Vaginal Prolapse and Bladder Suspension: Role of Endoscopic Surgery

Abstract

The goal of laparoscopic treatment for vaginal prolapse and bladder suspension is to restore normal anatomy by repairing pelvic floor defects. When a defect in the pelvic support system is of such magnitude that it requires the patient to undergo reparative surgery for symptomatic enterocele, rectocele, cystocele, urinary or fecal incontinence, or uterovaginal or rectal prolapse, the defect in the pelvic floor usually involves other components as well. Therefore surgery for vaginal prolapse, urinary incontinence, or any other pelvic floor defect must not be thought of as an isolated procedure. Restorative surgery for urinary continence, for example, changes the direction of force vectors to the remaining pelvic floor so a slight deficiency in another compartment existing at the time of the urinary incontinence surgery may become a marked deficiency postoperatively, necessitating further surgery. Up to 28% of patients undergoing a Burch colposuspension develop middle or posterior compartment deficiency (or both) and subsequently manifest enterocele, rectocele, and vaginal vault prolapse, which require additional surgery.¹