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Pelvic organ prolapse in women: Surgical repair of anterior vaginal wall prolapse

INTRODUCTION

Anterior vaginal wall prolapse describes support abnormalities of the anterior wall of the vagina. Prolapse of the anterior wall typically coexists with prolapse at other anatomic sites (vaginal apex, posterior vaginal wall) [1-3]. The prevailing view is that a common pathogenesis underlies support defects at different sites of the vaginal wall, replacing a previous focus on isolated anatomic compartments. Procedures for surgical repair of anterior vaginal wall defects should include repair of apical prolapse, if present [4].

Pelvic organ prolapse (POP) affects millions of women; approximately 200,000 inpatient surgical procedures for prolapse are performed annually in the United States [5,6]. Eleven to 19 percent of women will undergo surgery for prolapse or urinary incontinence by age 80 to 85 years, and 30 percent of these women will require an additional prolapse or incontinence surgery [7].

Reconstructive procedures for prolapse of the anterior vaginal wall are reviewed here. Related topics regarding POP in women are discussed separately, including:

Diagnosis and evaluation and conservative management (see "An overview of the epidemiology, risk factors, clinical manifestations, and management of pelvic organ prolapse in women" and "Vaginal pessary treatment of prolapse and incontinence")

Choosing a primary surgical procedure (see "Pelvic organ prolapse in women: Choosing a primary surgical procedure")

                                     

