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Current Concepts in the Diagnosis and Surgical Repair of Anterior Vaginal Prolapse Due to Paravaginal Defects

Anterior vaginal prolapse is often caused by defects in the paravaginal fascia. The purpose of this article is to review the current concepts in the diagnosis and surgical repair of anterior vaginal prolapse due to paravaginal defects. Articles related to paravaginal defects were identified through a MEDLINE search of English-language medical journals published between June 1909 and August 2000. Physical examination is usually used to diagnose paravaginal defects, but this method may have low specificity and low positive predictive value. Magnetic resonance imaging may be used to examine the pelvic anatomy, but it is expensive and may not be readily available to all physicians. Transabdominal ultrasound does not appear to be useful for detection of paravaginal defects. Paravaginal repair, both transvaginal and transabdominal approaches, appears to offer favorable cure rates and low recurrence rates of anterior vaginal prolapse. Paravaginal repair does not appear to be as effective as Burch colposuspension for treatment of stress urinary incontinence. The efficacy of laparoscopic paravaginal repair requires additional investigation. Complications including voiding dysfunction, hemorrhage, and urinary tract injury are uncommon. The long-term efficacy of paravaginal repair requires further investigation. Target Audience: Obstetricians & Gynecologists, Family Physicians Learning Objectives: After completion of this article, the reader will be able to describe the anatomic defects associated with anterior vaginal prolapse, to outline the various diagnostic tests used to make the diagnosis of a paravaginal defect, and to list the complications associated with paravaginal defect repair.