Does the reconstruction of the urogenital diaphragm improve the success rate of the anterior colporrhaphy?

Objective: The classical colporrhaphy shows a failure rate up to 60%. The aim of the present study was to assess the reoperation rate of anterior vaginal prolapse after plication of the adventitia of the bladder and after plication of the urogenital diaphragm, respectively. Patients: 11 patients (group A) undergoing plicating of the adventitia of the bladder were compared with 54 patients (group B) undergoing plication of the urogenital diaphragm. Results: Age and POPQ points (Ba, C) did not differ between the groups. Anterior wall repair was the only procedure in 6 patients of group A and 16 patients of group B. In the other patients of both groups anterior wall repair was combined with other pelvic floor procedures. No complication was recognized in group A (0/11). In group B one abscess occurred after posterior wall repair. All other complications of this group were related to the diaphragm procedure (7/54, p=0.203). In 2 cases intraoperative injuries of the bladder have happened. Postoperatively, 3 patients needed temporary catheterization due to urinary retention and 2 patients presented with ureteral obstruction, one mild unilateral and another severe one bilateral, requiring temporary nephrostomy. Until February 2008 the overall reoperation rate of cystocele was 6%. All descents were beyond the hymen (Ba +1 to +4 cm). 3/11 patients of group A and 1/54 patients of group B underwent recurrent surgery (p=0.002). Conclusion: The success rate of anterior colporrhaphy might be improved by reconstruction of the more solid diaphragm in primary treatment as opposed to the plication of the weak bladder adventitia. However, attention should be payed referring to the potential severe complications, first of all ureteral obstruction.

pelvic floor disorder - anterior colporrhaphy - urogenital diaphragm - recurrence of cystocele