Paravaginal Repair

  • Kathryn G. CunninghamEmail author
  • O. Lenaine Westney


Pelvic organ prolapse is defined as the descent of one or more of the pelvic organs including the uterus, vagina, bladder or bowel due to laxity of pelvic fascial structures and/or disruption of attachments to the pelvic sidewall. Usually defects arise together as the fascia has several interconnected layers. As the endopelvic fascia weakens and releases from the arcus tendinous fascia pelvis (ATFP), cystocele due to lateral paravaginal prolapse occurs. The pubocervical fascia is contiguous with the circular muscular layers of the vagina and attaches to the endopelvic fascia laterally. This can also weaken centrally producing a midline or central cystocele defect. Optimal surgical management requires addressing both lateral and central cystocele if present, with the goal of preventing persistent and/or recurrent prolapse. Central cystocele repair is addressed in Chap. 6. Reconstitution of the fascial attachments between the vagina and AFTP can be accomplished from the vaginal or abdominal approach depending on surgeon preference. Due to the FDA warning, most surgeons are veering away from synthetic mesh due to risk of erosion and extrusion, although synthetic mesh has been associated with less anatomical recurrence. This anatomic success has not been shown to correlate with subjective outcomes; therefore biologic graft or native repairs are used to avoid the risk of operative re-intervention for mesh complications. There are several surgical techniques utilized by surgeons today for paravaginal repair. We will describe our technique in this chapter, as well as surgical indications, preoperative preparation, alternate surgical techniques and surgical risks. In the end, it is important to educate your patient on all risks and benefits of each option and what would suit her needs best.


Paravaginal repair Pelvic organ prolapse Lateral defect Arcus Tendinous Fascia Pelvis (ATFP) Cystocele 

Supplementary material

Video 7.1

(WMV 681000 kb)


