UROGYNECOLOGICAL SURGERY CURRENT APPROACHES AND TREATMENTS FOR INCONTINENCE

Urogynecological_Surgery_Kapak

PARAVAGINAL REPAIR

Hüseyin Kayaalp

Ankara Bilkent City Hospital, Department of Perinatology, Ankara, Türkiye

Kayaalp H. Paravaginal Repair. In: Balsak D, Çim N, Ege S editors. Urogynecological Surgery Current Approaches and Treatments for Incontinence. 1st ed. Ankara: Türkiye Klinikleri; 2025. p.303-310.

ABSTRACT

Paravaginal defect is a pelvic floor disorder characterized by the detachment of the pubocervical fascia from the arcus tendineus fascia pelvis (ATFP), resulting in the loss of lateral support of the anterior vaginal wall. It is a common cause of pelvic organ prolapse (POP), frequently associated with multiple vaginal deliveries, complicated labors, advanced maternal age, postmenopausal connective tissue weakening, and chronic conditions that elevate intra-abdominal pressure, such as persistent coughing, constipation, or heavy lifting. Clinical manifestations are often nonspecific and may include a sensation of vaginal bulging or downward pressure, stress urinary incontinence particularly triggered by coughing or sneezing, pelvic pressure, dyspareunia, and sexual dysfunction. While the diagnosis of paravaginal defect is primarily established through a thorough gynecological examination, imaging modalities such as three-dimensional transperineal ultrasonography and magnetic resonance imaging (MRI) play a valuable role in clarifying the lateral localization of the defect and contributing to surgical planning and procedural success.When conservative management fails to alleviate symptoms, surgical intervention becomes necessary.

This chapter provides a comparative analysis of four different surgical approaches for the treatment of paravaginal defects: laparotomic, vaginal, laparoscopic, and robotic paravaginal repair. Each surgical technique possesses its own distinct advantages and limitations.The laparotomic approach offers direct visualization of pelvic anatomy but has become less favored due to its invasiveness and prolonged recovery time. The vaginal technique is less invasive and can be performed under regional anesthesia, but may have limitations in achieving complete anatomical correction in lateral defects. The laparoscopic method, with reduced tissue trauma and shorter hospitalization, is advantageous but requires advanced surgical expertise. Robotic repair, offering superior ergonomics and three-dimensional visualization, is a technologically advanced option, especially suitable for complex cases.

The choice of surgical technique should be individualized based on patient-specific factors, including age, overall health status, prolapse severity, symptom burden, and the presence of concomitant pelvic pathologies. Fertility desires, sexual activity, and patient preferences also play a significant role. Furthermore, the surgeon’s experience and the available technical resources influence procedural success. As each technique carries unique advantages and limitations, a tailored approach that balances risks and benefits is essential. Ultimately, patient-centered surgical planning aims to restore pelvic anatomy and improve quality of life.

Keywords: Pelvic organ prolapse; Paravaginal defect; Laparotomic paravaginal repair; Vaginal paravaginal repair; Laparoscopic paravaginal repair; Robotic paravaginal repair

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