We describe a new transvaginal technique for cystocele repair

1. Modified Extended Anterior Vaginal
Wall Repair for Cystocele
Maksim Valenčić
University Hospital Rijeka
Department for Urology

2. Cystocele
Herniation of the urinary bladder
through the wall of the vagina

3. Classification of pelvic floor
disorders in women
● Sandardised terminological program
for incontinence ( International
Continence Society, 1995. )
● POPQ – staging from 0 ( normal ) to
IV ( complete prolapse ) included

4. Classification of pelvic floor
disorders in women
• Anterior part – urethrocele
• Middle part – cystocele
• Posterior part – rectocele

5. Cystocele - causes
• Human upright posture
• Pregnancy
• Vaginal childbirth
• Chronic rise in intra-abdominal
pressure ( obesity, cough )
• Pelvic floor muscle weakness

6. Over the next 30 years,
growth in
demand for services to care
for
female pelvic floor disorders
will
increase at twice the rate of
growth
of the same population.Luber KM et al. Am J Obstet Gynecol. 2001 Jun;184(7):1496-501

7. Long-term recurrence rates after
anterior vaginal wall surgery of
> 60%, before the introduction
of synthetic grafts, were the
highest among all operations of
vaginal wall defects.

8. When propylen mash is used for
cystocele repair, extrusion rates as
high as 25% have been reported.
Julian TM. Am J Obstet Gynecol. Dec 1996;175(6):1472-5

9. Cystocele

10. Cystocele grad IV

11. Cystocele

12. Lateral cystogram in cystocele

13. Diagnostics
• Medical hystory
• Vaginal examination
• Urine and bacteriology
• Sonography
• Urodynamics
• Cystoskopy

14. Patients
106 pacijents with cystocele, treated
from 1999 to 2013 at the Department
for Urology of the Clinical Hospital
Centre Rijeka, Croatia

15. Age and cystocele grade in 106
patients treated between 1999 - 2013
Age 30-39 40-49 50-59 60-69 70-79 80
Grade 1j 0 0 0 0 0 0
Grade 2 1 0 3 1 7 0
Grade 3 0 5 13 6 6 1
Grade 4 0 1 3 8 25 2
Total 1 6 19 1 38 3
Age 30-39 40-49 50-59 60-69 70-79 80
Grade 1 0 0 0 0 0 0
Grade 2 1 0 1 1 8 0
Grade 3 0 6 18 9 11 2
Grade 4 0 1 6 11 29 2
Total 1 7 25 21 ¸48 4

16. Overal age of our patients with
cystocele:
• 67,24 years ( range 36 - 84 years )

17. Patients >60 years:
- 75% of all our patients
operated for cystocele

18. Incision of the anterior vaginal wall

19. Far vaginal dissection and
reinforcing of endopelvic fascia

20. Plication of the pubocervical
fascia

21. Complications
• Extent vaginal mucosa granulations
due to the vaginal wall lesion through
rigid monofilament suture ends in 4
patients.

22. Resultsi
Extended anterior vaginal wall
repair for cystocele is a safe
and simple procedure with
good anatomical results and
minimal complications rates.

23. Thank you
for your
attention!