ABSTRACT
I. INTRODUCTION In the third millennium there will be 20 million women between the ages of 45 and 65 and another 23 million older than 65 years of age in the United States (1). This alarming number and the cost of these 43 million patients requiring the diagnosis and treatment of genital prolapse (Fig. 1) or urinary incontinence in their lifetime will be staggering. We are experiencing an increase in genital prolapse particularly posthysterectomy vaginal vault prolapse, but most commonly seen are cystourethrocele, uterine descent, and rectocele (2). These patients may present with a protruding vaginal mass, and up to 25% may complain of urinary incontinence, usually stress urinary incontinence (2). Patients may also recognize that as the pelvic prolapse worsens their urinary incontinence becomes less noticeable (2). This cause and effect may be attributable to urethral kinking or urethral compression enhancing the urethral sphincteric continence mechanism (2). There is now a consensus opinion among urogynecologists, gynecologists, and urologists that these two conditionsprolapse and urinary incontinence-often occur concomitantly, so that relaxation of the anterior vaginal wall may lead to urethrovesical hypermobility and genuine stress incontinence (2-4). However, with pelvic relaxation being a global phenomenon, a coexisting cystocele, rectocele, enterocele, uterine descent, or vaginal vault prolapse may be present
Figure 1 Complete procidentia: (A) sagittale view; (B) lateral view; (C) superior view.
