Abstract
Introduction and hypothesis
It is reported that almost one in five women will need some form of pelvic organ prolapse surgery in their lifetime, with anterior wall repair accounting for nearly half of these. Cystoceles occur secondary to defect(s) in one or more of the vaginal wall support mechanisms, including its lateral paravaginal attachments. Paravaginal defects are very common in women presenting with cystocele, thus highlighting the importance of paravaginal defect repair for optimal cystocele correction in the majority of cases. Although there are several paravaginal defect repair procedures, some entail complex techniques, whereas others rely on the use of transvaginal mesh, which is currently not permitted in many countries.
Methods
In this video article we present a novel trans-obturator native tissue paravaginal defect repair for the management of cystocele.
Results
This procedure has the advantages of avoiding complex transabdominal paravaginal defect repair, the controversial use of transvaginal mesh, or a single-point fixation to an arcus tendineus fasciae pelvis that might be difficult to identify.
Conclusion
We believe that the trans-obturator cystocele repair procedure offers several advantages over existing paravaginal defect repair alternatives.
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References
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Funding
The study was funded by the National Sustainability Program I (NPU I) Nr. LO1503 and Charles University Research Fund (Progres Q39). K.M.I. is part-funded by project No. CZ.02.1.01/0.0/0.0/16_019/0000787 “Fighting INfectious Diseases,” awarded by the Ministry of Education, Youth and Sports of the Czech Republic, financed from The European Regional Development Fund.
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Ethical approval and patients’ consent were acquired prior to undertaking this procedure (Etická Komise, FN a LF UK v Plzni, Tr. Dr. E. Benese 13, 305 99 Plzen).
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The authors would like to stress that clinical evidence supporting the effectiveness of this procedure should be awaited prior to its use in routine clinical practice.
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Kalis, V., Kovarova, V., Rusavy, Z. et al. Trans-obturator cystocele repair of level 2 paravaginal defect. Int Urogynecol J 31, 2435–2438 (2020). https://doi.org/10.1007/s00192-020-04337-x
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DOI: https://doi.org/10.1007/s00192-020-04337-x