The Experts below are selected from a list of 75 Experts worldwide ranked by ideXlab platform
Todd R. Olson - One of the best experts on this subject based on the ideXlab platform.
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Paravaginal repair of lateral vaginal wall defects by fixation to the ischial periosteum and Obturator membrane.
American Journal of Obstetrics and Gynecology, 1998Co-Authors: Richard J. Scotti, Alan D. Garely, Wilma Markus Greston, Robert F. Flora, Todd R. OlsonAbstract:OBJECTIVE: The aim of the study was to evaluate the anatomic basis, efficacy, and safety of a technique for correcting lateral wall vaginal defects. STUDY DESIGN: Phase I was cadaveric dissection carried out to ascertain the strength and position of structures likely to support lateral vaginal wall defects. The ischial periosteum just anterior to the ischial spine was found to be strong tissue, relatively free of nerves and vessels. In phase II, paravaginal defects were repaired by placing sutures through the arcus tendineus and underlying Obturator Fascia, Obturator membrane, and ischial periosteum. Other defects and urinary incontinence were corrected within the same surgical setting. Forty patients were followed up for an average of 39 months (range 7-52 months). Preoperative evaluation consisted of an extensive history, cough stress test, spontaneous uroflowmetry, postvoid residual urine determination, urethral axis determination, site-specific pelvic floor defect evaluation, and multichannel urodynamic studies. After the operation patients underwent evaluations at 3 months, at 6 months, and then annually. RESULTS: Objective site-specific re-examination of the 40 patients revealed the following recurrences: lateral wall in 1 of 40 procedures, anterior wall in 3 of 35 procedures, posterior wall in 1 of 36 procedures, and apical wall in 1 of 27 procedures. Thirty-four of 36 women (94.4%) with urodynamically confirmed genuine stress incontinence or potential incontinence achieved cure (P
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Paravaginal repair of lateral vaginal wall defects by fixation to the ischial periosteum and Obturator membrane.
American journal of obstetrics and gynecology, 1998Co-Authors: Richard J. Scotti, Alan D. Garely, Wilma Markus Greston, Robert F. Flora, Todd R. OlsonAbstract:The aim of the study was to evaluate the anatomic basis, efficacy, and safety of a technique for correcting lateral wall vaginal defects. Phase I was cadaveric dissection carried out to ascertain the strength and position of structures likely to support lateral vaginal wall defects. The ischial periosteum just anterior to the ischial spine was found to be strong tissue, relatively free of nerves and vessels. In phase II, paravaginal defects were repaired by placing sutures through the arcus tendineus and underlying Obturator Fascia, Obturator membrane, and ischial periosteum. Other defects and urinary incontinence were corrected within the same surgical setting. Forty patients were followed up for an average of 39 months (range 7-52 months). Preoperative evaluation consisted of an extensive history, cough stress test, spontaneous uroflowmetry, postvoid residual urine determination, urethral axis determination, site-specific pelvic floor defect evaluation, and multichannel urodynamic studies. After the operation patients underwent evaluations at 3 months, at 6 months, and then annually. Objective site-specific re-examination of the 40 patients revealed the following recurrences: lateral wall in 1 of 40 procedures, anterior wall in 3 of 35 procedures, posterior wall in 1 of 36 procedures, and apical wall in 1 of 27 procedures. Thirty-four of 36 women (94.4%) with urodynamically confirmed genuine stress incontinence or potential incontinence achieved cure (P <.001). (1) The ischial periosteum and Obturator membrane are consistently strong reattachment sites. (2) Repair of paravaginal defects with these tissues is effective and safe. (3) Urodynamic parameters were unchanged after the operation except for measures of incontinence, which were improved (P <.001). (4) Performing other pelvic procedures did not negatively alter the success rates of paravaginal repair. (5) The urethral axis was favorably altered after the operation (P <.01).
Richard J. Scotti - One of the best experts on this subject based on the ideXlab platform.
