Advertisement

Anterior Colporrhaphy

  • Jubilee C. Tan
  • Tracey WilsonEmail author
Chapter

Abstract

Anterior vaginal wall prolapse is defined as clinically evident descent of the anterior vaginal compartment. This may be the result of a midline, lateral or transverse fascial defect. Oftentimes, the patient does not experience symptoms until the anterior prolapse descends to the level of the introitus. Associated symptoms may include: pelvic pressure, palpation of a vaginal bulge, voiding difficulties (the need for positional voiding), urinary incontinence, and interference with sexual activity. Younger patients may complain of the inability to retain a tampon. Surgical correction of the anterior vaginal wall defect is indicated when the prolapse has a negative impact on the patient’s quality of life.

The objective of the anterior colporrhaphy is to fold and tighten the layers of the vaginal muscularis and adventitia overlying the bladder (also called the pubocervical, pubovesical, or endopelvic fascia). This surgical procedure should be tailored to the specific site(s) of anterior compartment defect, and is most suited for the central (midline) defect. Patients should be assessed for stress urinary incontinence and other compartment defects, which can be corrected concomitantly.

When compared to non-native tissue repairs, the anterior colporrhaphy is associated with fewer complications. It does have a higher long-term failure rate but is the recommended procedure for patients with no history of prior repairs.

Keywords

Cystocele Anterior vaginal wall prolapse Pelvic organ prolapse Colporrhaphy 

Supplementary material

Video 6.1

(MP4 113917 kb)

Video 6.2

(MP4 113000 kb)

