Current concepts in the diagnosis and surgical repair of anterior vaginal prolapse due to paravaginal defects

Anterior vaginal prolapse is often caused by defects in the paravaginal fas cia. The purpose of this article is to review the current concepts in the d iagnosis and surgical repair of anterior vaginal prolapse due to paravagina l defects. Articles related to paravaginal defects were identified through a MEDLINE search of English-language medical journals published between Jun e 1909 and August 2000. Physical examination is usually used to diagnose pa ravaginal defects, but this method may have low specificity and low positiv e predictive value. Magnetic resonance imaging may be used to examine the p elvic anatomy, but it is expensive and may not be readily available to all physicians. Transabdominal ultrasound does not appear to be useful for dete ction of paravaginal defects. Paravaginal repair, both transvaginal and tra nsabdominal approaches, appears to offer favorable cure rates and low recur rence rates of anterior vaginal prolapse. Paravaginal repair does not appea r to be as effective as Burch colposuspension for treatment of stress urina ry incontinence. The efficacy of laparoscopic paravaginal repair requires a dditional investigation. Complications including voiding dysfunction, hemor rhage, and urinary tract injury are uncommon. The long-term efficacy of par avaginal repair requires further investigation.