Trapezoid concept of the support of the anterior vaginal wall. Lateral view of normal anterior vaginal wall support with bladder support extending back to the level of the ischial spines. 54–6).įIGURE 54–1 Two views of normal and abnormal support of the anterior vaginal wall. Anterior vaginal wall prolapse, especially in the posthysterectomy patient, may be commonly associated with an apical enterocele, or more rarely a true anterior enterocele ( Fig. The midline defect is what has been previously described as a distention-type cystocele the paravaginal defect, which is a separation of the normal attachment of the connective tissue of the vagina at the arcus tendineus fascia pelvis (white line) and the transverse defect, which occurs when the pubocervical fascia separates from its insertion around the cervix or at the apex ( Figs. More recently, three distinct defects have been described that can result in anterior vaginal wall prolapse. Distention cystocele was thought to result from overstretching and attenuation of the anterior vaginal wall, and displacement cystocele was attributed to pathologic detachment or elongation of the anterior lateral vaginal supports to the arcus tendineus fascia pelvis. Until recently, two types of anterior vaginal wall prolapse were described: distention and displacement cystocele. The cause of anterior vaginal wall prolapse is not completely understood but is probably multifactorial, with different factors implicated in individual patients. Karram Anterior Vaginal Wall ProlapseĪnterior vaginal wall prolapse, or cystocele, is defined as pathologic descent of the anterior vaginal wall and overlying bladder base. Vaginal Repair of Cystocele, Rectocele, and Enterocele
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