References

  1. 1.
    Bump RC, Mattiasson A, Bo K, Brubaker LP, DeLancey JO, Klarskov P, et al. The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction. Am J Obstet Gynecol. 1996;175(1):10–7.CrossRefPubMedGoogle Scholar
  2. 2.
    Richardson AC, Lyon JB, Williams NL. A new look at pelvic relaxation. Am J Obstet Gynecol. 1976;126(5):568–73.CrossRefPubMedGoogle Scholar
  3. 3.
    Weber AM, Walters MD, Piedmonte MR, Ballard LA. Anterior colporrhaphy: a randomized trial of three surgical techniques. Am J Obstet Gynecol. 2001;185(6):1299–304; discussion 304–6.CrossRefPubMedGoogle Scholar
  4. 4.
    Colombo M, Vitobello D, Proietti F, Milani R. Randomised comparison of Burch colposuspension versus anterior colporrhaphy in women with stress urinary incontinence and anterior vaginal wall prolapse. BJOG. 2000;107(4):544–51.CrossRefPubMedGoogle Scholar
  5. 5.
    Chmielewski L, Walters MD, Weber AM, Barber MD. Reanalysis of a randomized trial of 3 techniques of anterior colporrhaphy using clinically relevant definitions of success. Am J Obstet Gynecol. 2011;205(1):69.e1–8.CrossRefGoogle Scholar
  6. 6.
    Maher C, Feiner B, Baessler K, Christmann-Schmid C, Haya N, Marjoribanks J. Transvaginal mesh or grafts compared with native tissue repair for vaginal prolapse. Cochrane Database Syst Rev. 2016;2, CD012079.PubMedGoogle Scholar
  7. 7.
    Salvatore S, Athanasiou S, Digesu GA, Soligo M, Sotiropoulou M, Serati M, et al. Identification of risk factors for genital prolapse recurrence. NeurourolUrodyn. 2009;28(4):301–4.Google Scholar
  8. 8.
    Maher C, Baessler K, Barber MD, Cheon C, Dietz V, Detayrac R, et al. Pelvic organ prolapse surgery. In: Adams P, Cardoza L, Khoury S, Wein A, editors. Incontinence: 5th international consultation on incontinence. Paris, February 2012: ICUD-EAU; 2013. p. 1377–442.Google Scholar
  9. 9.
    Weemhoff M, Wassen MM, Korsten L, Serroyen J, Kampschoer PH, Roumen FJ. Postoperative catheterization after anterior colporrhaphy: 2 versus 5 days. A multicentre randomized controlled trial. Int Urogynecol J. 2011;22(4):477–83.CrossRefPubMedGoogle Scholar
  10. 10.
    Altman D, Vayrynen T, Engh ME, Axelsen S, Falconer C, Nordic Transvaginal Mesh Group. Anterior colporrhaphy versus transvaginal mesh for pelvic-organ prolapse. N Engl J Med. 2011;364(19):1826–36.CrossRefPubMedGoogle Scholar
  11. 11.
    Kwon CH, Goldberg RP, Koduri S, Sand PK. The use of intraoperative cystoscopy in major vaginal and urogynecologic surgeries. Am J Obstet Gynecol. 2002;187(6):1466–71; discussion 71–2.CrossRefPubMedGoogle Scholar
  12. 12.
    Maher C, Feiner B, Baessler K, Schmid C. Surgical management of pelvic organ prolapse in women. Cochrane Database Syst Rev. 2013;4, CD004014.Google Scholar
  13. 13.
    Summers A, Winkel LA, Hussain HK, DeLancey JO. The relationship between anterior and apical compartment support. Am J Obstet Gynecol. 2006;194(5):1438–43.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Hsu Y, Chen L, Summers A, Ashton-Miller JA, DeLancey JO. Anterior vaginal wall length and degree of anterior compartment prolapse seen on dynamic MRI. Int Urogynecol J Pelvic Floor Dysfunct. 2008;19(1):137–42.CrossRefPubMedGoogle Scholar
  15. 15.
    Wolf Jr JS, Bennett CJ, Dmochowski RR, Hollenbeck BK, Pearle MS, Schaeffer AJ, et al. Best practice policy statement on urologic surgery antimicrobial prophylaxis. J Urol. 2008;179(4):1379–90.CrossRefPubMedGoogle Scholar
  16. 16.
    Forrest JB, Clemens JQ, Finamore P, Leveillee R, Lippert M, Pisters L, et al. AUA Best Practice Statement for the prevention of deep vein thrombosis in patients undergoing urologic surgery. J Urol. 2009;181(3):1170–7.CrossRefPubMedGoogle Scholar
  17. 17.
    Committee on Practice B-G, the American Urogynecologic S. ACOG Practice Bulletin No. 155: urinary incontinence in women. Obstet Gynecol. 2015;126(5):e66–81.Google Scholar
  18. 18.
    Maher CF, Karram MM. Surgical management of anterior vaginal wall prolapse. In: Karram MM, Maher CF, editors. Surgical management of pelvic organ prolapse. 1st ed. Philadelphia: Elsevier/Saunders; 2013. p. 117–37.CrossRefGoogle Scholar
  19. 19.
    Karram MM. Native tissue vaginal repair of cystocele, rectocele, and enterocele. In: Baggish MS, Karram MM, editors. Atlas of pelvic anatomy and gynecologic surgery. 4th ed. Philadelphia: Elsevier; 2016. p. 599–621.Google Scholar
  20. 20.
    Muir TW. Anterior colporrhaphy for cystocele repair. In: Raz S, Rodríguez LV, editors. Female urology. 3rd ed. Philadelphia: Elsevier Saunders; 2008. p. 642–8.CrossRefGoogle Scholar
  21. 21.
    Nichols DH. Anterior colporrhaphy technique to shorten a pathologically long anterior vaginal wall. Int Surg. 1979;64(5):69–71.PubMedGoogle Scholar
  22. 22.
    Macer GA. Transabdominal repair of cystocele, a 20 year experience, compared with the traditional vaginal approach. Am J Obstet Gynecol. 1978;131(2):203–7.CrossRefPubMedGoogle Scholar
  23. 23.
    Walter S, Olesen KP, Hald T, Jensen HK, Pedersen PH. Urodynamic evaluation after vaginal repair and colposuspension. Br J Urol. 1982;54(4):377–80.CrossRefPubMedGoogle Scholar
  24. 24.
    Nieminen K, Hiltunen R, Takala T, Heiskanen E, Merikari M, Niemi K, et al. Outcomes after anterior vaginal wall repair with mesh: a randomized, controlled trial with a 3 year follow-up. Am J Obstet Gynecol. 2010;203(3):235.e1–8.CrossRefGoogle Scholar
  25. 25.
    Rudnicki M, Laurikainen E, Pogosean R, Kinne I, Jakobsson U, Teleman P. A 3-year follow-up after anterior colporrhaphy compared with collagen-coated transvaginal mesh for anterior vaginal wall prolapse: a randomised controlled trial. BJOG. 2016;123(1):136–42.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2017

Authors and Affiliations

  1. 1.Female Pelvic Medicine and Reconstructive SurgeryUniversity of Alabama at BirminghamBirminghamUSA
  2. 2.University of Alabama at BirminghamBirminghamUSA

Personalised recommendations