ABSTRACT
This chapter reviews the anatomy and pathology of anterior vaginal prolapse, with and without stress urinary incontinence, and describes methods of surgical repair. In a study of 71 women with anterior vaginal wall prolapse and stress urinary incontinence who underwent retropubic operations, DeLancey described paravaginal defects in 87% on the left and 89% on the right. Beyond careful history and physical examination, few diagnostic tests are needed to evaluate patients with anterior vaginal prolapse. The preparation for vaginal paravaginal repair begins similar to an anterior colporrhaphy. As for anterior colporrhaphy, vaginal flaps are developed by incising the vagina in the midline and dissecting the vaginal muscularis laterally. Reported success rates for native-tissue anterior colporrhaphy range from 37% to 100% with most cohorts reporting success rates greater than 80%.
