Non-surgical vaginal dilation is a safe and effective method for the creation of neovagina in the patient with vaginal agenesis. Compared to surgical methods, non-surgical vaginal dilation has the advantage of low morbidity, the creation of a more physiologic vaginal milieu, and no surgical scarring. To overcome some technical limitations of original Frank's method, in 1981 Ingram proposed a modification of the technique that used dilators of gradually increasing size mounted on a bicycle seat stool. Although several studies have shown satisfactory outcomes using Ingram's method, there are some practical difficulties in making and handling the bicycle seat stool. This article reports a case of a 24-year-old woman with Mayer-Rokitansky-Kster-Hauser syndrome whose vaginal agenesis is successfully treated with a simplified version of Ingram's method. This method uses dilators of gradually increasing size mounted on an ordinary chair instead of a bicycle seat stool. When necessary, the patient may use a fulcrum under the dilator.
Vagina/*abnormalities/pathology ; Humans ; Gynecology/instrumentation/methods ; Female ; Adult ; Abnormalities/therapy

Non-surgical vaginal dilation is a safe and effective method for the creation of neovagina in the patient with vaginal agenesis. Compared to surgical methods, non-surgical vaginal dilation has the advantage of low morbidity, the creation of a more physiologic vaginal milieu, and no surgical scarring. To overcome some technical limitations of original Frank's method, in 1981 Ingram proposed a modification of the technique that used dilators of gradually increasing size mounted on a bicycle seat stool. Although several studies have shown satisfactory outcomes using Ingram's method, there are some practical difficulties in making and handling the bicycle seat stool. This article reports a case of a 24-year-old woman with Mayer-Rokitansky-Kster-Hauser syndrome whose vaginal agenesis is successfully treated with a simplified version of Ingram's method. This method uses dilators of gradually increasing size mounted on an ordinary chair instead of a bicycle seat stool. When necessary, the patient may use a fulcrum under the dilator.
Vagina/*abnormalities/pathology ; Humans ; Gynecology/instrumentation/methods ; Female ; Adult ; Abnormalities/therapy

We present a case of vaginal ectopic ureter with ipsilateral partial duplication of the upper ureter (Y-type ureter), ipsilateral hypoplastic pelvic kidney and bicornuate uterus in a 20-year-old woman who presented with mild urinary incontinence since infancy. Ultrasonography, computed tomography and intravenous pyelography examination showed a left kidney with no evidence of a right kidney. Cystourethroscopy showed absence of the right hemitrigone. Magnetic resonance (MR) urography demonstrated the presence of a bicornuate uterus, an ectopic dysplastic right kidney in the pelvic cavity, and a right ureter that terminates in the vaginae fornix. The patient underwent right nephroureterectomy and urinary continence was restored completely. Although congenital malformations of the urinary tract are frequently associated with genital tract abnormalities, to best our knowledge, this is the first report of the coexistence of all of these anomalies in an individual. Our report also highlights the importance of MR urography in the diagnosis of such rare and complex anomalies.
Female ; Humans ; Kidney ; abnormalities ; pathology ; Kidney Diseases ; diagnosis ; pathology ; Magnetic Resonance Imaging ; Ureter ; abnormalities ; pathology ; Urinary Incontinence ; etiology ; Uterus ; abnormalities ; pathology ; Vagina ; abnormalities ; pathology ; Young Adult

PURPOSE: To evaluate the relibility of transrectal ultrasonography (TRUS) to define adult female genital organ and to diagnose and stage the cervical carcinomas. METHODS AND MATERIALS: After analysis of normal ultrasonographic anatomy of female pelvis in ten healthy women, I performed TRUS in thirty patients of uterine cervical carcinomas by rotating the 5 MHz electronic linear array transducer(SL2, Siemens, Erlangen, Germany) along the reference sagittal plane in the middle of uterine cervix & vagina. The results of TRUS were analyzed and compared to FIGO, surgical pathology, CT and MRT, ect. RESULTS: TRUS allowed good visualization of the uterus, uterine cervix, parametrium, vagina, anterior rectal wall, walls of the urinary bladder, and uterine cervical carcinomas. The accuracy of staging with TRUS was 83%, compared with the accuracy of 67% for clinical staging according to the criteria of the International Federation of Gynecotogy and Obstetrics(FIGO). For extent of parametrial involvement, the sensitivity of TRUS was 93%, with the specificity of 86% and the diagnostic accuracy of 89%. The same reliability parameters for clinical evaluation were 71%, 79%, and 75% respectively. CONCLUSION: Above findings suggest that low-cost TRUS could be usefully applied to pretreatment evaluation of patients with uterine cervical carcinoma.
Adult ; Cervix Uteri ; Diagnosis* ; Female ; Genitalia ; Humans ; Pathology, Surgical ; Pelvis ; Sensitivity and Specificity ; Ultrasonography* ; Urinary Bladder ; Uterus ; Vagina

