Procedure targets anterior vaginal segment defect: After previous transvaginal repair. (Gynecology).

MYRTLE BEACH, S.C. -- Anterior vaginal segment defects can get the support they deserve, Dr. Samuel Lentz said at the annual meeting of District IV of the American College of Obstetricians and Gynecologists.

With a median follow-up of 6 months, five patients who underwent transabdominal paravaginal and sacrospinous ligament repair for vaginal prolapse had satisfactory anatomical results. There were no postoperative complications of bleeding, infections, or trauma to adjacent structures, and all patients had resolution of their preoperative symptoms, said Dr. Lentz, a gynecologic oncologist at Wake Forest University, Winston-Salem, N.C.

"This is a surgical approach to a specific anatomic defect in patients who have typically had previous transvaginal repairs," he said.

Anterior segment defects can be divided into two basic groups from a clinical standpoint--anterior and posterior cystoceles, Dr. Lentz said.

The anterior cystocele is characterized by a weakness that is distal to the interureteric ridges. This is associated with rotational descent of the urethrovesical angle, and most patients have associated stress urinary incontinence.

The posterior cystocele is more typical. It is proximal to the interureteric ridges and can be divided into the distension cystocele and displacement cystocele.

The transabdominal bilateral paravaginal and sacrospinous ligament technique incorporates two operative procedures: the paravaginal repair and the sacrospinous sling suspension. The approach was successful in repairing a specific anterior vaginal segment defect: a displacement cystocele with vault inversion that lacked an accompanying enterocele, Dr. Lentz said.