International Urogynecology Journal

, Volume 24, Issue 10, pp 1593–1602 | Cite as

Surgical treatment of pelvic organ prolapse: a historical review with emphasis on the anterior compartment

  • E. J. M. LensenEmail author
  • M. I. J. Withagen
  • K. B. Kluivers
  • A. L. Milani
  • M. E. Vierhout
Review Article


Introduction and hypothesis

The objective of this work was to collect and summarize a detailed historical review of the surgical treatment of pelvic organ prolapse (POP) in which we specifically focused on the anterior compartment.


A literature search in English, Dutch, and German was carried out using the keywords pelvic organ prolapse, anterior colporrhaphy, cystocele, and interposition operations in several databases (e.g., PubMed and HathiTrust Digital Library). Other relevant journal and textbook articles were found by retrieving references cited in previous articles and textbooks.


Probably the first explanation of the treatment of POP dates from 1500 B.C. The Egyptians gave a description to “falling of the womb” in the Kahun Papyrus. More than a millennium later, Euryphon, a contemporary of Hippocrates (400 B.C.) described some interesting therapeutic options, from succussion (turning a women upside down for several minutes) to irrigating the displaced uterus with wine. A wide range of techniques has been attempted to repair the prolapsing anterior vaginal wall. By 1866, Sim had already performed a series of operations very similar to a modern anterior repair. The first reviews about the abdominal approach to correcting a cystocele were in 1890. The first description of using mesh to cystoceles was the use of tantalum mesh in 1955. In 1970, the first report of collagen mesh in urogynecology was described. Nowadays, robot-assisted surgery and cell-based tissue engineering are the latest interventions.


Many surgeons have tried to find the ideal surgical therapy for anterior compartment prolapse, but to date, this has not been achieved.


