34: Tissue guided regenerative surgery: The pathology of anterior vaginal wall collapse

Abstract

Anterior Vaginal Wall Collapse of Prolapse is commonly referred to as “cystocele” and classified according to the severity of the prolapse. All “cystoceles” are not the same. This video, which is part of a series on regenerative vaginal surgery, focus on a classification of the different defects present in anterior vaginal wall collapse. The objective is to introduce the reader into a new avenue: regenerative surgery, which consists of defect specific surgery and the utilization of native tissue in the repair with the manipulation of wound healing along regenerative medicine principles. Native tissue surgeries of the past followed a principle of all anterior wall bulges need to be pushed back, with a total disregard of the underlying cause of the bulge. Utilizing different video clips the variation in underlying pathology in anterior vaginal wall prolapse is shown. A classification of the pathology along the lines of defects seen in the support fascia of the anterior wall is shown: this is practical and focused on subsequent differing surgical techniques to repair the damaged wall. The principles of regenerative medicine require meticulous surgical skills to protect the native tissue and minimizing scar tissue formation, with a maximum regenerative result. Morbidity is vastly decreased. The influence of age on the type of expected pathology to be found is highlighted. All cystoceles are indeed not the same. Regenerative surgery is the future of native tissue surgery.