Do the anatomical defects associated with cystocoele affect the outcome of anterior repair? A clinical and radiological study
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- Adekanmi, O.A., Freeman, R.M., Jackson, S.A. et al. Int Urogynecol J (2009) 20: 1369. doi:10.1007/s00192-009-0962-2
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Introduction and hypothesis
The purpose of this study was to investigate the defects associated with cystocoele and the outcome of anterior repair.
Prospective study using POPQ and MRI before and after surgery.
Seventy women completed 1 year follow-up with anatomical and subjective failure rates of 51% and 32%, respectively. MRI features suggestive of central fascial defects were identified in 9%, isolated lateral defects in 33%, combined central and lateral defects in 12% and no obvious defect in 46%. Anatomical failure was more common in combined defects versus no fascial defects (OR 6.9, 95% CI 0.7–64.1). Interestingly, 50% of lateral defects were corrected by anterior repair. Defects of pubovesical (p = 0.045) and pubococcygeal muscles (p = 0.039) were associated with anatomical failure.
Cystocoeles recur anatomically in 50% of women by 1 year. However, the subjective outcomes are better. The combination of central and lateral fascial defects and pubovesical and pubococcygeal muscle defects appear to contribute to anatomical failure.