TRANSVAGINAL CORRECTION OF PELVIC PROLAPSE

Pelvic prolapse has a myriad of clinical manifestations ranging from u rethral incontinence to total vault prolapse. The evaluation and treat ment of these conditions is facilitated by dividing them into three an atomic regions. Anterior vaginal wall prolapse is the most common type and includes simple urethral hypermobility as well as severe cystocel e. Surgical treatment includes the modified anterior vaginal wall slin g, six-corner bladder neck suspension, and formal cystocele repair. Po sterior vaginal wall prolapse, manifested by rectocele and perineal re laxation, is corrected by plication of the prerectal and pararectal fa scia, reconstruction of the levator hiatus, and repair of the perineal body. Vault prolapse includes enterocele, uterine prolapse, and gener alized vault prolapse. The choice of treatment depends on the presence of anterior vaginal wall prolapse, the degree of vault prolapse, and the patient's desire to remain sexually active. It is important to rem ember that urethral incontinence is only one manifestation of pelvic p rolapse, and must be treated in conjunction with other prolapse to avo id recurrence or poor results.