Aruna N. Kekre

Postpartum urinary retention after vaginal delivery

To determine the incidence of covert and overt postpartum urinary retention (PUR) after vaginal delivery and to determine obstetric variables contributing to PUR.

Tamoxifen-induced endometrial changes in postmenopausal women with breast carcinoma

Objectives: To assess the effects of tamoxifen (TAM) on the endometrium in postmenopausal women. Methods: A case control study of postmenopausal women with breast carcinoma, who were undergoing treatment in the Department of Radiotherapy and Surgery at the Christian Medical College Hospital, Vellore, India was done. Thirty‐five women who were on tamoxifen (20 mg/day) for a period of at least 6 months formed the study group. Thirty‐three women who were not receiving tamoxifen, formed the control group. Subjects in both groups had a pelvic examination and transvaginal sonogram followed by endometrial biopsy. Results: There was a statistically significant difference in the mean endometrial thickness between the study group and control group (7.8±6.4 mm vs. 4.0±2.0 mm, respectively) More women in the tamoxifen group had an endometrial thickness of >5 mm but the number of women with polyps or hyperplasia of the endometrium did not differ significantly between the two groups. There were no women with endometrial carcinoma in either group. Conclusion: All patients on tamoxifen need to be evaluated by clinical examination annually. A transvaginal sonogram and endometrial biopsy/hysteroscopy may be performed on patients with abnormal vaginal bleeding, bloody discharge, staining or spotting.

Bowel vaginoplasty in children and young women: an institutional experience with 55 patients

Introduction and hypothesisAbsence of a vagina owing to congenital Mullerian defects or other acquired causes requires reconstruction of the female genital passage. We present our experience using various bowel segments.MethodsBowel vaginoplasty was performed in 55 patients from January 2004 through May 2014 for cervicovaginal atresia (20), Mayer–Rokitansky–Küster–Hauser (MRKH) syndrome (20), distal vaginal atresia (8), cloaca (2), cervical atresia (1), complex urogenital sinus (1), transverse vaginal septum (1), rhabdomyosarcoma of the vagina (1), and traumatic stricture of the vagina (1). The bowel segments used were sigmoid (50), ileum (2), anorectovestibular fistula ( 2), and loop rectovaginoplasty (1).ResultsThirty-nine patients who had the proximal vagina or uterus anastomosed to the bowel segment reported regular menstrual flows. Three patients are sexually active with satisfactory coital function. None of our patients developed pyometra. Five patients had neovaginal mucosal prolapse. Two patients had severe stenosis requiring excision of the neovagina. Seven patients had mild stenosis requiring dilatations in 6 patients and V-Y meatoplasty for 1 patient. One patient had a descending colon anastomotic leak requiring a diversion ileostomy.ConclusionsGenital reconstruction with bowel vaginoplasty is a highly skilled operation that provides a durable and lubricated replacement of the vagina with good outcomes. Utero-coloneovaginoplasty is a safe procedure preserving the menstrual flow in patients with a functional uterine fundus.

Spontaneous Rupture of the Urinary Bladder in the Puerperium

EDITORIAL COMMENT: We accepted this paper for publication because it is important for obstetricians to know that spontaneous rupture of the bladder can occur in the puerperium even when there is no predisposing cause such as obstructed labour or previous injury.

Cervicovaginal atresia with hematometra: restoring menstrual and sexual function by utero-coloneovaginoplasty