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paravaginal repair of lateral vaginal wall defects by fixation to the ischial periosteum and Obturator membrane
American Journal of Obstetrics and Gynecology, 1998Co-Authors: Richard J. Scotti, Alan D. Garely, Robert F. Flora, Wilma Markus Gresto, Todd R OlsoAbstract:OBJECTIVE: The aim of the study was to evaluate the anatomic basis, efficacy, and safety of a technique for correcting lateral wall vaginal defects. STUDY DESIGN: Phase I was cadaveric dissection carried out to ascertain the strength and position of structures likely to support lateral vaginal wall defects. The ischial periosteum just anterior to the ischial spine was found to be strong tissue, relatively free of nerves and vessels. In phase II, paravaginal defects were repaired by placing sutures through the arcus tendineus and underlying Obturator Fascia, Obturator membrane, and ischial periosteum. Other defects and urinary incontinence were corrected within the same surgical setting. Forty patients were followed up for an average of 39 months (range 7-52 months). Preoperative evaluation consisted of an extensive history, cough stress test, spontaneous uroflowmetry, postvoid residual urine determination, urethral axis determination, site-specific pelvic floor defect evaluation, and multichannel urodynamic studies. After the operation patients underwent evaluations at 3 months, at 6 months, and then annually. RESULTS: Objective site-specific re-examination of the 40 patients revealed the following recurrences: lateral wall in 1 of 40 procedures, anterior wall in 3 of 35 procedures, posterior wall in 1 of 36 procedures, and apical wall in 1 of 27 procedures. Thirty-four of 36 women (94.4%) with urodynamically confirmed genuine stress incontinence or potential incontinence achieved cure (P <.001). CONCLUSIONS: (1) The ischial periosteum and Obturator membrane are consistently strong reattachment sites. (2) Repair of paravaginal defects with these tissues is effective and safe. (3) Urodynamic parameters were unchanged after the operation except for measures of incontinence, which were improved (P <.001). (4) Performing other pelvic procedures did not negatively alter the success rates of paravaginal repair. (5) The urethral axis was favorably altered after the operation (P <.01).
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Paravaginal repair of lateral vaginal wall defects by fixation to the ischial periosteum and Obturator membrane.
American Journal of Obstetrics and Gynecology, 1998Co-Authors: Richard J. Scotti, Alan D. Garely, Wilma Markus Greston, Robert F. Flora, Todd R. OlsonAbstract:OBJECTIVE: The aim of the study was to evaluate the anatomic basis, efficacy, and safety of a technique for correcting lateral wall vaginal defects. STUDY DESIGN: Phase I was cadaveric dissection carried out to ascertain the strength and position of structures likely to support lateral vaginal wall defects. The ischial periosteum just anterior to the ischial spine was found to be strong tissue, relatively free of nerves and vessels. In phase II, paravaginal defects were repaired by placing sutures through the arcus tendineus and underlying Obturator Fascia, Obturator membrane, and ischial periosteum. Other defects and urinary incontinence were corrected within the same surgical setting. Forty patients were followed up for an average of 39 months (range 7-52 months). Preoperative evaluation consisted of an extensive history, cough stress test, spontaneous uroflowmetry, postvoid residual urine determination, urethral axis determination, site-specific pelvic floor defect evaluation, and multichannel urodynamic studies. After the operation patients underwent evaluations at 3 months, at 6 months, and then annually. RESULTS: Objective site-specific re-examination of the 40 patients revealed the following recurrences: lateral wall in 1 of 40 procedures, anterior wall in 3 of 35 procedures, posterior wall in 1 of 36 procedures, and apical wall in 1 of 27 procedures. Thirty-four of 36 women (94.4%) with urodynamically confirmed genuine stress incontinence or potential incontinence achieved cure (P
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Paravaginal repair of lateral vaginal wall defects by fixation to the ischial periosteum and Obturator membrane.
American journal of obstetrics and gynecology, 1998Co-Authors: Richard J. Scotti, Alan D. Garely, Wilma Markus Greston, Robert F. Flora, Todd R. OlsonAbstract:The aim of the study was to evaluate the anatomic basis, efficacy, and safety of a technique for correcting lateral wall vaginal defects. Phase I was cadaveric dissection carried out to ascertain the strength and position of structures likely to support lateral vaginal wall defects. The ischial periosteum just anterior to the ischial spine was found to be strong tissue, relatively free of nerves and vessels. In phase II, paravaginal defects were repaired by placing sutures through the arcus tendineus and underlying Obturator Fascia, Obturator membrane, and ischial periosteum. Other defects and urinary incontinence were corrected within the same surgical setting. Forty patients were followed up for an average of 39 months (range 7-52 months). Preoperative evaluation consisted of an extensive history, cough stress test, spontaneous uroflowmetry, postvoid residual urine determination, urethral axis determination, site-specific pelvic floor defect evaluation, and multichannel urodynamic studies. After the operation patients underwent evaluations at 3 months, at 6 months, and then annually. Objective site-specific re-examination of the 40 patients revealed the following recurrences: lateral wall in 1 of 40 procedures, anterior wall in 3 of 35 procedures, posterior wall in 1 of 36 procedures, and apical wall in 1 of 27 procedures. Thirty-four of 36 women (94.4%) with urodynamically confirmed genuine stress incontinence or potential incontinence achieved cure (P <.001). (1) The ischial periosteum and Obturator membrane are consistently strong reattachment sites. (2) Repair of paravaginal defects with these tissues is effective and safe. (3) Urodynamic parameters were unchanged after the operation except for measures of incontinence, which were improved (P <.001). (4) Performing other pelvic procedures did not negatively alter the success rates of paravaginal repair. (5) The urethral axis was favorably altered after the operation (P <.01).
