Paravaginal defects: prevalence and accuracy of preoperative detection.
The objective of this study was to determine the prevalence of paravaginal defects and to report the correlation between diagnosing a paravaginal defect preoperatively and observing the presence of one intraoperatively. This was a prospective study in which 77 patients with at least stage 2 prolapse of the anterior vaginal wall who desired surgical correction of their prolapse were assessed pre- and intraoperatively for the detection of a paravaginal defect. In order to differentiate a midline or central defect from a paravaginal defect, an index finger or ring forceps was placed vaginally toward each ischial spine separately. If the prolapse became reduced, the patient was clinically diagnosed with a paravaginal defect on that side. The intraoperative visualization or palpation of the pubocervical fascia detached from the arcus tendineus fasciae pelvis was used as the gold standard in diagnosing a paravaginal defect. The overall prevalence of a paravaginal defect in patients with at least stage 2 prolapse of the anterior vaginal wall was 37.7%. The sensitivities for detecting a left, right and bilateral paravaginal defect were 47.6, 40.0 and 23.5%, respectively, while the specificities for each side were 71.4, 67.3, and 80.0%, respectively. The overall prevalence of a paravaginal defect in patients with anterior vaginal wall prolapse is low. The standard clinical evaluation used to preoperatively detect a paravaginal defect in our hands is a poor predictor for the actual presence of a paravaginal defect.
Division of Urogynecology and Pelvic Reconstructive Surgery, Good Samaritan Hospital, 375 Dixmyth Avenue, Cincinnati, OH, USA. JeffreySegal@msn.com
Jeffrey L
JL
Segal
Brett J
BJ
Vassallo
Steven D
SD
Kleeman
William A
WA
Silva
Mickey M
MM
Karram
D005260:Female; D005500:Follow-Up Studies; D013509:Gynecologic Surgical Procedures; D006801:Humans; D008875:Middle Aged; D017773:Pelvic Floor / Q000002:abnormalities / Q000601:surgery; D011300:Preoperative Care; D015995:Prevalence; D011446:Prospective Studies; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014596:Uterine Prolapse / Q000175:diagnosis* / Q000601:surgery; D014621:Vagina / Q000002:abnormalities* / Q000601:surgery