We report a case of mixed tumor arising in the lower vaginal wall. The patient was a 20-yr-old nullipararous woman. The tumor was relatively well-defined with expansile margin, and showed solid sheets or fascicles of stromal-type spindle cells and ovoid epithelial cells with sparsely scattered nests of mature squamous epithelium and glands lined by mucinous epithelium. Cellular atypia was not conspicuous, however, mitosis was counted upto 6 per 10 high power fields. We examined this tumor immunohistochemically and ultrastructurally and reviewed the articles to identify the histogenesis. Positive reaction for vimenin and cytokeratin of stromaltype spindle cells and presence of desmosome-like structures and tonofilaments on electron microscopic examination suggested the epithelial origin of the stromaltype spindle cells.
Adult ; Female ; Humans ; Immunohistochemistry ; Keratins/biosynthesis ; Microscopy, Electron ; Mitosis ; Mixed Tumor, Malignant/*diagnosis/pathology/ultrastructure ; Vagina/*pathology ; Vaginal Neoplasms/*diagnosis/pathology/ultrastructure ; Vimentin/biosynthesis

OBJECTIVE: To analyze magnetic resonance imaging (MRI) findings of Mullerian remnants in young females clinically suspected of Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome in a primary amenorrhea workup. MATERIALS AND METHODS: Fifteen young females underwent multiplanar T2- and transverse T1-weighted MRI at either a 1.5T or 3.0T MR imager. Two gynecologic radiologists reached consensus decisions for the evaluation of Mullerian remnants, vagina, ovaries, and associated findings. RESULTS: All cases had bilateral uterine buds in the pelvic cavity, with unilateral cavitation in two cases. The buds had an average long-axis diameter of 2.64 +/- 0.65 cm. In all cases, bilateral buds were connected with fibrous band-like structures. In 13 cases, the band-like structures converged at the midline or a paramedian triangular soft tissue lying above the bladder dome. The lower one-third of the vagina was identified in 14 cases. Fourteen cases showed bilateral normal ovaries near the uterine buds. One unilateral pelvic kidney, one unilateral renal agenesis, one mild scoliosis, and three lumbar sacralization cases were found as associated findings. CONCLUSION: Typical Mullerian remnants in MRKH syndrome consist of bilateral uterine buds connected by the fibrous band-like structures, which converge at the midline triangular soft tissue lying above the bladder dome.
Abnormalities, Multiple/*pathology ; Adolescent ; Adult ; Female ; Humans ; Kidney/abnormalities/pathology ; Magnetic Resonance Imaging/*methods ; Middle Aged ; Mullerian Ducts/abnormalities/pathology ; Retrospective Studies ; Somites/abnormalities/pathology ; Spine/abnormalities/pathology ; Uterus/abnormalities/pathology ; Vagina/abnormalities/pathology

PURPOSE: lntra-arterial cisplatin infusion chemotherapy delivers higher concentration of this therapeutic agent to the limited area of cervical carcinoma. We evaluated the role of endorectal ultrasonography (ERUS) in the analysis of the tumor response to this chemotherapy. MATERIALS AND METHODS: ERUS was done in 20 patients of cervical carcinomas limited to the pelvis by rotating the 5 UHz linear arraytransducer along the reference sagittal plane in the middle of uterine cervix and vagina. We examined and compared the change of tumor size and morphology on ER US, before, during and after intra-arterial cisplatin (50 mg/m2) chemotherapy through internal lilac artery near uterine arterial branching. Colposcopy and radical hysterectomy with pelvic lymphadenectomy were performed in all patients, and ERUS findingswere compared with those findings. RESULTS: ERUS correlated well with surgery in the estimation of preoperative tumor size and morphology. Tumor reduction rate on ERUS (100-the largest area of the preoperative tumor/the largest area of the initial tumor) was as follows: more than 75% decrease of the original size in 3 patients, 75% -50% in 6 patients, 50%-25% in 8 patients, and less than 25% in 3 patients. Hyperechoic reflecting areas were noted in 4 patients, which corresponded to gaseous necrosis on postoperative pathology. CONCLUSION: ERUS is helpful to evaluate the morphologic change of cervical carcinoma limited tothe pelvis in intra-arterial cisplatin chemotherapy.
Arteries ; Cervix Uteri ; Cisplatin* ; Colposcopy ; Drug Therapy* ; Female ; Follow-Up Studies* ; Humans ; Hysterectomy ; Lymph Node Excision ; Necrosis ; Pathology ; Pelvis ; Ultrasonography* ; Vagina

