Skip to main content
SpringerLink
Log in

Paraurethral fascial sling urethropexy and vaginal paravaginal defects cystopexy in the correction of urethrovesical prolapse

  • Original Article
  • Published:
International Urogynecology Journal Aims and scope Submit manuscript

Abstract

The authors sought to determine whether a vaginal paravaginal defects cystopexy combined with a paraurethral fascial sling urethropexy is an effective surgical procedure in restoring normal anatomic positioning of the anterior pelvic compartment in cases of genitourinary prolapse associated with overt or masked genuine urinary stress incontinence. In this observational study of 75 patients, each underwent repair of all defects of pelvic support accompanied by this combined procedure for anterior compartment restoration. Sixty-one patients (81%) complained primarily of protruding masses; 25 (33%) had had at least one prior attempt at cystocele repair. Follow-up ranging from 6 months to 3 years was obtained in 72 cases. Sixty-eight (94.4%) patients denied postoperative urinary incontinence. Symptoms of genital prolapse were relieved in all but one. The combined paraurethral fascial sling urethropexy and vaginal paravaginal defects cystopexy present a valuable approach in operative repair when multiple pelvic compartments are involved in prolapse.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Norton PA. Histological and biochemical studies. In: Benson JT, ed. Female pelvic floor disorders: investigation and management. New York: WW Norton & Co, 1992:166–175

    Google Scholar 

  2. Bump RC, McClish DM. Cigarette smoking and pure genuine stress incontinence of urine: a comparison of risk factors and determinants between smokers and nonsmokers.Am J Obstet Gynecol 1994;170:579–582

    PubMed  Google Scholar 

  3. Marshall VF, Marchetti AA, Krantz KE. The correction of stress incontinence by simple vesicourethral suspension.Surg Gynecol Obstet 1949;88:509–518

    Google Scholar 

  4. Pereyra AJ, Lebherz TB, Growdon WA et al. Pubourethral supports in perspective: modified Pereyra procedure for urinary incontinence.Obstet Gynecol 1982;59:643–648

    PubMed  Google Scholar 

  5. Burch JC. Urethrovaginal fixation to Cooper's ligament for correction of stress incontinence, cystocele and prolapse.Am J Obstet Gynecol 1961;81:281–290

    PubMed  Google Scholar 

  6. Bergman A, Koonings PP, Ballard CA. Primary stress incontinence and pelvic relaxation: prospective randomized comparison of three operations.Am J Obstet Gynecol 1989;161:97–101

    PubMed  Google Scholar 

  7. Baden WF, Walker T eds. Surgical repair of vaginal defects. Philadelphia: JB Lippincott Company, 1992:54–56

    Google Scholar 

  8. Grody MHT. Anterior pelvic compartment reconstruction: the total vaginal approach. In: Grody MHT, ed. Benign postreproductive gynecologic surgery. New York: McGraw-Hill 1994:174–191

    Google Scholar 

  9. Grody MHT. Anatomic surgical restoration in extreme massive vaginal eversion. ACOG Audiovisual Library 1993; AVL 84

  10. Grody MHT, Nyirjesy P. Surgical correction of urethral kinking and funneling accompanying hypermotile urethra in massive vaginal eversion. ACOG Audiovisual Library 1994; AVL 94

  11. Nichols DH, Randall CL. Vaginal surgery, 3rd edn. Baltimore: Williams & Wilkins, 1989:85

    Google Scholar 

  12. White GR. Cystocele: a radical cure by suturing lateral sulci of vagina to white line of pelvic fascia.JAMA 1990;53:1707–1710

    Google Scholar 

  13. White GR. An anatomic operation for the cure of the cystocele.Am J Dis Wom Child 1912;65:286–291

    Google Scholar 

  14. Tanagho EA. Managing urinary incontinence: the role of the gynecologist.Int Urogynecol J 1994;5:1–2

    Article  Google Scholar 

  15. Miyazaki FS, Miyazaki DW. Raz four-corner suspension for severe cystocele: poor results.Int Urogynecol J 1994;5:94–97

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Obstetrics, Gynecology and Reproductive Sciences, Temple University School of Medicine, Philadelphia, Pennsylvania, USA

    M. H. T. Grody (Director of Gynecology), P. Nyirjesy, L. M. Kelley & M. L. Millar

Authors
  1. M. H. T. Grody
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. P. Nyirjesy
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. L. M. Kelley
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. M. L. Millar
    View author publications

    You can also search for this author in PubMed Google Scholar

Additional information

Editorial Comment: The repair of genital prolapse is continually evolving. In spite of the fact that White [12,13] described the vaginal paravaginal repair many years ago it is only now that it is being studied in detail, including comments on the anterior compartment and the surgical repair of stress incontinence. The senior author of this manuscript is an accomplished pelvic and vaginal surgeon who has made awardwinning video tapes of his procedures, and has also published a textbook onBenign postreproductive pelvic surgery (McGraw-Hill, New York, 1995). His results are excellent even in the long term. Those surgeons who do this type of surgery need to consider using his techniques to accomplish definitive repair by the vaginal route. The vaginal paravaginal repair will probably be standard practice for the repair of such defects within the next few years.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Grody, M.H.T., Nyirjesy, P., Kelley, L.M. et al. Paraurethral fascial sling urethropexy and vaginal paravaginal defects cystopexy in the correction of urethrovesical prolapse. Int Urogynecol J 6, 80–85 (1995). https://doi.org/10.1007/BF01962576

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF01962576

Keywords

Search

Navigation