Alan D. Garely - One of the best experts on this subject based on the ideXlab platform.
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paravaginal repair of lateral vaginal wall defects by fixation to the ischial periosteum and Obturator membrane
American Journal of Obstetrics and Gynecology, 1998Co-Authors: Richard J. Scotti, Alan D. Garely, Robert F. Flora, Wilma Markus Gresto, Todd R OlsoAbstract:OBJECTIVE: The aim of the study was to evaluate the anatomic basis, efficacy, and safety of a technique for correcting lateral wall vaginal defects. STUDY DESIGN: Phase I was cadaveric dissection carried out to ascertain the strength and position of structures likely to support lateral vaginal wall defects. The ischial periosteum just anterior to the ischial spine was found to be strong tissue, relatively free of nerves and vessels. In phase II, paravaginal defects were repaired by placing sutures through the arcus tendineus and underlying Obturator Fascia, Obturator membrane, and ischial periosteum. Other defects and urinary incontinence were corrected within the same surgical setting. Forty patients were followed up for an average of 39 months (range 7-52 months). Preoperative evaluation consisted of an extensive history, cough stress test, spontaneous uroflowmetry, postvoid residual urine determination, urethral axis determination, site-specific pelvic floor defect evaluation, and multichannel urodynamic studies. After the operation patients underwent evaluations at 3 months, at 6 months, and then annually. RESULTS: Objective site-specific re-examination of the 40 patients revealed the following recurrences: lateral wall in 1 of 40 procedures, anterior wall in 3 of 35 procedures, posterior wall in 1 of 36 procedures, and apical wall in 1 of 27 procedures. Thirty-four of 36 women (94.4%) with urodynamically confirmed genuine stress incontinence or potential incontinence achieved cure (P <.001). CONCLUSIONS: (1) The ischial periosteum and Obturator membrane are consistently strong reattachment sites. (2) Repair of paravaginal defects with these tissues is effective and safe. (3) Urodynamic parameters were unchanged after the operation except for measures of incontinence, which were improved (P <.001). (4) Performing other pelvic procedures did not negatively alter the success rates of paravaginal repair. (5) The urethral axis was favorably altered after the operation (P <.01).
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Paravaginal repair of lateral vaginal wall defects by fixation to the ischial periosteum and Obturator membrane.
American Journal of Obstetrics and Gynecology, 1998Co-Authors: Richard J. Scotti, Alan D. Garely, Wilma Markus Greston, Robert F. Flora, Todd R. OlsonAbstract:OBJECTIVE: The aim of the study was to evaluate the anatomic basis, efficacy, and safety of a technique for correcting lateral wall vaginal defects. STUDY DESIGN: Phase I was cadaveric dissection carried out to ascertain the strength and position of structures likely to support lateral vaginal wall defects. The ischial periosteum just anterior to the ischial spine was found to be strong tissue, relatively free of nerves and vessels. In phase II, paravaginal defects were repaired by placing sutures through the arcus tendineus and underlying Obturator Fascia, Obturator membrane, and ischial periosteum. Other defects and urinary incontinence were corrected within the same surgical setting. Forty patients were followed up for an average of 39 months (range 7-52 months). Preoperative evaluation consisted of an extensive history, cough stress test, spontaneous uroflowmetry, postvoid residual urine determination, urethral axis determination, site-specific pelvic floor defect evaluation, and multichannel urodynamic studies. After the operation patients underwent evaluations at 3 months, at 6 months, and then annually. RESULTS: Objective site-specific re-examination of the 40 patients revealed the following recurrences: lateral wall in 1 of 40 procedures, anterior wall in 3 of 35 procedures, posterior wall in 1 of 36 procedures, and apical wall in 1 of 27 procedures. Thirty-four of 36 women (94.4%) with urodynamically confirmed genuine stress incontinence or potential incontinence achieved cure (P
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Paravaginal repair of lateral vaginal wall defects by fixation to the ischial periosteum and Obturator membrane.
