Anterior vaginal repair for urinary incontinence associated with vaginal prolapse

Abstract

Classically, repair of cystocele alone is performed transvaginally whereas repair of urethrocele alone is approached transabdominally. When both problems occur simultaneously, which is quite frequent, one can consider the following options: (1) perform a classical transvaginal repair of the cystocele with a Kelly-Kennedy type anterior colporraphy, which is known for its high recurrence rate of postoperative incontinence (40–50%) in long term follow-ups because it leaves the urethra in a low, dependent position with very poor support, (2) perform a urethropexy transabdominally (Marshall- Marchetti, Burch, etc.), which certainly cures the urethrocele but is unlikely to provide a solid repair of the herniated bladder and disrupted pubocervical fascia, or (3) do two separate procedures, vaginal to correct the cystocele and abdominal to repair the urethrocele, which is far from being ideal for the patient. Therefore, our proposal for treatment of‘vaginal prolapse associated with stress urinary incontinence’ is to combine both repairs of the cystocele and urethrocele by means of the same transvaginal approach, in order to not only adequately correct the cystocele but also to provide a long lasting support to the bladder neck and proximal urethra in an elevated, fixed, non-obstructed, retropubic position. Following a clinical and radiographical classification of the patients in grades of severity from I to IV, we briefly reviewed the incidence, aetiology and diagnosis of this condition.