What is the Clinical Relevance of a Paravaginal Defect?

Excerpt

Most surgeons feel that anterior vaginal wall prolapse or a cystocele is caused by a generalized relaxation or attenuation of the connective tissue of the anterior vaginal wall. Although much confusion exists regarding the terminology and anatomy of the various support structures of the anterior vaginal wall, the concept of vaginal cystocele repair has remained the same for many years. Surgery is aimed at separating the vaginal epithelium from the underlying supportive structures of the bladder, followed by plication of what has been termed fascia across the midline in one or two layers. Some surgeons have also utilized the inside lining of the vaginal wall to facilitate this repair. The procedure is completed by excising excess vaginal tissue and closing the vaginal wall. Overall the recurrent prolapse rates after conventional anterior colporrhaphy range from 3 to 15% [1, 2], assuming there has not been a concomitant procedure that alters the vaginal axis such as a sacrospinous ligament fixation. Plication of the bladder neck (Kelly plication) has also been performed with anterior colporrhaphy as a treatment for stress incontinence [3]. …