Cystocele Treatment in Patients with Significant Medical Comorbidities Who Do Not Desire Vaginal Preservation
Clinical Scenario
This protocol addresses cystocele (anterior vaginal wall prolapse) in patients who carry significant medical comorbidities and who do not desire future vaginal intercourse or preservation of vaginal function.
The presence of significant medical comorbidities combined with the patient's preference to forgo vaginal intercourse or preservation defines the surgical decision pathway for this group.
Surgical Approach — Partial Overview
For this patient population, an obliterative surgical procedure is recommended as a first-line surgical treatment. This category of surgery is recognised as effective for pelvic organ prolapse in patients who meet these criteria.
The complete procedure selection, technical approach, and any concurrent interventions are detailed in the full structured protocol.
References
- Obliterative procedures––which narrow, shorten, or completely close the vagina––are effective for the treatment of POP and should be considered a first-line surgical treatment for women with significant medical comorbidities who do not desire future vaginal intercourse or vaginal preservation.
- Common types of obliterative surgical repair of POP include a Le Fort-style partial colpocleisis and total colpectomy.
- With any obliterative procedure, a suburethral plication or midurethral sling and a perineorrhaphy often are recommended to decrease the risk of postoperative stress urinary incontinence and recurrent posterior vaginal wall prolapse.
DOI: 10.1097/AOG.0000000000003519
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