American journal of obstetrics and gynecology, 1998Co-Authors: Richard J. Scotti, Alan D. Garely, Wilma Markus Greston, Robert F. Flora, Todd R. OlsonAbstract:The aim of the study was to evaluate the anatomic basis, efficacy, and safety of a technique for correcting lateral wall vaginal defects. Phase I was cadaveric dissection carried out to ascertain the strength and position of structures likely to support lateral vaginal wall defects. The ischial periosteum just anterior to the ischial spine was found to be strong tissue, relatively free of nerves and vessels. In phase II, paravaginal defects were repaired by placing sutures through the arcus tendineus and underlying Obturator Fascia, Obturator membrane, and ischial periosteum. Other defects and urinary incontinence were corrected within the same surgical setting. Forty patients were followed up for an average of 39 months (range 7-52 months). Preoperative evaluation consisted of an extensive history, cough stress test, spontaneous uroflowmetry, postvoid residual urine determination, urethral axis determination, site-specific pelvic floor defect evaluation, and multichannel urodynamic studies. After the operation patients underwent evaluations at 3 months, at 6 months, and then annually. Objective site-specific re-examination of the 40 patients revealed the following recurrences: lateral wall in 1 of 40 procedures, anterior wall in 3 of 35 procedures, posterior wall in 1 of 36 procedures, and apical wall in 1 of 27 procedures. Thirty-four of 36 women (94.4%) with urodynamically confirmed genuine stress incontinence or potential incontinence achieved cure (P <.001). (1) The ischial periosteum and Obturator membrane are consistently strong reattachment sites. (2) Repair of paravaginal defects with these tissues is effective and safe. (3) Urodynamic parameters were unchanged after the operation except for measures of incontinence, which were improved (P <.001). (4) Performing other pelvic procedures did not negatively alter the success rates of paravaginal repair. (5) The urethral axis was favorably altered after the operation (P <.01).
Robert F. Flora - One of the best experts on this subject based on the ideXlab platform.
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paravaginal repair of lateral vaginal wall defects by fixation to the ischial periosteum and Obturator membrane
American Journal of Obstetrics and Gynecology, 1998Co-Authors: Richard J. Scotti, Alan D. Garely, Robert F. Flora, Wilma Markus Gresto, Todd R OlsoAbstract:OBJECTIVE: The aim of the study was to evaluate the anatomic basis, efficacy, and safety of a technique for correcting lateral wall vaginal defects. STUDY DESIGN: Phase I was cadaveric dissection carried out to ascertain the strength and position of structures likely to support lateral vaginal wall defects. The ischial periosteum just anterior to the ischial spine was found to be strong tissue, relatively free of nerves and vessels. In phase II, paravaginal defects were repaired by placing sutures through the arcus tendineus and underlying Obturator Fascia, Obturator membrane, and ischial periosteum. Other defects and urinary incontinence were corrected within the same surgical setting. Forty patients were followed up for an average of 39 months (range 7-52 months). Preoperative evaluation consisted of an extensive history, cough stress test, spontaneous uroflowmetry, postvoid residual urine determination, urethral axis determination, site-specific pelvic floor defect evaluation, and multichannel urodynamic studies. After the operation patients underwent evaluations at 3 months, at 6 months, and then annually. RESULTS: Objective site-specific re-examination of the 40 patients revealed the following recurrences: lateral wall in 1 of 40 procedures, anterior wall in 3 of 35 procedures, posterior wall in 1 of 36 procedures, and apical wall in 1 of 27 procedures. Thirty-four of 36 women (94.4%) with urodynamically confirmed genuine stress incontinence or potential incontinence achieved cure (P <.001). CONCLUSIONS: (1) The ischial periosteum and Obturator membrane are consistently strong reattachment sites. (2) Repair of paravaginal defects with these tissues is effective and safe. (3) Urodynamic parameters were unchanged after the operation except for measures of incontinence, which were improved (P <.001). (4) Performing other pelvic procedures did not negatively alter the success rates of paravaginal repair. (5) The urethral axis was favorably altered after the operation (P <.01).
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Paravaginal repair of lateral vaginal wall defects by fixation to the ischial periosteum and Obturator membrane.
