Paravaginal Repair

Paravaginal herniation is commonly associated with urinary incontinence. The defect is suspected on pelvic exam when, on the Valsalva maneuver, the lateral sulcus bulges out, causing a cystocele with prominent vaginal rugae. The diagnosis is confirmed if both lateral sulci are supported and, on maximal Valsalva, the cystocele is no longer present. The defect can be unilateral or bilateral (33,107). It is caused by the tearing away of the pubocervical fascia from the arcus white line. The defect can be complete from the ischial spine to the pubic bone or partial, usually starting in the proximal portion. To start the repair, the pelvic floor is elevated with the vaginal hand and the bladder is mobilized medially. Interrupted permanent sutures are placed through the torn edge of the pubocervical fascia and then through the arcus white line. The first suture is placed proximally just above the ischial spine with the obturator canal directly above. Interrupted sutures are continued distally until the defect is closed, usually requiring four to six sutures. The paravaginal repair is done before performing the Burch procedure.

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