Robert F. Zacharin

Grafting as a principle in the surgical management of vesicovaginal and rectovaginal fistulae.

Summary: The treatment of 49 genital fistulae in the past 18 years is reported from the Department of Gynaecology, Alfred Hospital, Melbourne. The series included 32 vesicovaginal fistulae, 15 rectovaginal fistulae and 2 double fistulae.

The Problem of the Large Enterocele

Summary: Dissatisfaction with available methods of treating large enterocele prompted a re‐examination of the problem.

Recto-Vaginal Fistula

While the occurrence of recto-vaginal fistula due to an obstetric cause is less frequent than vesico-vaginal fistula, nevertheless those same factors which cause vesico-vaginal fistula are responsible for recto-vaginal fistula.

Genital Prolapse in Ruminants

Many believe the human genital tract is tion with faeces and soil. The irritation of supported by both pelvic cellular tissues the infection produces straining efforts, so and pelvic musculature, and that damage worsening the prolapse. Death is due to to these structures is necessary for prolapse infection, haemorrhage and urinary probto occur. lems. Parturition is said to be the prominent There are many theories of aetiology form of damage, and followingthis, the twin effects to time and gravity play a

A MODIFIED TECHNIQUE FOR ABDOMINOPERINEAL URETHRAL SUSPENSION.

Abstract 1. A recent modification in the technique of performing abdominoperineal urethral suspension is described.

Anatomy of the Genital Tract Supports

There has been wide controversy, ranging over many aspects of the supporting anatomy of the genital tract, and although presently it is common belief that both the levator ani complex and pelvic cellular tissues have important complementary roles to play, nevertheless in the past there has been great argument as to which was the more important, and in particular how each exerted its effect on genital tract stability. These problems will be considered in terms of evolutionary anatomy, human anatomy, comparative anatomy, and functional anatomy.

James Marion Sims (1813–1883) and the First Fistula Hospital

C. Lee Buxton (1968) wrote: “Dynamic, vital, imaginative, sometimes contentious, always filled with dedication to a burning mission, this ever gentlemany physician by professional and personal attributes of permanent quality, helped create gynaecology as a speciality. His dramatic surgical success with vesico-vaginal fistula is the accomplishment for which he is best known, but the qualities of stubborn dedication and persistence revealed in his quest for success in this operation, are a more profound revelation of the man than the operation itself.”

The Clinical Features of Enterocoele

There has been much confusion with enterocoele nomenclature in the past ever since first descriptions by de Garengeot (1743) and Astley Cooper (1804). Gaillard Thomas (1885) presented a comprehensive classification of hernias appearing in the vagina or vulva and included “vaginal enterocoele or hernia, meaning the descent of a small portion of small intestine into the vagina”. Pudendal or perineal enterocoele similarly was applied to small bowel descent into the labium majus or perineum and these two groups were further subdivided depending upon the contents of the sac. Vaginal hernia, declared by Sweetser (1919) to be a great rarity, found an exit either anterior or posterior to the broad ligament, the anterior hernia descending between the broad ligament and bladder to push the anterior vaginal wall forward, whilst the posterior perforated part of the levator muscle pushing forward the posterior vaginal wall. Miles (1926) suggested pelvic hernia as an inclusive term for all herniae passing through the pelvic floor, and subvarieties were named by their point of egress to be consistent with best usage in hernia nomenclature. Miles subdivisions were pudendal, perineal and vaginal; the latter being split further into anterior or posterior, depending upon the relationship of the sac to the uterus with the anterior vaginal hernia following the cleavage plane between bladder and anterior vaginal wall.

Analysis of Results of Answers to Journal Questionnaire of Readers' Preferences

The response rate to the questionnaire circulated in the August, 1993 issue of the Journal was 13.3% with completed questionnaires being received from 527 subscribers. This compared favourably with the response rate to the previous questionnaire of slightly less than 10% (1).

The Incidence, Etiology and Pathology of Obstetric Fistula

”Kaltume Bakar had been married seven years and menstruation began two years after marriage. No preparations were made for the baby because nobody knew if it would be a live birth. During labor an old woman came and stayed with her. She was not a midwife but there was nobody in the village with any knowledge of midwifery. She was three days in labor and the old woman just sat in the room, asking now and then if she wanted help. The husband sat outside doing nothing either. It was the rainy season with a river between them and a motorable road.