Laparoscopic and Minimally Invasive Procedures Continued
Laparoscopic Paravaginal Repair (Cystocele Repair)
The bladder and urethra are supported by the anterior or upper vaginal wall. When there is a break in the support of the anterior vaginal wall, the bladder and urethra fall, resulting in a cystourethrocele. Review of the gynecologic literature reveals that the most common reason for so called "bladder drop" is a paravaginal defect or loss of support of the lateral attachment of the vagina. Greater than 90% of cystoceles are due to paravaginal defects. In an attempt to repair the cystocele, most physicians would perform an anterior repair (anterior colporrhaphy); however, this is rarely the correct anatomical operation. In patients with a cystocele from paravaginal defects, the most appropriate surgical procedure is the paravaginal repair, which is also called cystocele surgery or repair.
The cystocele repair is accomplished by suturing the lateral aspect of the anterior vaginal wall back to its original point of attachment, known as the arcus tendineus fascia pelvis (ATFP) or the "white line". Re-approximation of the vaginal wall to the fascia overlying the obturator internus muscle will restore the bladder and the urethra to its normal anatomical position. Important points of paravaginal cystocele repair:
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90% of cystoceles are due to paravaginal defects |
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Paravaginal repairs are traditionally performed using sutures |
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Paravaginal and mid-line defects can be present simultaneously |
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Paravaginal repairs can be performed laparoscopically |
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Paravaginal repairs can be performed with Burch urethropexy (incontinence) |
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Paravaginal repairs can be coupled with other prolapse surgeries |
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Paravaginal Repair Figure: 1
Normal Vaginal Support |
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Paravaginal Repair Figure: 2
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Paravaginal Repair Figure: 3
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Paravaginal defects - Loss of lateral vagina attachment at the arcus tendineus resulting in a cystocele (bladder drop). |
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Paravaginal Repair Figure:4
Normal Anterior Vaginal Wall - (aerial view) |
Paravaginal Repair Figure: 5
Paravaginal (lateral) defect - resulting in a cystocele (aerial view)
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Paravaginal Defect Repair - Repairing the vagina restores support to the bladder thus removing the cystocele or bladder drop. |
