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Surgical management of anterior vaginal wall prolapse: an evidencebased literature review

  • Review Article
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Abstract

The aim of this review is to summarize the available literature on surgical management of anterior vaginal wall prolapse. A Medline search from 1966 to 2004 and a hand-search of conference proceedings of the International Continence Society and International Urogynecological Association from 2001 to 2004 were performed. The success rates for the anterior colporrhaphy vary widely between 37 and 100%. Augmentation with absorbable mesh (polyglactin) significantly increases the success rate for anterior vaginal wall prolapse. Abdominal sacrocolpopexy combined with paravaginal repair significantly reduced the risk for further cystocele surgery compared to anterior colporrhaphy and sacrospinous colpopexy. The abdominal and vaginal paravaginal repair have success rates between 76 and 100%, however, no randomized trials have been performed. There is currently no evidence to recommend the routine use of any graft in primary repairs, and possible improved anatomical out-comes have to be tempered againstcomplications including mesh erosions, infections and dyspareunia.

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Author information

Authors and Affiliations

  1. Royal Women’s, Mater and Wesley Hospitals, Level 4 Suite 86 Sandford Jackson Building, 30 Chasely Street Auchenflower, 4066, QLD, Brisbane, Australia

    Christopher Maher & Kaven Baessler

Authors
  1. Christopher Maher
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  2. Kaven Baessler
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Corresponding author

Correspondence to Christopher Maher.

Appendices

Appendix 1

Hierarchy of study types, levels of evidence and grading recommendations

Hierarchy of study types

  • Systematic reviews and meta-analyses of randomised controlled trials

  • Randomised controlled trials

  • Non-randomised intervention studies

  • Observational studies

  • Non-experimental studies

  • Expert opinion

Levels of Evidence

  1. Level 1.

    meta-anaylsis of randomized controlled trials (RCTs) or good quality randomized controlled trial or ‘all or none’ studies in which no treatment is not an option.

  2. Level 2.

    “low” quality RCT (e.g. <80% followup) or meta-analysis (with homogeneity) of prospective ‘cohort studies’ or well conducted case-control studies with a low risk of confounding and bias.

  3. Level 3.

    retrospective ‘case-control studies’ or good quality ‘case series’.

  4. Level 4.

    expert opinion.

The Delphi process can be used to give ‘expert opinion’ greater authority: a series of questions are posed to a panel; the answers are collected into a series of ‘options’ that are serially ranked; if a 75% agreement is reached then a Delphi consensus statement can be made.

Grades of Recommendation

  1. Grade A.

    usually depends on consistent level 1 evidence; can follow from level 2 evidence if there is a large and consistent body of evidence.

  2. Grade B.

    usually depends on consistent level 2 and/or 3 studies or ‘majority evidence’ or extrapolated evidence from randomized controlled trials.

  3. Grade C.

    usually depends on level 4 studies or ‘majority evidence’ or extrapolated evidence from level 2/3 studies or Delphi processed expert opinion.

  4. Grade D.

    “No recommendation possible” if evidence is inadequate or conflicting.

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Maher, C., Baessler, K. Surgical management of anterior vaginal wall prolapse: an evidencebased literature review. Int Urogynecol J 17, 195–201 (2006). https://doi.org/10.1007/s00192-005-1296-3

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