Surgical correction of paravaginal defects
The durable surgical correction of pelvic organ prolapse remains a significant challenge for pelvic reconstructive surgeons. Prolapse of the anterior vaginal wall, usually in the form of a cystocele, is the most common form of pelvic organ prolapse (1). Recent studies suggest that, of the various segments of the vagina which may be involved in prolapse (anterior, posterior, or apical), the anterior vaginal wall is the segment most likely to demonstrate recur- rent prolapse after reconstructive surgery (2). Additionally, normal anterior vaginal support plays an important role in supporting the urethra and loss of this support can contribute to the development of stress urinary incontinence (3). It is therefore important that the pelvic reconstructive surgeon understand the normal support mechanisms of the anterior vaginal wall and the full spectrum of techniques for correction of anterior vaginal prolapse and cystoceles.
