Skip to main content

Advertisement

SpringerLink
Log in

Do the anatomical defects associated with cystocoele affect the outcome of anterior repair? A clinical and radiological study

  • Original Article
  • Published:
International Urogynecology Journal Aims and scope Submit manuscript

Abstract

Introduction and hypothesis

The purpose of this study was to investigate the defects associated with cystocoele and the outcome of anterior repair.

Methods

Prospective study using POPQ and MRI before and after surgery.

Results

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.

Conclusions

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. 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 1304-1306

    Article  PubMed  CAS  Google Scholar 

  2. Macer GA (1978) Transabdominal repair of cystocoele: a 20 year experience compared with the traditional vaginal approach. Am J Obstet Gynecol 131(2):203–207

    PubMed  CAS  Google Scholar 

  3. Maher C, Baessler K, Glazener CMA, Adams EJ, Hagen S (2007) Surgical management of pelvic organ prolapse in women. Cochrane Database of Systematic Reviews, Issue 3. Art. No.: CD004014. doi:10.1002/14651858.CD004014.pub3.

  4. White GR (1909) Cystocoele. A radical cure by suturing lateral sulci of vagina to the white line of pelvic fascia. JAMA LIII(21):1707–1710

    Google Scholar 

  5. Bump RC, Mattiasson A, Bø K, Brubaker LP, DeLancey JO, Klarskov P et al (1996) The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction. Am J Obstet Gynecol 175(1):10–17

    Article  PubMed  CAS  Google Scholar 

  6. Samuelsson EC, Victor FT, Tibblin G, Svärdsudd KF (1999) Signs of genital prolapse in a Swedish population of women 20 to 59 years of age and possible related factors. Am J Obstet Gynecol 180(2 Pt 1):299–305

    Article  PubMed  CAS  Google Scholar 

  7. Scherf C, Morison L, Fiander A, Ekpo G, Walraven G (2002) Epidemiology of pelvic organ prolapse in rural Gambia, West Africa. BJOG 109(4):431–436

    Article  PubMed  Google Scholar 

  8. Ellerkmann RM, Cundiff GW, Melick CF, Nihira MA, Leffler K, Bent AE (2001) Correlation of symptoms with location and severity of pelvic organ prolapse. Am J Obstet Gynecol 185(6):1332–8 discussion 1337-8

    Article  PubMed  CAS  Google Scholar 

  9. Weber AM, Walters MD (1997) Anterior vaginal prolapse: review of anatomy and techniques of surgical repair. Obstet Gynecol 89(2):311–318

    Article  PubMed  CAS  Google Scholar 

  10. Chou Q, DeLancey JO (2001) A structured system to evaluate urethral support anatomy in magnetic resonance images. Am J Obstet Gynecol 185(1):44–50

    Article  PubMed  CAS  Google Scholar 

  11. DeLancey JO (1992) Anatomic aspects of vaginal eversion after hysterectomy. Am J Obstet Gynecol 166(6 Pt 1):1717–1724 discussion 1724-8

    PubMed  CAS  Google Scholar 

  12. Huddleston HT, Dunnihoo DR, Huddleston PM 3rd, Meyers PC Sr (1995) Magnetic resonance imaging of defects in DeLancey’s vaginal support levels I, II, and III. Am J Obstet Gynecol 172(6):1778–1782 discussion 1782-4

    Article  PubMed  CAS  Google Scholar 

  13. Weber AM, Abrams P, Brubaker L, Cundiff G, Davis G, Dmochowski RR et al (2001) The standardization of terminology for researchers in female pelvic floor disorders. Int Urogynecol J Pelvic Floor Dysfunct 12(3):178–186

    Article  PubMed  CAS  Google Scholar 

  14. Digesu GA, Santamato S, Khullar V, Santillo V, Digesu A, Cormio G et al (2003) Validation of an Italian version of the prolapse quality of life questionnaire. Eur J Obstet Gynecol Reprod Biol 106(2):184–192

    Article  PubMed  Google Scholar 

  15. Hall AF, Theofrastous JP, Cundiff GW, Harris RL, Hamilton LF, Swift SE et al (1996) Interobserver and intraobserver reliability of the proposed International Continence Society, Society of Gynecologic Surgeons, and American Urogynecologic Society pelvic organ prolapse classification system. Am J Obstet Gynecol 175(6):1467–1470 discussion 1470-1