  1. 1.
    Whiteside J, Matthew DB, Paraiso MF, Hugney CM, Walters MD. Clinical evaluation of anterior vaginal wall support defects: Interexaminer and intraexaminer reliability. Am J Obstet Gynecol. 2004;191:100–4.CrossRefPubMedGoogle Scholar
  2. 2.
    Barber M, Cundiff GW, Weidner AC, Coates KW, Bump RC, Addison WA. Accuracy of clinical assessment of paravaginal defects in women with anterior vaginal wall prolapse. Am J Obstet Gynecol. 1999;181:87–90.CrossRefPubMedGoogle Scholar
  3. 3.
    Maher C, Feiner B, Baessler K, Schmid C. Surgical management of pelvic organ prolapse in women. Cochrane Database of Systematic Reviews. 2013;4:CD004014. doi:10.1002/14651858.CD004014.pub5. Review.Google Scholar
  4. 4.
    Baden WF, Walker TA. Genesis of the vaginal profile: a correlated classification of vaginal relaxation. Clin Obstet Gynecol. 1972;15:1048–54.CrossRefPubMedGoogle Scholar
  5. 5.
    Nguyen JK, Bhatia NN. Resolution of motor urge incontinence after surgical repair of pelvic organ prolapse. J Urol. 2001;166:2263–6.CrossRefPubMedGoogle Scholar
  6. 6.
    Romanzi L, Chaikin DC, Blaivas JG. The effect of genital prolapse on voiding. J Urol. 1999;161:581–6.CrossRefPubMedGoogle Scholar
  7. 7.
    Simsiman AJ, Luber KM, Menefee SA. Vaginal paravaginal repair with procine dermal reinforcement: Correction of advanced anterior caginal prolapse. Am J Obstet Gynecol. 2006;195:1832–6.CrossRefPubMedGoogle Scholar
  8. 8.
    Gomelsky A, Rudy DC, Dmochowski RR. Porcine dermis interposition graft for repair of high grade anterior compartment defects with or without comcomitant pelvic organ prolapse procedures. J Urol. 2004;171:1581–4.CrossRefPubMedGoogle Scholar
  9. 9.
    Powell CR, Simsiman AJ, Menefee SA. Anterior vaginal wall hammock with fascia lata for the correction of stage 2 or greater anterior vaginal compartment relaxation. J Urol. 2004;171:264–7.CrossRefPubMedGoogle Scholar
  10. 10.
    Young S, Daman JJ, Bony LG. Vaginal paravaginal repair: one year outcomes. Am J Obstet Gynecol. 2001;185:1360–7.CrossRefPubMedGoogle Scholar
  11. 11.
    Haylen BT, de Ridder D, Freeman RM, Swift SE, Berghmans B, Lee J, et al. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. J Neurourol Urodyn. 2010;29:4–20.Google Scholar
  12. 12.
    Menefee SA, Dyer KY, Lukacz ES, Simsiman AJ, Luber KM, Nguyen JN. Colporrhaphy compared with mesh or graft-reinforced vaginal paravaginal repair for anterior vaginal wall prolapse. Am J Obstet Gynecol. 2011;118:1337–44.CrossRefGoogle Scholar
  13. 13.
    Altman D, Vayrynen T, Engh ME, Axelsen S, Falconer C. Anterior Colporrhaphy versus transvaginal mesh for pelvic-organ prolapse. N Engl J Med. 2011;364:1826–36.CrossRefPubMedGoogle Scholar
  14. 14.
    Benson JT, Lucente V, McClellan E. Vaginal versus abdominal reconstructive surgery for the treatment of pelvic support defects: a prospective randomized study with long-term outcome evaluation. Am J Obstet Gynecol. 1996;175:1418–21.CrossRefPubMedGoogle Scholar
  15. 15.
    Araki I, Haneda Y, Mikami Y, Takeda M. Inctontinence and detrusor dysfunction associated with pelvic organ prolapse: clinical value or preoperative urodynamic evaluation. Int Urogynecol J. 2009;20:1301–6.CrossRefGoogle Scholar
  16. 16.
    Reena C, Kekre AN, Kekre N. Occult stress incontinence in women with pelvic organ prolapse. Int J Gynecol Obstet. 2007;97:31–4.CrossRefGoogle Scholar
  17. 17.
    Nieminen K, Hiltunen R, Takala T, Heiskanen E, Merikari M, Niemi K, Heinonen PK. Outcomes after anterior vaginal wall repair with mesh: a randomized, controlled trial with a 3 year follow-up. Am J Obstet Gynecol. 2010;203:235.e1–8.CrossRefGoogle Scholar
  18. 18.
    Bratzler DW, Hunt DR. The surgical infection prevention and surgical care improvement projects: national initiatives to improve outcomes for patients having surgery. Clin Infect Dis. 2006;43:322–30.CrossRefPubMedGoogle Scholar
  19. 19.
    Nguyen JN, Burchette RJ. Outcome after anterior vaginal prolapse repair: a randomized controlled trial. Obstet Gynecol. 2008;111:891–8.CrossRefPubMedGoogle Scholar
  20. 20.
    Food and Drug Administration. Urogynecologic surgical mesh: update on the safety and effectiveness of transvaginal placement for pelvic organ prolapse, U.S.F.a.D. Administration, Editor. 2011. p. 1–15. Health Notification/Ucm061975.htmGoogle Scholar
  21. 21.
    White GR. An anatomical operation for the cure of cystocele. Am J Obstet Dis Wom Child. 1912;65:286–90.Google Scholar
  22. 22.
    Richardson AC. Cystocele: paravaginal repair. In: The female pelvic floor disorders: investigation and management. New York: Norton Medical Books; 1992.Google Scholar
  23. 23.
    Minassian VA, Parekh M, Poplawsky D, Gorman J, Litzy L. Randomized controlled trial comparing two procedures for anterior vaginal wall prolapse. NeurourolUrodyn. 2014;33:72–7.Google Scholar
  24. 24.
    Miklos JR, Kohli N. Laparoscopic paravaginal repair plus burch colposusspension: review and descriptive technique. Urology. 2000;56:64–9.CrossRefPubMedGoogle Scholar
  25. 25.
    Rodriguez LV, Bukkapatnam R, Shah SM, Raz S. Transvaginal paravaginal repair of high grade cystocele central and lateral defects with concomitant suburethral sling: report of early results, outcomes, and patient satisfaction with a new technique. J Urol. 2005;66:57–65.CrossRefGoogle Scholar
  26. 26.
    Handel LN, Frenkl TL, Kim YH. Result of cystocele repair: a comparison of traditional anterior colporrhaphy, polypropylene mesh and porcine dermis. J Urol. 2007;178:153–6.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2017

Authors and Affiliations

  1. 1.Department of UrologyMD Anderson Cancer CenterHoustonUSA

Personalised recommendations