Cystocele Pelvic organ prolapse Surgery 



Pelvic organ prolapse


Stress urinary incontinence


Conflicts of interest



  1. 1.
    White GR (1909) Cystocele radical cure by suturing lateral sulci of vagina to white line of pelvic fascia. JAMA 53:1707–1710CrossRefGoogle Scholar
  2. 2.
    Emge LA, Durfee RB (1966) Pelvic organ prolapse: four thousand years of treatment. Clin Obstet Gynecol 9(4):997–1032PubMedCrossRefGoogle Scholar
  3. 3.
    Peckham-Murray G (1895) Mechanism and treatment of complete procidentia uteri. Am J Obstet Gynecol 29:648–665Google Scholar
  4. 4.
    Rawls RM (1918) Cystocele; review of the literature, with a further preliminary report of an operation for its relief. Am J Obstet Gynecol 78:328–347Google Scholar
  5. 5.
    Peyer JK (1750) Parerga anatomica et medica septem: Observatio circa urachum in foetu humano pervium. Observationes quaedam anatomicae. J. Delbeek & G. BootGoogle Scholar
  6. 6.
    Phillips EJ, Kersey (1706) The new world of words: Universal English dictionary. Printed for J. PhillipsGoogle Scholar
  7. 7.
    Sims JM (1858) Silver sutures in surgery. Samuel S. & William Wood, New YorkGoogle Scholar
  8. 8.
    Lister JB, BMA Meeting (1867) On the antiseptic principle in the practice of surgery. The Lancet 90:353–356Google Scholar
  9. 9.
    Geradin R (1825) Memoire presente a la societe medicale de Metz en 1823. Arch Gen Med 8Google Scholar
  10. 10.
    Huguier (1860) Memoires sur les allongements hypertrophiques du col de l’uterus. ParisGoogle Scholar
  11. 11.
    Sims JM (1866) Clinical notes on uterine surgery. Robert HardwickeGoogle Scholar
  12. 12.
    Emmet TA (1880) The principles and practice of gynecology. H. C. Lea, PhiladelphiaGoogle Scholar
  13. 13.
    Reed CAL (1901) A textbook of gynecology. Appleton & co., New YorkGoogle Scholar
  14. 14.
    Cowperthwaite AC (1888) A text-book of gynecology: designed for the student and general practititioner. Gross & Delbridge, ChicagoGoogle Scholar
  15. 15.
    LeFort LC (1877) Nouveau procédé pour la guérison du prolapsus utérin. Bull Gen Ther 92:337–346Google Scholar
  16. 16.
    Neugebauer LA (1881) Einige Worte über die mediane Vaginalnaht als Mittel zur Beseitigung des Gebärmuttervorfalls. Centralb Gynakol 23:369Google Scholar
  17. 17.
    Fothergill WE (1912) A clinical lecture on the precise relationship of cystocele, prolapse and rectocele, and the operation for their relief: delivered in the post-graduate course at the Manchester royal infirmary. Br Med J 1(2676):817–818PubMedCrossRefGoogle Scholar
  18. 18.
    (1977) Classic pages in obstetrics and gynecology. Anterior colporrhaphy and its combination with amputation of the cervix as a single operation. William Edward Fothergill. J Obstet Gynaecol Br Emp 27:146–147, 1915. Am J Obstet Gynecol 129(4):457–458Google Scholar
  19. 19.
    Delancey JO (2012) Surgery for cystocele III: do all cystoceles involve apical descent?: observations on cause and effect. Int Urogynecol J 23(6):665–667PubMedCrossRefGoogle Scholar
  20. 20.
    Dührssen A (1894) Ueber die operative Heilung der mobilen und fixirten Retroflexio uteri auf vaginalem Wege, mit besonderer Berücksichtigung der Dauererfolge. Archiv für Gynäkologie 37:447Google Scholar
  21. 21.
    Freund WA (1896) Centralb Gynakol 20:1009Google Scholar
  22. 22.
    Watkins TJ (1899) The treatment of cystocele and uterine prolapse after the menopause. Am J Obstet Gynecol 15:420–423Google Scholar
  23. 23.
    Wertheim E (1899) Zur plastischen Verwendung des Uterus bei Prolaps. Centralb Gynakol 23:369Google Scholar
  24. 24.
    Schauta F (1909) Über Prolapsoperationen. Gynäk Rundschau 3:729Google Scholar
  25. 25.
    St. George Wilson J (1938) Transposition (interposition) of the uterus for severe uterine and vaginal prolapse. BJOG Int J Obstet Gynaecol 45(4):655–662CrossRefGoogle Scholar
  26. 26.
    Watkins TJ (1912) Transposition of the uterus and bladder in the treatment of extensive cystocele and uterine prolapse. Am J Obstet Gynecol 65:225–242Google Scholar
  27. 27.
    Brandt T (1868) Nouvelle méthode gymnastique et magnétique pour le traitement des maladies des organes du bassin: et principalement des affections utérines. FritzeGoogle Scholar
  28. 28.
    Hogner R (1895) On the value of kinesitherapy in gynecologic practice. JAMA J Am Med Assoc XXIV(4):115–119CrossRefGoogle Scholar
  29. 29.
    Profanter P (1888) Die Manuelle Behandlung des Prolapsus Uteri, WienGoogle Scholar
  30. 30.