    Article  PubMed  CAS  Google Scholar 

  16. Miedel A, Tegerstedt G, Mörlin B, Hammarström M (2008) A 5-year prospective follow-up study of vaginal surgery for pelvic organ prolapse. Int Urogynecol J Pelvic Floor Dysfunct 19(12):1593–1601

    Article  PubMed  Google Scholar 

  17. Goodrich MA, Webb MJ, King BF, Bampton AE, Campeau NG, Riederer SJ (1993) Magnetic resonance imaging of pelvic floor relaxation: dynamic analysis and evaluation of patients before and after surgical repair. Obstet Gynecol 82(6):883–891

    PubMed  CAS  Google Scholar 

  18. Ostrzenski A, Osborne NG, Ostrzenska K (1997) Method for diagnosing paravaginal defects using contrast ultrasonographic technique. J Ultrasound Med 16(10):673–677

    PubMed  CAS  Google Scholar 

  19. Ostrzenski A, Osborne NG (1998) Ultrasonography as a screening tool for paravaginal defects in women with stress incontinence: a pilot study. Int Urogynecol J Pelvic Floor Dysfunct 9(4):195–199

    Article  PubMed  CAS  Google Scholar 

  20. Nguyen JK, Hall CD, Taber E, Bhatia NN (2000) Sonographic diagnosis of paravaginal defects: a standardization of technique. Int Urogynecol J Pelvic Floor Dysfunct 11(6):341–345

    Article  PubMed  CAS  Google Scholar 

  21. Dietz HP, Pang S, Korda A, Benness C (2005) Paravaginal defects: a comparison of clinical examination and 2D/3D ultrasound imaging. Aust NZ J Obstet Gynaecol 45(3):187–190

    Article  Google Scholar 

  22. Dietz HP (2007) Quantification of major morphological abnormalities of the levator ani. Ultrasound Obstet Gynecol 29(3):329–334

    Article  PubMed  CAS  Google Scholar 

  23. Dietz HP, Simpson JM (2008) Levator trauma is associated with pelvic organ prolapse. BJOG 115(8):979–984

    Article  PubMed  CAS  Google Scholar 

  24. Klutke C, Golomb J, Barbaric Z, Raz S (1990) The anatomy of stress incontinence: magnetic resonance imaging of the female bladder neck and urethra. J Urol 143(3):563–566

    PubMed  CAS  Google Scholar 

  25. 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):1350–1361

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgement

Dr P. Papapanos (inter-observer image analysis).

Conflicts of interest

R.M. Freeman is an Editor of this journal. None for the other authors.

Contribution to authorship

R.M. Freeman (design, investigator, supervision and writing the paper); O.A. Adekanmi (design, investigator, study, image and data analyses); S. Jackson (radiology protocol and MRI reporting); M. Puckett (radiology protocol, inter-observer image analysis); L. Bombieri (advice and support on design and MRI methodology, review of MD thesis); M.R. Waterfield (design, methodology, statistical advice and analysis).

Details of ethics approval

South and West Devon Health Authority: Plymouth Trial 1439. December 2000.

Funding

Plymouth Urogynaecology Unit Research Fund.

Author information

Authors and Affiliations

  1. Directorate of Obstetrics and Gynaecology, Derriford Hospital, Plymouth Hospitals NHS Trust, Plymouth, PL6 8DH, UK

    Olugbenga A. Adekanmi

  2. Urogynaecology Unit, Directorate of Obstetrics and Gynaecology, and Peninsula Medical School, Plymouth Hospitals NHS Trust, Derriford Hospital, Plymouth, PL6 8DH, UK

    Robert M. Freeman & Luigi Bombieri

  3. Department of Radiology, Plymouth Hospitals NHS Trust, Derriford Hospital, Plymouth, UK

    Simon A. Jackson

  4. Radiology Department, Torbay Hospital, Torquay, UK

    Mark Puckett

  5. Urogynaecology Unit, Directorate of Obstetrics and Gynaecology, Peninsula Medical School, Plymouth, PL6 8DH, UK

    Malcolm R. Waterfield

Authors
  1. Olugbenga A. Adekanmi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Robert M. Freeman
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Simon A. Jackson
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Mark Puckett
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Luigi Bombieri
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Malcolm R. Waterfield
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Olugbenga A. Adekanmi.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Adekanmi, O.A., Freeman, R.M., Jackson, S.A. et al. Do the anatomical defects associated with cystocoele affect the outcome of anterior repair? A clinical and radiological study. Int Urogynecol J 20, 1369–1377 (2009). https://doi.org/10.1007/s00192-009-0962-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00192-009-0962-2

Keywords

Search

Navigation