Surgery for cystocele III: do all cystoceles involve apical descent?

Excerpt

The randomized trial by Altman et al. [1] that is the focus of this discussion adds important information about the outcome of surgery for a specific subset of women with anterior vaginal wall prolapse in whom surgeons felt that an operation to improve apical support was not needed. The fact that these cystoceles were treated, both with and without mesh in the absence of an operation directed to improve apical descent, has attracted attention of surgeons interested in this topic. I have been asked to comment on the way in which the findings of this study are related to current concepts concerning the pathophysiology of anterior vaginal prolapse (cystocele) and, specifically, the role of apical support in the formation of cystocele. …