Anterior Vaginal Prolapse

Sandip P. Vasavada and Matthew D. Barber

The successful management of anterior vaginal wall prolapse remains one of the greatest challenges in female pelvic reconstructive surgery. Prolapse of the anterior vaginal wall is the most common presentation of pelvic organ prolapse. Recent studies suggest that, of the various segments of the vagina that may be involved in prolapse (anterior, posterior, or apical), the anterior vaginal wall is the segment most likely to demonstrate recurrent prolapse after reconstructive surgery. Additionally, normal anterior vaginal support has an important role in supporting the urethra, and loss of this support can contribute to the development of stress urinary incontinence. It is, therefore, important that the pelvic reconstructive surgeon understand the normal support mechanisms of the anterior vaginal wall and the full spectrum of techniques for correction of anterior vaginal prolapse and cystoceles.

The vagina is a hollow, flattened fibromuscular tube lined with nonkeratinized stratified squamous epithelium. Underlying the vaginal epithelium is the vaginal muscu-laris, a well developed layer made up primarily of smooth muscle along with collagen and elastin. Some have labeled this layer of the anterior vaginal wall pubocervical fascia or vesicopelvic fascia. Although these terms are widely used, the use of the term "fascia" is a misnomer, because it does not accurately reflect the histology of the vagina. Advanced anterior vaginal prolapse can result from defects in several areas of pelvic support including:

description of the anatomy of anterior vaginal support can be found in Chapters 4-1 and 4-2.

Herbal Remedies For Acid Reflux

Herbal Remedies For Acid Reflux

Gastroesophageal reflux disease is the medical term for what we know as acid reflux. Acid reflux occurs when the stomach releases its liquid back into the esophagus, causing inflammation and damage to the esophageal lining. The regurgitated acid most often consists of a few compoundsbr acid, bile, and pepsin.

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