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Anterior Repair (Colporrhaphy) for Cystocele

Anterior repair is a vaginal procedure to repair a cystocele (dropped bladder) utilizing the patients own tissue/fascia for the repair. Even though the anterior repair is the most commonly utilized operation (and the oldest) for correction of a cystocele, anterior vaginal wall repair is probably not the most effective, nor is anterior repair the correct operation for restoring a woman's anatomy and maintaining vaginal length and function in many cases of cystocele. The problem with using anterior bladder or vaginal wall repair in young, healthy, sexually-active woman with a paravaginal defect (cystocele) is the surgeon does not really surgically support the bladder, but instead reduces the bulge by "scrunching " the fascia under the bladder together. Most larger, symptomatic bladders are caused by the anterior vaginal wall tearing away laterally from its support to the pelvic sidewall muscles. This is called a paravaginal defect and this should be repaired laparoscopically when present.

The anterior repair for a cystocele should or can be utilized in patients with:

  • Midline defects
  • Mild anterior wall relaxation
  • Defects which are not paravaginal
  • Cystocele of any type in patients whose vaginal function and length is not important

Click here to read new data from Dr. Moore and Dr. Miklos regarding the novel single incision vaginal approach to treat cystocele and vault prolapse.   This is the FIRST one year data to be presented on this newer technique in the world.  This was presented at the 39th Global Congress of Minimally Invasive Gynecology ~ Annual Meeting of the AAGL.

Normal SupportNormal Support - side view


Midline Defect Repair

The following illustrate a sequence of events in the repair of a midline defect cystocele. The patient has a cystocele due to a midline break in the pubocervical fascia.

Skin incisionFig. 1 - Skin Incision - the skin overlying is out.

Identifying Midline DefectFig. 2 - Identifying Midline Defect The break in the pubocervical pascia, the supporting layer of the bladder, is identified. Note - one can identify the bladder wall because the supportive floor (fascia) is defective

Repairing DefectFig. 3 - Repairing Defect - The break in the pubocervical fascia (support layer) is repaired

Closing the VaginaFig. 4 - Closing the Vagina - The covering layer known as the vaginal epithelium or skin is closed using suture.

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