American Journal of Obstetrics and Gynecology, 1998Co-Authors: Richard J. Scotti, Alan D. Garely, Wilma Markus Greston, Robert F. Flora, Todd R. OlsonAbstract:OBJECTIVE: The aim of the study was to evaluate the anatomic basis, efficacy, and safety of a technique for correcting lateral wall vaginal defects. STUDY DESIGN: Phase I was cadaveric dissection carried out to ascertain the strength and position of structures likely to support lateral vaginal wall defects. The ischial periosteum just anterior to the ischial spine was found to be strong tissue, relatively free of nerves and vessels. In phase II, paravaginal defects were repaired by placing sutures through the arcus tendineus and underlying Obturator Fascia, Obturator membrane, and ischial periosteum. Other defects and urinary incontinence were corrected within the same surgical setting. Forty patients were followed up for an average of 39 months (range 7-52 months). Preoperative evaluation consisted of an extensive history, cough stress test, spontaneous uroflowmetry, postvoid residual urine determination, urethral axis determination, site-specific pelvic floor defect evaluation, and multichannel urodynamic studies. After the operation patients underwent evaluations at 3 months, at 6 months, and then annually. RESULTS: Objective site-specific re-examination of the 40 patients revealed the following recurrences: lateral wall in 1 of 40 procedures, anterior wall in 3 of 35 procedures, posterior wall in 1 of 36 procedures, and apical wall in 1 of 27 procedures. Thirty-four of 36 women (94.4%) with urodynamically confirmed genuine stress incontinence or potential incontinence achieved cure (P
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Paravaginal repair of lateral vaginal wall defects by fixation to the ischial periosteum and Obturator membrane.
American journal of obstetrics and gynecology, 1998Co-Authors: Richard J. Scotti, Alan D. Garely, Wilma Markus Greston, Robert F. Flora, Todd R. OlsonAbstract:The aim of the study was to evaluate the anatomic basis, efficacy, and safety of a technique for correcting lateral wall vaginal defects. Phase I was cadaveric dissection carried out to ascertain the strength and position of structures likely to support lateral vaginal wall defects. The ischial periosteum just anterior to the ischial spine was found to be strong tissue, relatively free of nerves and vessels. In phase II, paravaginal defects were repaired by placing sutures through the arcus tendineus and underlying Obturator Fascia, Obturator membrane, and ischial periosteum. Other defects and urinary incontinence were corrected within the same surgical setting. Forty patients were followed up for an average of 39 months (range 7-52 months). Preoperative evaluation consisted of an extensive history, cough stress test, spontaneous uroflowmetry, postvoid residual urine determination, urethral axis determination, site-specific pelvic floor defect evaluation, and multichannel urodynamic studies. After the operation patients underwent evaluations at 3 months, at 6 months, and then annually. Objective site-specific re-examination of the 40 patients revealed the following recurrences: lateral wall in 1 of 40 procedures, anterior wall in 3 of 35 procedures, posterior wall in 1 of 36 procedures, and apical wall in 1 of 27 procedures. Thirty-four of 36 women (94.4%) with urodynamically confirmed genuine stress incontinence or potential incontinence achieved cure (P <.001). (1) The ischial periosteum and Obturator membrane are consistently strong reattachment sites. (2) Repair of paravaginal defects with these tissues is effective and safe. (3) Urodynamic parameters were unchanged after the operation except for measures of incontinence, which were improved (P <.001). (4) Performing other pelvic procedures did not negatively alter the success rates of paravaginal repair. (5) The urethral axis was favorably altered after the operation (P <.01).
Larissa V. Rodriguez - One of the best experts on this subject based on the ideXlab platform.
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Transvaginal Paravaginal Native Tissue Anterior Repair Technique: Initial Outcomes.