    Piya-Anant M, Therasakvichya S, Leelaphatanadit C, Techatrisak K (2003) Integrated health research program for the Thai elderly: prevalence of genital prolapse and effectiveness of pelvic floor exercise to prevent worsening of genital prolapse in elderly women. J Med Assoc Thail Chotmaihet thangphaet 86(6):509–515Google Scholar
  31. 31.
    White GR (1912) An anatomical operation for the cure of cystocele. Am J Obstet Gynecol 65:286–290Google Scholar
  32. 32.
    Richardson AC, Lyon JB, Williams NL (1976) A new look at pelvic relaxation. Am J Obstet Gynecol 126(5):568–573PubMedGoogle Scholar
  33. 33.
    Maher C, Baessler K (2006) Surgical management of anterior vaginal wall prolapse: an evidencebased literature review. Int Urogynecol J Pelvic Floor Dysfunct 17(2):195–201PubMedCrossRefGoogle Scholar
  34. 34.
    Weber AM, Walters MD, Piedmonte MR, Ballard LA (2001) Anterior colporrhaphy: a randomized trial of three surgical techniques. Am J Obstet Gynecol 185(6):1299–1304, discussion 1304–1296PubMedCrossRefGoogle Scholar
  35. 35.
    (1888) Annual of the universal medical sciences. In: Sajous CE (ed) Book Annual of the universal medical sciences. City. F.A. Davis, H48–H49Google Scholar
  36. 36.
    Wlaccaz, Dumoret (1890) Revue médico-chirurgicale des maladies des femmes, ParisGoogle Scholar
  37. 37.
    Tuffier TL (1890) Société de médecine et de chirurgie de Bordeaux. Gazette hebdomadaire des sciences médicales de Bordeaux 11Google Scholar
  38. 38.
    Byford HT (1890) The cure of cystocele by inguinal suspension of the bladder; colpo-cystorrhaphy. Am J Obstet Gynecol 23:152Google Scholar
  39. 39.
    Lowson D (1898) An operation for elevation of the female bladder in prolapse or cystocele. Br Med J 23:232–234CrossRefGoogle Scholar
  40. 40.
    Burch JC (1961) Urethrovaginal fixation to Cooper’s ligament for correction of stress incontinence, cystocele, and prolapse. Am J Obstet Gynecol 81:281–290PubMedGoogle Scholar
  41. 41.
    Marshall VF, Marchetti AA, Krantz KE (1949) The correction of stress incontinence by simple vesicourethral suspension. Surg Gynecol Obstet 88(4):509–518PubMedGoogle Scholar
  42. 42.
    Dainer M, Hall CD, Choe J, Bhatia NN (1999) The Burch procedure: a comprehensive review. Obstet Gynecol Surv 54(1):49–60PubMedCrossRefGoogle Scholar
  43. 43.
    Wiskind AK, Creighton SM, Stanton SL (1992) The incidence of genital prolapse after the Burch colposuspension. Am J Obstet Gynecol 167(2):399–404, discussion 404–395PubMedCrossRefGoogle Scholar
  44. 44.
    Tanagho EA (1976) Colpocystourethropexy: the way we do it. J Urol 116(6):751–753PubMedGoogle Scholar
  45. 45.
    Quadri G, Magatti F, Belloni C, Mattioli G (1997) Transabdominal repair of cystocele by wedge colpectomy during combined abdominal-vaginal surgery. Int Urogynecol J Pelvic Floor Dysfunct 8(5):278–283PubMedCrossRefGoogle Scholar
  46. 46.
    Weinstein M, Roberts M (1949) Simultaneous repair of cystocele and high rectal prolapse during total hysterectomy. West J Surg Obstet Gynecol 57(1):34–37PubMedGoogle Scholar
  47. 47.
    Macer GA (1978) Transabdominal repair of cystocele, a 20 year experience, compared with the traditional vaginal approach. Am J Obstet Gynecol 131(2):203–207PubMedGoogle Scholar
  48. 48.
    Baker KR, Drutz HP (1991) Retropubic colpourethropexy: clinical and urodynamic evaluation of 289 cases. Int Urogynecol J 2:196–200CrossRefGoogle Scholar
  49. 49.
    Kelly HA, Dumm WM (1998) Urinary incontinence in women, without manifest injury to the bladder. 1914. Int Urogynecol J Pelvic Floor Dysfunct 9(3):158–164PubMedCrossRefGoogle Scholar
  50. 50.
    Kennedy W (1937) Incontinence of urine in the female, the urethral sphincter mechanism, damage of function, and restoration of control. Am J Obstet Gynecol 34:576–589Google Scholar
  51. 51.
    Glazener CM, Cooper K (2001) Anterior vaginal repair for urinary incontinence in women. Cochrane Database Syst Rev (1):CD001755Google Scholar
  52. 52.
    Nichols DH, Randall CL (1989) Vaginal surgery. Williams & WilkinsGoogle Scholar
  53. 53.
    Te Linde RW, Mattingly RF (1977) Te Linde’s Operative gynecology. LippincottGoogle Scholar
  54. 54.
    Käser O, Iklé FA, Hirsch HA (1985) Atlas of gynecological surgery: Including urological, proctological and mammary procedures. G. Thieme VerlagGoogle Scholar
  55. 55.
    Brewer JI, DeCosta EJ (1967) Textbook of gynecology. Williams & WilkinsGoogle Scholar
  56. 56.
    Shaw W, Howkins J (1960) Textbook of operative gynæcology. Williams and WilkinsGoogle Scholar
  57. 57.
    Farrell SA, Dempsey T, Geldenhuys L (2001) Histologic examination of “fascia” used in colporrhaphy. Obstet Gynecol 98(5 Pt 1):794–798PubMedCrossRefGoogle Scholar
  58. 58.
