International Urogynecology Journal

, Volume 15, Issue 6, pp 378–383

Paravaginal defects: prevalence and accuracy of preoperative detection

  • Jeffrey L. Segal
  • Brett J. Vassallo
  • Steven D. Kleeman
  • William A. Silva
  • Mickey M. Karram
Original Article

DOI: 10.1007/s00192-004-1196-y

Cite this article as:
Segal, J.L., Vassallo, B.J., Kleeman, S.D. et al. Int Urogynecol J (2004) 15: 378. doi:10.1007/s00192-004-1196-y

Abstract

The objective of this study was to determine the prevalence of paravaginal defects and to report the correlation between diagnosing a paravaginal defect preoperatively and observing the presence of one intraoperatively. This was a prospective study in which 77 patients with at least stage 2 prolapse of the anterior vaginal wall who desired surgical correction of their prolapse were assessed pre- and intraoperatively for the detection of a paravaginal defect. In order to differentiate a midline or central defect from a paravaginal defect, an index finger or ring forceps was placed vaginally toward each ischial spine separately. If the prolapse became reduced, the patient was clinically diagnosed with a paravaginal defect on that side. The intraoperative visualization or palpation of the pubocervical fascia detached from the arcus tendineus fasciae pelvis was used as the gold standard in diagnosing a paravaginal defect. The overall prevalence of a paravaginal defect in patients with at least stage 2 prolapse of the anterior vaginal wall was 37.7%. The sensitivities for detecting a left, right and bilateral paravaginal defect were 47.6, 40.0 and 23.5%, respectively, while the specificities for each side were 71.4, 67.3, and 80.0%, respectively. The overall prevalence of a paravaginal defect in patients with anterior vaginal wall prolapse is low. The standard clinical evaluation used to preoperatively detect a paravaginal defect in our hands is a poor predictor for the actual presence of a paravaginal defect.

Keywords

Anterior colporrhaphy Cystocele Paravaginal defects Pelvic organ prolapse 

Copyright information

© International Urogynecological Association 2004

Authors and Affiliations

  • Jeffrey L. Segal
    • 1
  • Brett J. Vassallo
    • 1
  • Steven D. Kleeman
    • 1
  • William A. Silva
    • 1
  • Mickey M. Karram
    • 1
  1. 1.Division of Urogynecology and Pelvic Reconstructive SurgeryGood Samaritan HospitalCincinnatiUSA

Personalised recommendations