Objectives To evaluate subjective and objective outcomes, complication, recurrence, and reoperation rates after transvaginal mesh surgery for the management of pelvic organ prolapse. Methods This was a retrospective analysis of transvaginal mesh surgery carried out using self‐cut mesh measuring subjective outcomes using validated questionnaires, and objective outcomes using Pelvic Organ Prolapse Quantification. Patients diagnosed with stage ≥2 pelvic organ prolapse were counseled about all possible surgical options. After thorough explanation about the benefits and risks during transvaginal mesh surgery, patients who gave signed consent were scheduled for surgery and evaluated at 1 and 3 years postoperatively. Results We included 101 patients who completed a minimum of 3‐year follow up. One year and 3‐year follow up showed significant improvement both on subjective and objective outcomes. Recurrences were observed in three patients (3%), with one (1%) patient undergoing reoperation. One case (1%) of intraoperative complication (bladder injury) and four cases (4%) of postoperative complications (two mesh exposure, one hematoma and one significant increase in post‐voiding residual) were recorded. Overall patients’ satisfaction was positive. Conclusions Transvaginal mesh surgery using self‐cut mesh is associated with significant improvement in both subjective and objective outcomes, offering low recurrence and complication rates, and high patient satisfaction rates. It can be a safe, effective and cost‐efficient option not only for recurrence cases, but also as primary management of pelvic organ prolapse using a standardized technique and proper patient selection.

Background. Vesicouterine fistula (VUF) is a rare pathological communication between the uterus or cervix and the bladder. Youssef's syndrome is an atypical presentation of a patient with a vesicouterine fistula, characterized by a triad of cyclic hematuria, amenorrhea, and absence of urinary incontinence. Because of this atypical presentation, the patient may go undiagnosed and patient management will be delayed. Case presentation. A 39-year-old woman complained of hematuria. The patient underwent a second caesarean section in 2008 and a few weeks after the procedure the patient complained of leakage of urine from her vagina. Six months later the patient complained hematuria on her menstrual cycle and amenorrhea, with absence of urinary incontinence. Ultrasound examination found adhesions between the uterus and vagina, and irregular bladder mucosa. Patient  underwent cystoscopy with endometriosis were suspected on vesicovaginal repair scars and a bladder biopsy was also performed with the results of no endometrial stroma and glands then followed by hysteroscopy. Hysteroscopy result showed a 20 mm diameter hole with irregular margins. Subsequently, the patient was treated with hysterorrhaphy laparotomy and fistula repair. Conclusion. One type of vesicouterine fistula is Youssef's syndrome, which is a complication following a lower segment caesarean section with undiagnosed bladder injury. The diagnosis can be confirmed by cystoscopy, intravenous pyelography, hysterosalpingogram, sonography, and other types of imaging tests. Management of patients with VUF can be conservative, medical, or surgical.

Inversio uteri adalah salah satu komplikasi persalinan dengan risiko kematian tinggi akibat perdarahan dan syok. Laporan ini menjelaskan mengenai presentasi dan manajemen kasus inversio uteri. Seorang wanita berusia 33 tahun, P4A0 post partum spontan di bidan hari ke 5 dirujuk ke RS Mohammad Hoesin dengan riwayat uterus yang ikut keluar saat persalinan, namun uterus dapat dimasukkan kembali. Tanda-tanda vital pasien dalam batas normal. Pada pemeriksaan abdomen didapatkan tinggi fundus uteri sulit dinilai. Pada saat dilakukan inspeksi terdapat benjolan berupa keseluruhan uterus yang terbalik keluar dari serviks. Pemeriksaan laboratorium menunjukkan penurunan kadar hemoglobin (9.1 g/dL) dan peningkatan kadar leukosit (10.34x103/mm2). Pada pemeriksaan USG tidak tampak uterus pada kavum pelvis dengan kesan yang sesuai dengan gambaran inversio komplit. Pasien dipasangkan kateter lalu diputuskan untuk histerektomi supraservikal pervaginam. Kemudian pada pasien dilakukan pemasangan tampon vagina, pemberian antibiotik, antifibrinolitik serta obat simptomatik dengan stabilisasi berupa cairan dan transfusi. Setelah dua hari, tampon dilepas dan pasien membaik tanpa adanya komplikasi.