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Literature review current through: Nov 2014. | This topic last updated: Jun 5, 2014.
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References
Top
  1. Rooney K, Kenton K, Mueller ER, et al. Advanced anterior vaginal wall prolapse is highly correlated with apical prolapse. Am J Obstet Gynecol 2006; 195:1837.
  2. Summers A, Winkel LA, Hussain HK, DeLancey JO. The relationship between anterior and apical compartment support. Am J Obstet Gynecol 2006; 194:1438.
  3. Delancey JO. Surgery for cystocele III: do all cystoceles involve apical descent? : Observations on cause and effect. Int Urogynecol J 2012; 23:665.
  4. Brincat CA, Larson KA, Fenner DE. Anterior vaginal wall prolapse: assessment and treatment. Clin Obstet Gynecol 2010; 53:51.
  5. Jones KA, Shepherd JP, Oliphant SS, et al. Trends in inpatient prolapse procedures in the United States, 1979-2006. Am J Obstet Gynecol 2010; 202:501.e1.
  6. Boyles SH, Weber AM, Meyn L. Procedures for pelvic organ prolapse in the United States, 1979-1997. Am J Obstet Gynecol 2003; 188:108.
  7. Olsen AL, Smith VJ, Bergstrom JO, et al. Epidemiology of surgically managed pelvic organ prolapse and urinary incontinence. Obstet Gynecol 1997; 89:501.
  8. Abrams P, Cardozo L, Fall M, et al. The standardisation of terminology of lower urinary tract function: report from the Standardisation Sub-committee of the International Continence Society. Neurourol Urodyn 2002; 21:167.
  9. Pilia-Allen, A, Benson, J. Cystocele. In: The female pelvic floor: Disorders of function and support, Brubaker, L, Saclarides, T (Eds), F.A. Davis, Philadelphia 1996. p. 269.
  10. Nichols DH, Milley PS, Randall CL. Significance of restoration of normal vaginal depth and axis. Obstet Gynecol 1970; 36:251.
  11. Weber AM, Walters MD. Anterior vaginal prolapse: review of anatomy and techniques of surgical repair. Obstet Gynecol 1997; 89:311.
  12. Boyles SH, Edwards SR. Repair of the anterior vaginal compartment. Clin Obstet Gynecol 2005; 48:682.
  13. Oelrich TM. The striated urogenital sphincter muscle in the female. Anat Rec 1983; 205:223.
  14. Graves EJ, Gillum BS. Detailed diagnoses and procedures, National Hospital Discharge Survey, 1995. Vital Health Stat 13 1997; :1.
  15. White GR. Cystocele--a radical cure by suturing lateral sulci of the vagina to the white line of pelvic fascia. 1909. Int Urogynecol J Pelvic Floor Dysfunct 1997; 8:288.
  16. White GR. An anatomical operation for the cure of cystocele. Am J Obstet Dis Women Child 1912; 65:286.
  17. Delancey JO. Fascial and muscular abnormalities in women with urethral hypermobility and anterior vaginal wall prolapse. Am J Obstet Gynecol 2002; 187:93.
  18. Beck RP, McCormick S. Treatment of urinary stress incontinence with anterior colporrhaphy. Obstet Gynecol 1982; 59:269.
  19. Richardson AC, Lyon JB, Williams NL. A new look at pelvic relaxation. Am J Obstet Gynecol 1976; 126:568.
  20. Richardson AC, Edmonds PB, Williams NL. Treatment of stress urinary incontinence due to paravaginal fascial defect. Obstet Gynecol 1981; 57:357.
  21. Benson J. Female pelvic floor disorders: Investigation and management, WW Norton & Company, New York 1992.
  22. Nichols D, Randall C. Vaginal surgery, Williams and Wilkins, Baltimore 1989.
  23. Maher CF, Feiner B, DeCuyper EM, et al. Laparoscopic sacral colpopexy versus total vaginal mesh for vaginal vault prolapse: a randomized trial. Am J Obstet Gynecol 2011; 204:360.e1.
  24. Rooney, K, Mueller, E, Kenton, K, et al. Can advanced stages of anterior or posterior vaginal wall prolapse occur without apical involvement? J Pelvic Surgery 2006; 12:70.
  25. Elkadry EA, Kenton KS, FitzGerald MP, et al. Patient-selected goals: a new perspective on surgical outcome. Am J Obstet Gynecol 2003; 189:1551.
  26. Hullfish KL, Bovbjerg VE, Steers WD. Patient-centered goals for pelvic floor dysfunction surgery: long-term follow-up. Am J Obstet Gynecol 2004; 191:201.
  27. Mahajan ST, Elkadry EA, Kenton KS, et al. Patient-centered surgical outcomes: the impact of goal achievement and urge incontinence on patient satisfaction one year after surgery. Am J Obstet Gynecol 2006; 194:722.