Angiomyolipomas are a form of mesenchymal hamartoma that consists of blood vessels, smooth muscle cells, and mature fat cells. The vast majority of these tumors occur in the kidney. Extrarenal angiomyolipomas are extremely rare and have been reported in the liver, nasal cavity, vagina, spermatic cord, skin, and mediastinum. We report a case of symptomatic angiomyolipoma manifestated caused by colonic intussusception. A 67-year-old male was admitted because of lower abdominal pain that began 10 days prior. Abdominal computed tomography showed intussusception, and colonofiberscopic finding showed a lumen filled with a smooth surfaced pedunculated mass in the left side colon. The patient underwent a partial segmental resection of the sigmoid colon. I report a case of angiomyolipoma that was confirmed by the pathology findings.
Abdominal Pain ; Adipocytes ; Aged ; Angiomyolipoma* ; Blood Vessels ; Colon* ; Colon, Sigmoid ; Hamartoma ; Humans ; Intussusception* ; Kidney ; Liver ; Male ; Mediastinum ; Myocytes, Smooth Muscle ; Nasal Cavity ; Pathology ; Skin ; Spermatic Cord ; Vagina

The potential role and determinants of response to a cisplatin-based regimen of neoadju-vant chemotherapy in women with a histologically confirmed first diagnosis of stage IB-III cervical cancer were analyzed. From 1993 to 1996, 92 patients with bulky(designated as more than 3X3 cm2 size) mass were treated with cisplatin 60 mg/m2 and etoposide 100 mg/m2, admi-nistered intravenously at 7 day intervals. Seventy cases of radical hysterectomy with pelvic lymph node dissection and 22 cases of radiation therapy were performed 2 to 3 weeks after chemotherapy. At the end of the cycles, the overall clinical response rate of portio was 83.7 %(34.8 % with a complete response and 48.9 % with a partial response). The older ages, lower stages, and squamous cell types correlated favorably with the clinical response of the portio, but neither with the parametrium nor with the vagina. After the operation, we found the diff-erences in histologic responses, with the following parameters : lymphovascular space invasion, 3 mm below stromal invasion and lymph node metastasis. Theses parameters correlated with the clinical responses, and the down-staging of cases were 70 %. In comparison with radiolog-ical findings of pretreatment and postoperative tissue pathology, we could find a decrease in pelvic LN metastasis. The tumor-free survival rate calculated by the Kaplan-Meier product limit method was 75 % but it was 86.1 % for cases without the occurrence of persistent disease after the completion of the treatments. All patients suffered from nausea and vomiting, but grade 4 toxicity was not detected after the routine use of antiemetics. There were no events that delayed the next step in the treatment or caused difficulty during the operation. The results of this study suggest that the neoadjuvant chemotherapy should be accepted as a routine tool in treating high risk cervical cancer in order to improve the likelihood of favorable outcomes.
Antiemetics ; Cisplatin ; Diagnosis ; Drug Therapy ; Etoposide ; Female ; Humans ; Hysterectomy ; Kaplan-Meier Estimate ; Lymph Node Excision ; Lymph Nodes ; Nausea ; Neoplasm Metastasis ; Pathology ; Survival Rate ; Uterine Cervical Neoplasms* ; Vagina ; Vomiting

PURPOSE: This study was done to determine whether muscle strength training programs have an impact on improving symptoms of urinary incontinence (UI) and physical function among elderly women with UI who reside in long-term care facilities. METHODS: A randomized controlled trial was conducted. Participants had to be over 65 years, score over 15 score on the mini-mental state examination, and be able to walk alone or with an assistant. Seventy residents were randomly allocated to either the training group (n=35) or control group (n=35). The program consisted of 50 minutes, twice a week for 8 weeks, and included Kegel's exercise, Thera-band training and indoor walking. Main outcomes were UI symptoms, peak vaginal pressure and physical functions measured with timed up and go test (TUG), one leg standing test (OLST), activities of daily living (ADL) and grip strength. Changes in outcome measurements were calculated from baseline to 4 weeks and to 8 weeks using repeated measures ANOVA. RESULTS: There were significant differences in peak vaginal pressure (p<.001), TUG (p<.001), OLST (p=.012) and grip strength (p<.001) in the interaction between groups and time. CONCLUSION: Future studies are suggested to confirm the effect of muscle strength training in long-term care facilities where elderly women with UI reside.
Aged ; Aged, 80 and over ; Female ; Hand Strength ; Humans ; Long-Term Care ; Muscle Strength/*physiology ; Resistance Training ; Urinary Incontinence/pathology/*therapy ; Vagina/physiology ; Walking