title: Posterior vaginal compartment repairs: Where are the main anatomical defects?
abstract: OBJECTIVE
  Traditionally, it has been believed that posterior vaginal compartment prolapse was largely due to defects in the rectovaginal fascia, with surgical repairs concentrating on addressing this defect. We aimed to determine the relative size of defects at the different vaginal levels (I-III) following a large number of posterior vaginal compartment repairs (PRs) to determine whether this traditional viewpoint is still appropriate.
  
  
  METHODS
  In a cross-sectional study of 300 consecutive PRs, mostly following prior or concomitant hysterectomy, two sets of markers of posterior compartment prolapse were used to measure anatomical defects at levels I-III: (i) from Pelvic Organ Prolapse Quantification (POP-Q) system points C, Ap, Bp, and genital hiatus (GH), and from Posterior Repair Quantification (PR-Q) perineal gap (PG), posterior vaginal-vault descent (PVVD), midvaginal laxity (MVL)-vault undisplaced, and rectovaginal fascial laxity (RVFL).
  
  
  RESULTS
  The largest defects were found at level I (PVVD: mean 6.0 cm; point C, mean minus 0.9 cm), and level III (PG, mean 2.9 cm; GH, mean 3.7 cm). Level II defects (MVL-vault undisplaced, mean 1.3 cm; RVFL, mean 1.1 cm; points Ap, Bp, both mean 1.0 cm) were relatively small.
  
  
  CONCLUSIONS
  This study suggests that the defects found at surgery for posterior vaginal compartment prolapse were more frequent at the vaginal vault (level I) and vaginal introitus (level III) than at midvagina (level II). These findings should have implications for surgical planning.
authors.affiliation: St. Vincent's Clinic, Suite 904, 438 Victoria Street, Darlinghurst, 2010, NSW, Australia. bernard@haylen.co.
authors.forename: Bernard T
authors.initials: BT
authors.lastname: Haylen
authors.affiliation: St. Vincent's Hospital, Darlinghurst, NSW, Australia.
authors.forename: Sushen
authors.initials: S
authors.lastname: Naidoo
authors.affiliation: Kirby Institute, University of New South Wales, Kensington, NSW, Australia.
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Kerr
authors.affiliation: St. Vincent's Hospital, Darlinghurst, NSW, Australia.
authors.forename: Chin H
authors.initials: CH
authors.lastname: Yong
authors.affiliation: Mater Hospital, North Sydney, NSW, Australia.
authors.forename: Warwick
authors.initials: W
authors.lastname: Birrell
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D059925:Anatomic Landmarks; D001837:Body Weights and Measures; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008875:Middle Aged; D056887:Pelvic Organ Prolapse / Q000473:pathology* / Q000601:surgery*; D014621:Vagina / Q000473:pathology* / Q000601:surgery*
keywords: Anatomical defects; Key anatomical indicators (KAI); Pelvic organ prolapse; Posterior Repair Quantification (PR-Q); Posterior vaginal compartment; Prolapse surgery