  28. Brubaker, L, Norton, P. Current Clinical Nomenclature for Description of Pelvic Organ Prolapse. Journal of Pelvic Surgery 1996; 2:257.
  29. Madjar S, Frischer Z, Nieder AM, Waltzer WC. Bladder wall abscess following midurethral sling procedure. Int Urogynecol J Pelvic Floor Dysfunct 2006; 17:180.
  30. Lee SY, Kim JY, Park SJ, et al. Bilateral recurrent thigh abscesses for five years after a transobturator tape implantation for stress urinary incontinence. Korean J Urol 2010; 51:657.
  31. DeSouza R, Shapiro A, Westney OL. Adductor brevis myositis following transobturator tape procedure: a case report and review of the literature. Int Urogynecol J Pelvic Floor Dysfunct 2007; 18:817.
  32. Connolly TP. Necrotizing surgical site infection after tension-free vaginal tape. Obstet Gynecol 2004; 104:1275.
  33. Sivanesan K, Abdel-Fattah M, Tierney J. Perineal cellulitis and persistent vaginal erosion after transobturator tape (Obtape)--case report and review of the literature. Int Urogynecol J Pelvic Floor Dysfunct 2007; 18:219.
  34. Karsenty G, Boman J, Elzayat E, et al. Severe soft tissue infection of the thigh after vaginal erosion of transobturator tape for stress urinary incontinence. Int Urogynecol J Pelvic Floor Dysfunct 2007; 18:207.
  35. Harmanli O, Boyer RL, Metz S, et al. Double-blinded randomized trial of preoperative antibiotics in midurethral sling procedures and review of the literature. Int Urogynecol J 2011; 22:1249.
  36. Duff P, Park RC. Antibiotic prophylaxis in vaginal hysterectomy: a review. Obstet Gynecol 1980; 55:193S.
  37. Mittendorf R, Aronson MP, Berry RE, et al. Avoiding serious infections associated with abdominal hysterectomy: a meta-analysis of antibiotic prophylaxis. Am J Obstet Gynecol 1993; 169:1119.
  38. ACOG Committee on Practice Bulletins--Gynecology. ACOG practice bulletin No. 104: antibiotic prophylaxis for gynecologic procedures. Obstet Gynecol 2009; 113:1180.
  39. American Urologic Association: Urologic surgery antimicrobial prophylaxis http://www.auanet.org/content/media/antimicroprop08.pdf (Accessed on August 16, 2011).
  40. Quadri G, Magatti F, Belloni C, Mattioli G. Transabdominal repair of cystocele by wedge colpectomy during combined abdominal-vaginal surgery. Int Urogynecol J Pelvic Floor Dysfunct 1997; 8:278.
  41. Lovatsis D, Drutz HP. Is transabdominal repair of mild to moderate cystocele necessary for correction of prolapse during a modified Burch procedure? Int Urogynecol J Pelvic Floor Dysfunct 2001; 12:193.
  42. Walsh CJ, Wall L. "Anterior Compartment" Pelvic Reconstructive Surgery, Stanton SL, Zimmern P. (Eds), Springer-Verlag, London 2005. p.161.
  43. Walters MD. Surgical correction of anterior vaginal wall prolapse. In: Urogynecology and Reconstructive Pelvic Surgery, 3, Walters MD, Karram MM. (Eds), Mosby Elsevier, Philadelphia 2007. p.234.
  44. Feiner B, Maher C. Vaginal mesh contraction: definition, clinical presentation, and management. Obstet Gynecol 2010; 115:325.
  45. Vollebregt A, Fischer K, Gietelink D, van der Vaart CH. Primary surgical repair of anterior vaginal prolapse: a randomised trial comparing anatomical and functional outcome between anterior colporrhaphy and trocar-guided transobturator anterior mesh. BJOG 2011; 118:1518.
  46. Sand PK, Koduri S, Lobel RW, et al. Prospective randomized trial of polyglactin 910 mesh to prevent recurrence of cystoceles and rectoceles. Am J Obstet Gynecol 2001; 184:1357.
  47. Weber AM, Walters MD, Piedmonte MR, Ballard LA. Anterior colporrhaphy: a randomized trial of three surgical techniques. Am J Obstet Gynecol 2001; 185:1299.
  48. Gandhi S, Goldberg RP, Kwon C, et al. A prospective randomized trial using solvent dehydrated fascia lata for the prevention of recurrent anterior vaginal wall prolapse. Am J Obstet Gynecol 2005; 192:1649.
  49. Meschia M, Pifarotti P, Bernasconi F, et al. Porcine skin collagen implants to prevent anterior vaginal wall prolapse recurrence: a multicenter, randomized study. J Urol 2007; 177:192.