Urology, 2020Co-Authors: Temitope Rude, Melissa T. Sanford, Jie Cai, Claudia Sevilla, David A. Ginsberg, Larissa V. RodriguezAbstract:Abstract Objective To present the surgical technique and initial outcomes for a novel lattice-work technique, developed to increase the durability of the native tissue repair. Methods/ Materials All patients undergoing transvaginal anterior prolapse repair with a single surgeon with at least 30 days of follow-up were prospectively enrolled starting in 2017. All patients received the same repair (Fig. 1). 2.0 polydioxanone (PDS) sutures are placed at the level of the Obturator Fascia/arcus tendineus distally and proximally on each side. The midline anterior colporrhaphy is performed with 4 2.0 PDS sutures which are then intertwined with the Obturator sutures and tied to form a lattice of sutures to reinforce the cystocele repair and elevate the central defect repair laterally. Clinic notes, objective physical exam, and standardized subjective patient questionnaires (Pelvic Floor Disorders Inventory) were evaluated for patient outcomes. Recurrence was defined anatomically (Pelvic organ prolapse-Q Ba ≥-1) and subjectively (bothersome vaginal bulge). Results There were 109 patients enrolled with a mean follow-up time was 12 months. Over the follow-up period, there were 12 anatomic recurrences (11%). This was not associated with concomitant apical or posterior repair. Mean time to recurrence was 13.9 months. There were no intraoperative complications. Transient urinary retention was the most notable complication (19%, managed conservatively). Rate of de novo stress urinary incontinence was low at 4%. Conclusion This novel lattice-work technique is simple to perform and has excellent short term anatomic outcomes. Transient postoperative retention was observed; however, all cases self-resolved. Further follow-up is ongoing to characterize the long-term durability of this repair.
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Severe cystocele: Optimizing results
Current Urology Reports, 2007Co-Authors: Jennifer T. Anger, Shlomo Raz, Larissa V. RodriguezAbstract:Despite multiple variations in cystocele repair techniques, success rates have been historically low. In this review we summarize strategies to optimize long-term results of vaginally approached cystocele repair for the high-grade defect. Our proposed strategies include addressing prolapse of the vaginal apex (the uterus or the vaginal cuff), using the Obturator Fascia as an anchor for lateral cystocele defect repair, augmenting the repair with loosely woven polypropylene mesh, and placing a midurethral sling.
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transvaginal paravaginal repair of high grade cystocele central and lateral defects with concomitant suburethral sling report of early results outcomes and patient satisfaction with a new technique
Urology, 2005Co-Authors: Larissa V. Rodriguez, Raviender Bukkapatnam, Sovrin M Shah, Shlomo RazAbstract:Baden-Walker classification grade III-IV (pelvic organ prolapse quantification [POP-Q] system stage III-IV) cystocele is associated with a constellation of abnormalities including urethral hypermobility, lateral defect, central defect, and concomitant vault and posterior wall prolapse. We describe a new transvaginal paravaginal technique to correct this group of abnormalities and report on our early results. We prospectively evaluated patients with high-grade cystocele who underwent repair with the new transvaginal paravaginal repair. Preoperative evaluation included history and physical examination, dynamic pelvic magnetic resonance imaging, urodynamics, and symptom questionnaire. All patients first underwent a distal urethral polypropylene sling surgery. After repair of the central defect of the cystocele, a paravaginal repair of the lateral defect was performed by using a circular 5 cm x 5 cm soft polypropylene mesh attached proximally to the sacrouterine/cardinal ligament, distally to the bladder neck, and laterally to the infralevator Obturator Fascia. Postoperative evaluation at 3-month intervals included history and physical examination using the POP-Q system, a voiding dysfunction and incontinence symptom questionnaire, the validated short form of the Urogenital Distress Inventory (UDI-6), a validated global quality-of-life question, and a postvoid residual. We performed the repair in 98 patients with a mean age of 65 years (range, 40 to 86 years). Of these, 26% underwent concomitant vaginal hysterectomy, 45% had enterocele repair, and 94% had rectocele repair. There were 2 complications, including transient ureteral obstruction due to bladder wall hematoma and 1 patient who presented with a recurrent enterocele requiring surgical repair. No patient experienced urinary retention. De novo stress urinary incontinence was seen in 3 patients; de novo urge incontinence was seen in 2 patients. Postoperative POP-Q scores showed 85% of patients with stage 0-I, 13% with stage II, and 2% with stage III anterior vaginal wall prolapse. Of patients with preoperative stress urinary incontinence, 70% reported never experiencing symptoms under any circumstances. Quality of life improved from 4.7 to 1 (P < 0.005). Transvaginal paravaginal repair of grade III-IV cystocele using soft polypropylene mesh fixed to the Obturator Fascia, sacrouterine ligaments, and bladder neck area provides excellent support of the central defect repair as well as repair of the lateral defect. The operation is safe, simple, and outpatient based, and provides excellent anatomic results with minimal complications. Concomitant distal polypropylene sling did not increase the rate of complications and did not compromise results of stress urinary incontinence surgery.
