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Paravaginal defect: anatomy, clinical findings, and imaging

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Abstract

Introduction and hypothesis

The paravaginal defect has been a topic of active discussion concerning what it is, how to diagnose it, its role in anterior vaginal wall prolapse, and if and how to repair it. The aim of this article was to review the existing literature on paravaginal defect and discuss its role in the anterior vaginal wall support system, with an emphasis on anatomy and imaging.

Methods

Articles related to paravaginal defects were identified through a PubMed search ending 1 July 2015.

Results

Support of the anterior vaginal wall is a complex system involving levator ani muscle, arcus tendineus fascia pelvis (ATFP), pubocervical fascia, and uterosacral/cardinal ligaments. Studies conclude that physical examination is inconsistent in detecting paravaginal defects. Ultrasound (US) and magnetic resonance imaging (MRI) have been used to describe patterns in the appearance of the vagina and bladder when a paravaginal defect is suspected. Different terms have been used (e.g., sagging of bladder base, loss of tenting), which all represent changes in pelvic floor support but that could be due to both paravaginal and levator ani defects.

Conclusion

Paravaginal support plays a role in supporting the anterior vaginal wall, but we still do not know the degree to which it contributes to the development of prolapse. Both MRI and US are useful in the diagnosis of paravaginal defects, but further studies are needed to evaluate their use.

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Abbreviations

ATFP:

Arcus tendineus fascia pelvis

US:

Ultrasound

MRI:

Magnetic resonance imaging

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Acknowledgments

Dr. DeLancey gratefully acknowledges NIH grants P50 HD044406 and R01 HD038665 that provide support for his effort.

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Authors and Affiliations

  1. Centre for Clinical Research, Department of Obstetrics and Gynecology, North Denmark Regional Hospital, Bispensgade 67, 9800, Hjorring, Denmark

    Louise T. S. Arenholt

  2. Department of Radiology, Aarhus University Hospital, Skejby, Denmark

    Bodil Ginnerup Pedersen

  3. Department of Obstetrics and Gynecology, Aalborg University Hospital, Skejby, Denmark

    Karin Glavind & Marianne Glavind-Kristensen

  4. Pelvic Floor Research Group, Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA

    John O. L. DeLancey

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  1. Louise T. S. Arenholt
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  2. Bodil Ginnerup Pedersen
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Correspondence to Louise T. S. Arenholt.

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Conflicts of interest

LTS Arenholt has accepted travel grant from Astellas and has consulted Astellas on topics not relevant to this manuscript. M. Glavind-Kristensen and K. Glavind have accepted travel grants from Astellas.

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Arenholt, L.T.S., Pedersen, B.G., Glavind, K. et al. Paravaginal defect: anatomy, clinical findings, and imaging. Int Urogynecol J 28, 661–673 (2017). https://doi.org/10.1007/s00192-016-3096-3

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  • DOI: https://doi.org/10.1007/s00192-016-3096-3

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