Paravaginal Repair

The paravaginal defect repair has been widely used for correction of anterior vaginal prolapse thought to result from lateral vaginal detachment. Similar to anterior colporrha phy, current evaluation of the success rate of this procedure for treatment of anterior vaginal prolapse is limited to case series and retrospective reviews. Reports of retropubic paravaginal repair demonstrate anatomic success rates ranging from 92% to 97% for the abdominal approach (Table 8-3.5). There are few long-term data on the efficacy of laparoscopic paravaginal repair for the treatment of anterior vaginal prolapse. Reports of vaginal paravaginal repair demonstrate success rates of 76% to 100% after variable lengths of follow-up (Table 8-3.6). Failure or recurrence of anterior vaginal prolapse after paravaginal defect may occur laterally, centrally, or both. Studies that have differentiated lateral from central recurrence have revealed that central recurrence (22%-25%) is more common than a lateral recurrence (2%-8%). To date, there are no studies comparing paravaginal defect repair with or without midline anterior repair to traditional anterior colporrha-phy alone.

Table 8-3.3. Anterior colporrhaphy and simultaneous sling/anti-incontinence procedure for treatment of anterior vaginal prolapse

Authors (Year) No.of Patients Study Design Mean Follow-up (y) Recurrence (%)

Cross et al.14 (1997) 42 Retrospective cohort 1-3.25 8-17

Safir et al.15 (1999) 130 Retrospective cohort 0.5-3.5 4-5

Table 8-3.3. Anterior colporrhaphy and simultaneous sling/anti-incontinence procedure for treatment of anterior vaginal prolapse

Authors (Year) No.of Patients Study Design Mean Follow-up (y) Recurrence (%)

Cross et al.14 (1997) 42 Retrospective cohort 1-3.25 8-17

Safir et al.15 (1999) 130 Retrospective cohort 0.5-3.5 4-5

Table 8-3.4. Anterior colporrhaphy with patch augmentation of repair for treatment of anterior vaginal prolapse

Authors (Year)

Patch Material

No. of Patients

Study Design

Mean Follow-up

Recurrence (%)

Groutz et al.16 (2001)

Cadaver fascia

21

Retrospective cohort

20mo

0

Kobashi et al.17 (2000)

Cadaver fascia

50

Prospective cohort

6mo maximum

0

Migliari et al.18 (2000)

Polypropylene mesh

12

Retrospective cohort

20.5mo

25% grade I cystocele

Weber et al.3 (2001)

Polyglactin 910 mesh

35

Randomized controlled trial

23.3mo

58

Table 8-3.5. Outcomes of abdominal paravaginal repair for treatment of anterior vaginal prolapse

Authors (Year)

No. of Patients

Study Design

Mean Follow-up

Cure (%)

Richardson et al.19 (1976)

60

Retrospective cohort

20mo

97

Richardson et al.20 (1981)

233

Retrospective cohort

Not reported

95

Shull and Baden21 (1989)

149

Retrospective cohort

48mo

95

Bruce et al.22 (1999)

52

Retrospective cohort

17mo

92

Scotti et al.23 (1998)

40

Prospective cohort

39mo

97

Table 8-3.6. Outcomes of vaginal paravaginal repair for treatment of anterior vaginal prolapse

Authors (Year)

No.of Patients

Study Design

Mean Follow-up

Cure (%)

White24 (1909)

19

Retrospective cohort

Not reported

100

Shull et al.25 (1994)

62

Retrospective cohort

1.6 y

76

Farrell and Ling26 (1997)

27

Retrospective cohort

8mo

80

Nguyen and Bhatia27 (1999)

10

Retrospective cohort

1y

100

Elkins et al.28 (2000)

25

Retrospective cohort

Not reported

76

Mallipeddi et al.29 (2001)

35

Retrospective cohort

20mo

97

Young et al.30 (2001)

100

Retrospective cohort

11 mo

78

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