As our population ages, pelvic organ prolapse is becoming more common. A woman’s lifetime risk of surgery for pelvic organ prolapse is at least 11.1%, and almost one in three will need repair for recurrent prolapse. Traditional repair for anterior vaginal wall prolapse has a high failure/recurrence rate of 40% to 60% and these techniques are based on surgical knowledge from a century ago. Back then the goal of pelvic organ prolapse surgery was to reduce the bulge, not correct the cause of prolapse. According to a questionnaire by the American Urogynecology Society, 80% of urogynecologists still perform this 100 year-old technique with its dismal current rates.
Why is anterior vaginal wall prolapse repair so difficult? Perhaps midline defects and paravaginal defect repairs are not the real cause of anterior vaginal wall prolapsed? If not, why the high failure rates of midline plication and paravaginal repairs? Of the 300,000- 400,000 pelvic organ prolapse surgeries performed annually in the United States, 30% to 40% are for recurrences and 60% occur at the same site. This is the Achilles’ heel.
This also brings up some questions: (1) Is traditional anterior colporrhaphy (midline plication) the “gold standard” for repair of the prolapsed anterior vaginal wall as some academics propose? (2) Is prolapse of the anterior vaginal wall a true hernia as Richardson suggested? (3) How and where does vaginal birth cause vaginal defects?
Robert Kovac S (2013) The Achilles’ Heel of Pelvic Reconstructive Surgery. Gynecol Obstet 3:e111. doi: 10.4172/2161-0932.1000e111