Introduction: The Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome is a condition in which there is an absence of the uterus and the upper part (2/3) of the vagina. Women with MRKH syndrome show normal development of secondary sexual characteristics and a normal 46, XX karyotype. MRKH syndrome is a common cause of primary amenorrhea. Ultrasonography examination confirms kidneys, presence of the ovaries, and absence of uterus. Treatment should include a multidisciplinary approach to create a functional vagina. One of the procedures is laparoscopic Davydov vaginoplasty. Aim: To report MRKH syndrome case treated with laparoscopic Davydov vaginoplasty. Method: Ms. A, 21 years old, P0A0, came to FER clinic Moh. Hoesin Hospital Palembang with complaint, never had menstruation, the patient admitted her breast, and her pubic had growth. She wants to get married in the next six months. From the US result, there was non visualized uterus, genital band (+), and both ovaries within normal limit ~ MRKH Syndrome. Karyotype Examination: 46, XX. Patient was diagnosed with primary amenorrhea caused by MRKH syndrome and was planned for neovagina (Davydov Procedure). Result: A woman 21-year-old, P0A0, was diagnosed with primary amenorrhea caused by MRKH syndrome. The Davydov procedure was done to create a neovagina. Intraoperative, after protrusion of the wood mold as a marker shown, an incision is made to the left and right side so that the mold penetrates the abdominal cavity, then the mold is pulled into the vaginal canal slowly. The anterior and posterior peritoneal layers are drawn into the vaginal canal. The anterior and posterior peritoneal layers were withdrawn with an ovum clamp and then interrupted suture. The anterior and posterior peritoneal layers were sutured in a circular method to form a vaginal cuff. The vaginal wall is sutured (interrupted) to hold mold fixed. Conclusion: MRKH syndrome is a disorder that occurs in females and mainly affects the reproductive system. This condition causes the vagina and the uterus to be underdeveloped or even absent at birth. Patients with diagnosed MRKH syndrome require interdisciplinary care. Davydov procedure is a laparoscopically-assisted technique, which has an advantage over traditional approaches. It has shorter operating time, lower intraoperative complications, shorter hospital stay, and no external scars. Postoperatively, sexual function is similar to women without gynecological disorders.

Background. A vesicovaginal fistula (FVV) is a direct pathological connection between the bladder and vagina resulting in uncontrolled leakage of urine into the vagina from the bladder. Based on the cause, fistulas are divided into two, namely obstetric fistula and gynecological fistula. The risk factors that influence the occurrence of FFV consist of obstetric risk factors (age, parity, delivery method, duration of delivery, birth weight) and gynecological risk factors (history of gynecological surgery, history of pelvic radiotherapy, history of gynecologic malignancy). The purpose of this study was to determine the relationship between risk factors and the incidence of vesicovaginal fistula. Methods. This research is an observational-analytic study with a cross-sectional method. The number of samples obtained was 74 patients who met the inclusion criteria using secondary data from medical records. Analysis of the data used is the chi-square test. Results. There were 37 people who experienced vesicovaginal fistula. Where there were 9 patients with obstetric vesicovaginal fistula (24.3%) and 28 people (75.7%). From the Chi-Square test analysis, there was a significant relationship between delivery method (p=0.029), birth weight (p=0.029), history of gynecological surgery (p=0.038), history of pelvic radiotherapy (p=0.016), history of gynecological malignancy (p=0.016). =0.010). Meanwhile, there was no significant relationship between age (p=0,347), parity (p=1,000), and duration of labor (p=0,082). Conclusion. There was a significant relationship between the delivery method, birth weight, history of gynecological surgery, history of pelvic radiotherapy, history of gynecological malignancy. There was no significant relationship between age, parity, and duration of vaginal delivery.