title: The long and short of it: anterior vaginal wall length before and after anterior repair.
abstract: OBJECTIVE
  Anterior vaginal wall length (AVL) is on average 6.1 ± 1.3 cm in women with normal support and lengthened in women with cystocele. We hypothesize that AVL is reduced after anterior repair and that women with larger cystoceles will have greater reduction in AVL.
  
  
  METHODS
  Demographic, clinical, and surgical data were collected for women undergoing hysterectomy and anterior repair in whom intraoperative vaginal wall measurements had been made between November 2009 and April 2014. In the operating room, AVL was defined preoperatively as the distance from the hymenal ring to the anterior cervicovaginal junction at the hysterectomy incision site, and postoperatively, from the hymenal ring to the same location on the anterior cuff. During the anterior repair the fibromuscular tissues were plicated using an interrupted technique.
  
  
  RESULTS
  Measurements were available for 40 women. Average age was 61.7 ± 10 years, median parity was 2.5 and median preoperative Pelvic Organ Prolapse Quantification System (POP-Q) point Ba was 3 cm distal to the hymen. On average, AVL was reduced after surgery by 2.5 cm. Mean postoperative AVL was similar to mean AVL in women with normal pelvic support (6.4 ± 0.8 cm vs 6.1 ± 1.3 cm, p = 0.15). Longer preoperative AVLs had greater AVL change (R (2) = 0.78, p = <0.0001).
  
  
  CONCLUSIONS
  In women undergoing anterior repair, mean AVL was reduced by 28 % and returned to the normal range after surgery. These data highlight a rarely discussed effect of anterior repair, which is restoration of normal anterior vaginal wall length.
authors: Department of Obstetrics and Gynecology, University of Michigan, L4000 Women's Hospital, 1500 E. Medical Center Dr., SPC 5276, Ann Arbor, MI, 48109-5276, USA, scarolyn@med.umich.edu.
authors: Carolyn W
authors: CW
authors: Swenson
authors: Angela M
authors: AM
authors: Simmen
authors: Mitchell B
authors: MB
authors: Berger
authors: Daniel M
authors: DM
authors: Morgan
authors: John O
authors: JO
authors: DeLancey
mesh_terms: D000368:Aged; D052858:Cystocele / Q000473:pathology* / Q000601:surgery; D005260:Female; D013509:Gynecologic Surgical Procedures; D006801:Humans; D008875:Middle Aged; D014621:Vagina / Q000033:anatomy & histology* / Q000601:surgery