Vaginal invagination: definition, clinical presentation and surgical management.
OBJECTIVE
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 cm(2).


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.
Royal Brisbane & Women's Hospital, Urogynaecology, Butterfield Street, Herston, QLD 4029, Australia. cocoschmid@hotmail.com
Corina
C
Schmid
Peter
P
O'Rourke
Christopher
C
Maher
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000379:methods*; D006801:Humans; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D015995:Prevalence; D011446:Prospective Studies; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D014596:Uterine Prolapse / Q000453:epidemiology* / Q000601:surgery*; D014621:Vagina / Q000473:pathology* / Q000601:surgery