  50. Guerette NL, Peterson TV, Aguirre OA, et al. Anterior repair with or without collagen matrix reinforcement: a randomized controlled trial. Obstet Gynecol 2009; 114:59.
  51. www.fda.gov/MedicalDevices/DeviceRegulationandGuidance/PostmarketRequirements/PostmarketSurveillance/ucm134497.htm (Accessed on October 30, 2013).
  52. Murphy M, Society of Gynecologic Surgeons Systematic Review Group. Clinical practice guidelines on vaginal graft use from the society of gynecologic surgeons. Obstet Gynecol 2008; 112:1123.
  53. Sung VW, Rogers RG, Schaffer JI, et al. Graft use in transvaginal pelvic organ prolapse repair: a systematic review. Obstet Gynecol 2008; 112:1131.
  54. http://www.icsoffice.org/Publications/ICI_4/files-book/comite-15.pdf (Accessed on January 23, 2012).
  55. Robert M, Girard I, Brennand E, et al. Absorbable mesh augmentation compared with no mesh for anterior prolapse: a randomized controlled trial. Obstet Gynecol 2014; 123:288.
  56. Maher C, Feiner B, Baessler K, Schmid C. Surgical management of pelvic organ prolapse in women. Cochrane Database Syst Rev 2013; 4:CD004014.
  57. de Tayrac R, Devoldere G, Renaudie J, et al. Prolapse repair by vaginal route using a new protected low-weight polypropylene mesh: 1-year functional and anatomical outcome in a prospective multicentre study. Int Urogynecol J Pelvic Floor Dysfunct 2007; 18:251.
  58. Sivaslioglu AA, Unlubilgin E, Dolen I. A randomized comparison of polypropylene mesh surgery with site-specific surgery in the treatment of cystocoele. Int Urogynecol J Pelvic Floor Dysfunct 2008; 19:467.
  59. Hiltunen R, Nieminen K, Takala T, et al. Low-weight polypropylene mesh for anterior vaginal wall prolapse: a randomized controlled trial. Obstet Gynecol 2007; 110:455.
  60. Jia X, Glazener C, Mowatt G, et al. Efficacy and safety of using mesh or grafts in surgery for anterior and/or posterior vaginal wall prolapse: systematic review and meta-analysis. BJOG 2008; 115:1350.
  61. Sokol AI, Iglesia CB, Kudish BI, et al. One-year objective and functional outcomes of a randomized clinical trial of vaginal mesh for prolapse. Am J Obstet Gynecol 2012; 206:86.e1.
  62. Foon R, Toozs-Hobson P, Latthe PM. Adjuvant materials in anterior vaginal wall prolapse surgery: a systematic review of effectiveness and complications. Int Urogynecol J Pelvic Floor Dysfunct 2008; 19:1697.
  63. Nguyen JN, Burchette RJ. Outcome after anterior vaginal prolapse repair: a randomized controlled trial. Obstet Gynecol 2008; 111:891.
  64. Altman D, Väyrynen T, Engh ME, et al. Anterior colporrhaphy versus transvaginal mesh for pelvic-organ prolapse. N Engl J Med 2011; 364:1826.
  65. Withagen MI, Milani AL, den Boon J, et al. Trocar-guided mesh compared with conventional vaginal repair in recurrent prolapse: a randomized controlled trial. Obstet Gynecol 2011; 117:242.
  66. Murray S, Haverkorn RM, Lotan Y, Lemack GE. Mesh kits for anterior vaginal prolapse are not cost effective. Int Urogynecol J 2011; 22:447.
  67. Shippey SH, Quiroz LH, Sanses TV, et al. Anatomic outcomes of abdominal sacrocolpopexy with or without paravaginal repair. Int Urogynecol J 2010; 21:279.
  68. Lowder JL, Park AJ, Ellison R, et al. The role of apical vaginal support in the appearance of anterior and posterior vaginal prolapse. Obstet Gynecol 2008; 111:152.
  69. Callens A, Vaillant L, Lecomte P, et al. Does hormonal skin aging exist? A study of the influence of different hormone therapy regimens on the skin of postmenopausal women using non-invasive measurement techniques. Dermatology 1996; 193:289.
  70. Maheux R, Naud F, Rioux M, et al. A randomized, double-blind, placebo-controlled study on the effect of conjugated estrogens on skin thickness. Am J Obstet Gynecol 1994; 170:642.
  71. Raz R, Stamm WE. A controlled trial of intravaginal estriol in postmenopausal women with recurrent urinary tract infections. N Engl J Med 1993; 329:753.
  72. Knoepp LR, Bracken JN, Hoskey KA, et al. Post-operative instructions: Is there a consensus within the realm of urogynecology? Fem Pelvic Med Reconstr Surg 2011; 17:S31.