INCIDENCE OF RECURRENT CYSTOCELE AFTER ANTERIOR COLPORRHAPHY WITH ANDWITHOUT CONCOMITANT TRANSVAGINAL NEEDLE SUSPENSION

OBJECTIVE: Our purpose was to compare the recurrent cystocele rate aft er anterior colporrhaphy versus anterior colporrhaphy performed in con junction with transvaginal needle bladder neck suspension. STUDY DESIG N: A retrospective chart review of all patients undergoing anterior co lporrhaphy with and without needle bladder neck suspension over a 3-ye ar period was conducted. Preoperatively all patients had symptomatic a nterior vaginal wall relaxation. Patients undergoing concomitant needl e suspension procedures had genuine stress incontinence. Twenty-seven patients underwent anterior colporrhaphy alone, and 40 patients underw ent anterior colporrhaphy with needle suspension. Demographic data inc luding age, parity, menopausal status, and use of estrogen replacement was collected for each group, The recurrence rate of anterior vaginal wall relaxation was determined for each group by reviewing standardiz ed postoperative office notes. RESULTS: There was no significant diffe rence in the duration of follow-up between the two groups (13.2 months in the anterior repair group vs 13 months in the anterior repair-need le suspension group). However, a significant difference in recurrent c ystocele rates was found between the two groups (7% [2/27] in the ante rior repair group compared with 33%[13/40] in the anterior repair-need le suspension group, p < 0.01). CONCLUSION: The incidence of recurrent cystocele is significantly higher after anterior colporrhaphy with co ncomitant needle bladder neck suspension compared with anterior colpor rhaphy alone. This difference may be related to the vaginal retropubic dissection at the time of transvaginal needle bladder neck suspension resulting in an iatrogenic paravaginal defect or denervation of the a nterior vaginal wall.