Role of Office-Based Vaginoscopy in a Tertiary Care Center

Abstract

Introduction:The detection of vaginal mesh/suture exposure can be challenging due to pain and varied location. We reviewed our experience with office-based vaginoscopy to evaluate these women.Methods: An IRB-approved review of an electronic medical record database at a tertiary care center provided the list of all vaginoscopy procedures performed by a single FPMRS (Female Pelvic Medicine and Reconstructive Surgery) specialist. Vaginoscopy was performed with a flexible cystoscope and findings photographically documented. Demographics, indications, findings, additional imaging (translabial ultrasound and magnetic resonance imaging), and intraoperative findings for corroboration were collected by a neutral investigator.Results: From 2014 to 2020, 159 vaginoscopies were conducted in 128 women with 23 having repeat procedures. Presenting symptoms prompting vaginoscopy included dyspareunia (46), hispareunia (6), vaginal bleeding or discharge (24), or pelvic pain (31), with multiple symptoms present in 63%. The yield of vaginoscopy in detecting mesh/suture exposure was 32% (51/159): 33% (23/71) without prior removal attempts and only vaginal complaints, 37% (18/49) with history of prior surgical mesh/suture removal, 38% (10/26) with history of prior office mesh removal at another facility and none (0/13) when evaluating for bladder mesh complications. Comparatively, only 3 exposures were suspected on imaging. The apex was the most common site of exposure (63%). Mesh/suture removal was mostly performed via a vaginal approach (90%), with 93% corroboration with office-based findings.Conclusions: Office-based vaginoscopy is a safe and simple tool to exclude or detect mesh or suture exposure in selected patients and precisely locate the site/size of exposure to aid in surgical planning of mesh/suture-related complications.