Modified Extended Anterior Vaginal Wall Repair for Cystocele

Maksim ValenčićUniversity Hospital Rijeka

Department for Urology

Cystocele

Herniation of the urinary bladder through the wall of the vagina

Classification of pelvic floor disorders in women

● Sandardised terminological program for incontinence ( International Continence Society, 1995. )

● POPQ – staging from 0 ( normal ) to IV ( complete prolapse ) included

Classification of pelvic floor disorders in women

• Anterior part – urethrocele

• Middle part – cystocele

• Posterior part – rectocele

Cystocele - causes

• Human upright posture

• Pregnancy

• Vaginal childbirth• Chronic rise in intra-abdominal pressure

( obesity, cough )

• Pelvic floor muscle weakness

Over the next 30 years, growth in

demand for services to care for female pelvic floor disorders

will increase at twice the rate of

growth of the same population.

Luber KM et al. Am J Obstet Gynecol. 2001 Jun;184(7):1496-501

Long-term recurrence rates after anterior vaginal wall surgery of > 60%, before the introduction of

synthetic grafts, were the highest among all operations of vaginal wall defects.

When propylen mash is used for

cystocele repair, extrusion rates as

high as 25% have been reported.

Julian TM. Am J Obstet Gynecol. Dec 1996;175(6):1472-5

Cystocele

Cystocele grad IV

Cystocele

Lateral cystogram in cystocele

Diagnostics

• Medical hystory

• Vaginal examination

• Urine and bacteriology

• Sonography

• Urodynamics

• Cystoskopy

Patients

106 pacijents with cystocele, treated

from 1999 to 2013 at the Department

for Urology of the Clinical Hospital

Centre Rijeka, Croatia

Age and cystocele grade in 106 patients treated between 1999 - 2013

Age 30-39 40-49 50-59 60-69 70-79 80

Grade 1j 0 0 0 0 0 0

Grade 2 1 0 3 1 7 0

Grade 3 0 5 13 6 6 1

Grade 4 0 1 3 8 25 2

Total 1 6 19 1 38 3

Age 30-39 40-49 50-59 60-69 70-79 80

Grade 1 0 0 0 0 0 0

Grade 2 1 0 1 1 8 0

Grade 3 0 6 18 9 11 2

Grade 4 0 1 6 11 29 2

Total 1 7 25 21 ¸48 4

Overal age of our patients with cystocele:

• 67,24 years ( range 36 - 84 years )

Patients >60 years:

- 75% of all our patients operated for cystocele

Incision of the anterior vaginal wall

Far vaginal dissection and reinforcing of endopelvic fascia

Plication of the pubocervical fascia

Complications

• Extent vaginal mucosa granulations

due to the vaginal wall lesion through

rigid monofilament suture ends in 4

patients.

Resultsi

Extended anterior vaginal wall repair for cystocele is a safe and simple procedure with good anatomical results and minimal complications rates.

Thank you

for your

attention!