The Paravaginal Defect Repair

Abstract

The paravaginal defect repair, first described by White in 1909,1 restores the natural support of the vaginal fomices by reapproximating them to the arcus tendineus fascia pelvis overlying the levator and obturator internus muscles. Pelvic surgeons employing this surgical technique distinguish between cystocoele caused by attenuation or tearing of the pubocervical fascia (the midline defect) and cystocoele caused by detachment of the pubocervical fascia from its sidewaR support (the paravaginal defect).The paravaginal defect repair can be undertaken either through an abdominal or vaginal approach. Both procedures have been used to treat cystocoele and stress urinary incontinence with success rates that range from 66 to 97 percent. The postoperative morbidity associated with paravaginal repair, including urinary retention, detrusor instability, and recurrent pelvic prolapse, is reduced when compared to the traditional anterior colporrhaphy and retropubic incontinence procedures.Research efforts should focus on comparing the abdominal paravaginal repair to other established retropubic incontinence procedures. It may prove to be equally efficacious, while producing a decreased incidence of peri-operative morbidity. The vaginal paravaginal repair should permit a more comprehensive approach to cystocoele repair, while at the same time producing a higher cure rate of stress urinary incontinence than the needle suspension procedures.