Accuracy of clinical assessment of paravaginal defects in women with anterior vaginal wall prolapse

OBJECTIVE: The objective of this study was to determine the accuracy of cli nical assessment of paravaginal defects in women with anterior vaginal wall prolapse. STUDY DESIGN: A retrospective chart review of all women undergoing surgery for anterior vaginal wall prolapse during the years of 1994 to 1996 identif ied operative notes that described the surgical assessment of paravaginal s upport. These surgical findings were compared with the preoperative clinica l assessment. Clinical parameters that predicted poor correlation were iden tified. Statistical analysis used the chi(2) test. RESULTS: One hundred seventeen patients had surgery for anterior vaginal pr olapse. Seventy had documentation of an intraoperative paravaginal support evaluation. Of these. 44 patients had vaginal procedures, and 26 had abdomi nal procedures. All patients had at least stage 2 prolapse before surgery, and all were noted to have excellent pelvic support 4 to 6 weeks after surg ery. The prevalence of paravaginal defects at surgery was 47% on the right and 41% on the left. The sensitivity and negative predictive value for the clinical assessment for paravaginal defects were good on both the right and Left sides, whereas the specificity and positive predictive values were po or. Stage of prolapse, previous hysterectomy, or previous anterior colporrh aphy did not significantly affect the accuracy of the clinical examination in predicting fascial defects. However, previous retropubic urethropexy did significantly decrease the accuracy of the clinical examination in predict ing right paravaginal defects (P < .01) but not left. CONCLUSION: Although preoperative clinical assessment for paravaginal defec ts is useful, it does not substitute for careful intraoperative evaluation for endopelvic fascial defects.