BackgroundCervicovaginal atresia is a rare Mullerian anomaly. The management of cervicovaginal atresia has evolved from historical recommendations of hysterectomy to various reconstructive procedures more recently. The latter carries a risk of significant morbidity and unknown fertility. We present our experience in the management of this complex anomaly.MethodsTwenty patients with cervicovaginal atresia were operated in our hospital from January 2004 through December 2013. The details of their anatomical variations and functional outcomes were analyzed.ResultsEighteen out of twenty patients had cervical agenesis. Two patients had cervical hypoplasia. All patients underwent utero-coloneovaginoplasty. Post operatively, all patients have regular menstrual cycles. One patient is married, sexually active and has satisfactory coital function. One patient had a bowel anastomotic leak that required a diversion ileostomy. Two patients developed mild stenosis. One patient has mild neovaginal mucosal prolapse. No patient has developed pyometra.ConclusionPatients with cervicovaginal atresia need to be counselled about the various reconstructive options available and the potential risks. Social and economic factor play a significant role in determining the plan of management. For patients from conservative societies, utero-coloneovaginoplasty provides a safe conduit for the passage of menstrual flow and coitus, at the cost of permanent infertility.

Transvaginal Sonography of the Endometrium in South Indian Postmenopausal Women

EDITORIAL COMMENT: We accepted this paper because it has a simple important message, namely that postmenopausal women with an endometrial thickness ≤4 mm will not have an endometrial cancer; they are likely to have endometrial atrophy. A vaginal ultrasound examination to measure endometrial thickness is a noninvasive investigation. There are about 100 papers on this subject in the world literature at present, and it appears that this investigation will adequately exclude endometrial malignancy in postmenopausal women. This is especially useful in older, unfit or frail women. However, if bleeding is heavy or persists it would still be recommended that hysteroscopy and/or curettage be performed.

Vitamin D deficiency in postmenopausal women with pelvic floor disorders.

Introduction: The aim of this study is to evaluate the association of vitamin D deficiency and pelvic floor disorders (PFD) including pelvic organ prolapse (POP) and stress urinary incontinence in postmenopausal women. Materials and Methods: This is a prospective case control study on 120 women with or without symptoms of PFD. Relevant history and clinical examination were conducted. Serum 25-hydroxy vitamin D levels were measured in all women. Chi square and student t test were used to test significance of association. Logistic regression was used to adjust for age. Odds ratios and 95% confidence intervals were calculated. Results: Of the 120 postmenopausal women included, 51 had PFD on clinical examination. Of the 51 cases, 28 women had POP and 14 women had stress incontinence (SUI) while nine women had both POP and SUI. The study showed that vitamin D levels were significantly lower in women with PFD than those without PFD. Menopausal status of more than 5 years was also significantly associated with PFD. Conclusion: Findings suggest association of vitamin D deficiency and PFD in postmenopausal women. In addition, postmenopausal women have a high prevalence of vitamin D deficiency indicating a need to evaluate vitamin D levels in these women.

Symptoms, prevalence, and risk factors of overactive bladder in women in south India

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Hydroureteronephrosis in women with pelvic organ prolapse: a prospective cohort study

Pelvic organ prolapses (POP) is protrusion of pelvic organs (bladder, uterus, rectum) through the vagina from its normal position. The prevalence of POP in the general population is about 37% which increases to 64.8% in older women. Among them at least 30% may require surgery. The reported prevalence of hydroureteronephrosis (HUN) in women with pelvic organ prolapse is 7-50%. However, the true prevalence still unclear due to lack of prospective studies on sufficiently large cohorts.

Prevalence of voiding and defecatory dysfunction in postmenopausal women with pelvic organ prolapse: a prospective observational study

Pelvic organ prolapse (POP), is defined by the international continence society as the the symptomatic descent of the anterior vaginal wall, the posterior vaginal wall, the apex of the vagina or the vaginal vault. Women with POP may presents with symptoms of urinary incontinence, fecal incontinence, voiding dysfunction, and defecatory dysfunction, this interrelated group of conditions collectively describe as “Disorders of the Pelvic Floor”. This study aims to understand the prevalence and relationship between pelvic organ prolapse and voiding dysfunction and defecatory dysfunction. The available outcome of these measures can be used by clinicians and researchers to assess the functional outcomes of prolapse and its treatment on patients with an emphasis on symptom and quality-of-life assessment. ABSTRACT