagnosis of complication ranged from 1 to 36 months, with a mean of 8.16 months. In three-fourth of the cases, it was detected within 6-months of the VPS implantation. Extrusion of the distal VPS catheter through the vagina was the chief complaint. Surgical procedures were performed in the following order of frequency (A) removal of the entire VPS catheter (n=14), and (B) removal of the distal/peritoneal VPS catheter (n=3). During the postoperative period, one of the children died. Extrusion of the distal VPS catheter through the vaginal orifice is a rare complication of VPS insertion. It occurred across all the age groups but was more common during early childhood. Three-fourth of them were treated by removal of the entire VPS catheter. For VPS revision, delayed re-VPS insertion was the preferred option.

Management of sexual dysfunction following poorly healed episiotomy in a multipara in low-income setting

Background: Episiotomy describes an incision made on the perineum to widen the vaginal orifice so as to aid delivery of the baby. Though not routinely recommended, it is a common during delivery. Despite the intended positive outcomes, complications like sexual dysfunction, urinary incontinence, chronic pelvic pain, perineal infection do occur following it. When sexual dysfunction occurs as sequelae as a result of poor episiotomy repair technique or poor healing, it can affect sexual intercourse and lead to marital disharmony especially in societies that tend to lean towards patriarchy Case presentation: A 31-year-old Nigerian multiparous lady with three living children presented on account of complaints of lax introitus and lack of sexual satisfaction by the partner. She had poorly healed bilateral episiotomy scar following her last delivery. She has been practicing Kegel’s exercise with no improvement. There was associated threat to their relationship by her partner. Perineolasty and vaginoplasty was done. She had successful recovery and improvement in the quality of sex. Conclusion: This is a rare case of a woman in our clime visiting the clinic to request for perineal reconstruction following complaints by her partner and threat to their relationship. Obstetricians should pay attention to any complaint or worry following episiotomy and offer appropriate care to meet the sexuality needs of the parous following childbirth. Keywords: episiotomy; Kegel’s exercise; perineoplasty; vaginoplasty.

A Case of Congenital Urethrovaginal Fistula in a Female Child with Suspected Imperforate Hymen: A Case Report

Urethrovaginal fistula is an abnormal communication between the urethra and vagina. Urethrovaginal fistula results in urinary incontinence with urine continually leaking from the vagina. In children congenital anomaly may also be the cause. Congenital Urethrovaginal fistula is an extremely rare genitourinary anomaly. The reported five cases in the literature are all associated with urogenital abnormalities like vaginal septum, vaginal agenesis and imperforate hymen. We present a case of a 7-year-old female that was referred from a peripheral hospital for micturating cystourethrography (MCUG) on account of urinary incontinence and passage of urine from vaginal orifice. Following MCUG the urethra, proximal fistula between the urethra and vagina, distended urinary bladder, contrast opacified uterus and a fallopian tube were all demonstrated. We report this case because of its rarity in the literature.

Midline and Mediolateral Episiotomy: Risk Assessment Based on Clinical Anatomy

Episiotomy is the surgical incision of the vaginal orifice and perineum to ease the passage of an infant’s head while crowning during vaginal delivery. Although episiotomy remains one of the most frequently performed surgeries around the world, short- and long-term complications from the procedure are not uncommon. We performed midline and mediolateral episiotomies with the aim of correlating commonly diagnosed postepisiotomy complications with risk of injury to perineal neuromuscular and erectile structures. We performed 61 incisions on 47 female cadavers and dissected around the incision site. Dissections revealed that midline incisions did not bisect any major neuromuscular structures, although they did increase the risk of direct and indirect injury to the subcutaneous portion of the external anal sphincter. Mediolateral incisions posed greater risk of iatrogenic injury to ipsilateral nerve, muscle, erectile, and gland tissues. Clinician discretion is advised when weighing the potential risks to maternal perineal anatomy during vaginal delivery when episiotomy is indicated. If episiotomy is warranted, an understanding of perineal anatomy may benefit diagnosis of postsurgical complications.

Recurrent formation of haematocolpos in a young girl with multiple congenital anomalies of the urogenital tract

An 11-year-old girl, a known case of left crossed fused renal ectopia and sacral hypoplasia presented to the gynaecological OPD in Karachi, Pakistan, in February 2019 with complaints of abdominal pain. On examination, she was found to have a septum covering her vaginal orifice. She was subsequently diagnosed with haematocolpos secondary to imperforate hymen. Incision and drainage was done. However, despite surgical management, she continued to have recurrent formation of haematocolpos for the next two months secondary to multiple complete and partial transverse vaginal septa and post-operative formation of adhesions. Definitive management was done with ultrasound guided needle puncture and drainage, followed by post-operative tampon use to maintain patency. Keywords: Haematocolpos, urogenital abnormalities, Continuous...

Migration of Neglected Vaginal Pessaries: A Case Report

Introduction: Vaginal pessaries are commonly used to manage pelvic organ prolapse. Pessaries are usually tolerated although some severe complications can occur in cases of negligence, including vesicovaginal and rectovaginal fistulas. Case Presentation: This is a report of two cases of a neglected vaginal pessary and migration into the rectovaginal space to form a vaginal orifice. Based on examinations, no vaginal pessaries in both cases migrated into the rectum. These pessaries were removed by cutting and rotating movements. Finally, the two patients were discharged after surgery without any complications. Conclusions: Neglected pessaries can lead to serious complications. Thus, patient education, local estrogen treatment, and careful follow-ups are important to prevent such complications.

Histomorphological and Histochemical Investigation of The Vagina of Adult Guinea Pigs (Cavia porcellus)

This study was carried out to identify the morphological, histological and histochemical features of the vagina of the adult guinea pig (Cavia porcellus). To perform such project, 14 adult guinea pigs at their diestrous period were bought from the local breeders directly. Animals were euthanized, dissected and subsequently specimens from the cranial, middle and caudal portions of the vagina were collected and fixed. Fixation was implemented by using 10% neutral buffered formalin and Bouin’s solution. Post routine processing such as dehydration, clearing, embedding and blocks preparation, tissue sections of 6 μm were prepared and stained by using hematoxylin-eosin, Masson’s Trichrome, Alcian blue and Periodic acid shiff stains. Gross findings revealed that the vagina in the adult guinea pigs was characteristically very long tube-like structure with wide diameter. The vagina entirely was running ventral to the colon and then under the rectum in the pelvic cavity. It was terminated caudally by the vaginal orifice independent to the urethral orifice of the urinary system. Microscopic findings revealed mucous columnar lining epithelium which was folded at the vaginal fornix decreased caudally toward the external vaginal orifice where the epithelium changed into stratified squamous epithelium not keratinized. Thin dense lamina propria was continuous with loose connective tissue of the submucosa. Thickness of tunica muscularis was decreased which was surrounded with thick adventitia. Histochemically, the non-ciliated mucous columnar cells present in the lining epithelium of the cranial and middle regions of the vagina were positively stained with AB (pH 2.5) and PAS stains. The reaction with AB (pH 2.5) was more intense compared to the staining with PAS so that it indicated that mucin was more acidic than neutral in nature. Characteristic conclusions include that the vagina opening was U-shaped not circular and closed by transparent closure during the diestrous period. Histologically, the vagina also lined with mucoid lining and only the orifice and adjacent area lined with stratified squamous epithelium. Moreover, current study recorded differences in both macroscopic and microscopic aspects of the vagina in the guinea pigs compared to other animal considered laboratory species.