Modified 4-defect Repair of Cystocele

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Abstract

PURPOSE: The 4-defect repair of cystocele is widely used to correct discreteness and deficiencies of vesicourethral support. We support. We modified this technique this technique that used during pelvic recon struction in 15 women.
MATERIALS AND METHODS
For 2 years 15 patients (age range: 46 to 81 years) had undergone cystocele repair using the modified 4-defect repair technique. All patients received physical and radiologic examination, and urodynamic study. There was 3 patients with type I stress urinary incontinence in urodynamic study. Transvaginal hysterectomy had been performed in 10 patients (66.7%) with uterine prolapse and sacrocolpopexy had been performed in 3 patients (20.0%) with vaginal stump prolapse. a Kelly type plication was used in the anterior vaginal wall to suspend the bladder neck and proximal urethral. Vertical midline incision was made in anterior vaginal wall over cystocele to make an entry into the retropubic area, and the urethropelvic ligament, cardinal ligament and perivesical fascia were exposed. Repair of central defect was achieved by approximation and suspension of the cardinal ligaments over 1-0 polypropylene sutures and midline plication of the perivesical fascia.
RESULTS
A total of 15 patients was available to followup for more tan 6 months. Repair of grade IV cystocele was accompanied by other transvaginal repair in 8 patients (53.3%). 6 patients had grade III cystoceles and only 1 patient ha d grade II cystocele. Although there were some mild complications, many patients satisfied with their relief of symptoms after operation. Of the patients urinary tract infection was detected in 5 (33.35), lower abdominal discomfort in 4 (26.7%), dysuria in 2 (13.3), urgency in 1 and frequency in 1. These complications were improved with conservative management. One patient required loosening of tied polypropylene due to acute urinary retention, and she was improved also. All patients were continent and there was no descent of anterior vaginal wall at the time of followup.
CONCLUSIONS
This modified 4-defect repair with Kelly plication was effective for reduction of the cystocele.