    Lensen EJ, van den Berg-van Erp SH, Stoutjesdijk JA, Hasaart TH, Withagen MI, Kluivers KB et al. (2013) Does the method of dissecting in anterior colporraphy lead to a difference in thickness of removed vaginal tissue? Eur J Obstet Gynecol Reprod Biol. doi: 10.1016/j.ejogrb.2012.12.028
  59. 59.
    Raz S, Klutke CG, Golomb J (1989) Four-corner bladder and urethral suspension for moderate cystocele. J Urol 142(3):712–715PubMedGoogle Scholar
  60. 60.
    Kilicarslan H, Guvenal T, Ayan S, Gokce G, Cetin A, Gultekin EY (2003) Comparison of outcomes of three different surgical techniques performed for stress urinary incontinence. Int J Urol 10(3):126–130, discussion 131PubMedCrossRefGoogle Scholar
  61. 61.
    DeLancey JO (1992) Anatomic aspects of vaginal eversion after hysterectomy. Am J Obstet Gynecol 166(6 Pt 1):1717–1724, discussion 1724–1718PubMedCrossRefGoogle Scholar
  62. 62.
    Moore J, Armstrong JT, Willis SH (1955) The use of tantalum mesh in cystocele with critical report of ten cases. Am J Obstet Gynecol 69(5):1127–1135PubMedGoogle Scholar
  63. 63.
    Goldberger MA, Davids AM (1947) The treatment of urinary stress incontinence by the implantation of a tantalum plate. Am J Obstet Gynecol 54(5):829–837PubMedGoogle Scholar
  64. 64.
    Friedman EA, Meltzer RM (1970) Collagen mesh prosthesis for repair of endopelvic fascial defects. Am J Obstet Gynecol 106(3):430–433PubMedGoogle Scholar
  65. 65.
    Ruparelia B, Gunasheela S, Sundar K (2000) Anterior and Posterior vaginal prolapse repairs with porcine skin collagen (PelvicolTM) implant. Int Urogynecol J Pelvic Floor Dysfunct 11(Suppl 1):FDP33–S45Google Scholar
  66. 66.
    Meschia M, Pifarotti P, Bernasconi F, Magatti F, Riva D, Kocjancic E (2007) Porcine skin collagen implants to prevent anterior vaginal wall prolapse recurrence: a multicenter, randomized study. J Urol 177(1):192–195PubMedCrossRefGoogle Scholar
  67. 67.
    Dahlgren E, Kjolhede P (2011) Long-term outcome of porcine skin graft in surgical treatment of recurrent pelvic organ prolapse. An open randomized controlled multicenter study. Acta Obstet Gynecol Scand 90(12):1393–1401PubMedCrossRefGoogle Scholar
  68. 68.
    Zacharin RF (1992) Free full-thickness vaginal epithelium graft in correction of recurrent genital prolapse. Aust N Z J Obstet Gynaecol 32(2):146–148PubMedCrossRefGoogle Scholar
  69. 69.
    Julian TM (1996) The efficacy of Marlex mesh in the repair of severe, recurrent vaginal prolapse of the anterior midvaginal wall. Am J Obstet Gynecol 175(6):1472–1475PubMedCrossRefGoogle Scholar
  70. 70.
    Safir MH, Gousse AE, Rovner ES, Ginsberg DA, Raz S (1999) 4-Defect repair of grade 4 cystocele. J Urol 161(2):587–594PubMedCrossRefGoogle Scholar
  71. 71.
    Jia X, Glazener C, Mowatt G, MacLennan G, Bain C, Fraser C et al (2008) Efficacy and safety of using mesh or grafts in surgery for anterior and/or posterior vaginal wall prolapse: systematic review and meta-analysis. BJOG 115(11):1350–1361PubMedCrossRefGoogle Scholar
  72. 72.
    Abed H, Rahn DD, Lowenstein L, Balk EM, Clemons JL, Rogers RG (2011) Incidence and management of graft erosion, wound granulation, and dyspareunia following vaginal prolapse repair with graft materials: a systematic review. Int Urogynecol J 22(7):789–798PubMedCrossRefGoogle Scholar
  73. 73.
    Baessler K, Maher CF (2006) Mesh augmentation during pelvic-floor reconstructive surgery: risks and benefits. Curr Opin Obstet Gynecol 18(5):560–566PubMedCrossRefGoogle Scholar
  74. 74.
    Milani AL, Heidema WM, van der Vloedt WS, Kluivers KB, Withagen MI, Vierhout ME (2008) Vaginal prolapse repair surgery augmented by ultra lightweight titanium coated polypropylene mesh. Eur J Obstet Gynecol Reprod Biol 138(2):232–238PubMedCrossRefGoogle Scholar
  75. 75.
    Boennelycke M, Gras S, Lose G (2012) Tissue engineering as a potential alternative or adjunct to surgical reconstruction in treating pelvic organ prolapse. Int Urogynecol J. doi: 10.1007/s00192-012-1927-4
  76. 76.
    McIntyre M, Goudelocke C, Rovner ES (2010) An update on surgery for pelvic organ prolapse. Curr Opin Urol 20(6):490–494PubMedCrossRefGoogle Scholar

Copyright information

© The International Urogynecological Association 2013

Authors and Affiliations

  • E. J. M. Lensen
    • 1
    Email author
  • M. I. J. Withagen
    • 1
  • K. B. Kluivers
    • 1
  • A. L. Milani
    • 2
  • M. E. Vierhout
    • 1
  1. 1.Department Obstetrics & Gynaecology 791Radboud University Nijmegen Medical CentreNijmegenThe Netherlands
  2. 2.Department of Obstetrics & GynaecologyReinier de Graaf GroepDelft/VoorburgThe Netherlands

Personalised recommendations