Indication : Cystocele caused by paravaginal or lateral tear in the fascia
This repair is accomplished by suturing the lateral aspect of the anterior vaginal wall back to its original point of attachment, known as the arcus tendineus fascia pelvis (ATFP) or the “white line.” Re-approximation of the vaginal wall to the fascia overlying the obturator internus muscle will restore the bladder and the urethra to its normal anatomical position. Important points of paravaginal cystocele repair:
On the left is an aerial view of normal anatomy. On the right demonstrates bilateral paravaginal defects. The anterior vaginal wall that supports the bladder tears away from its lateral attachment to the pelvic sidewalls (ie the Arcus Tendineus) resulting in Paravaginal Defects and dropping of the bladder (Cystocele).
Repairing the vagina by utilizing sutures to reattach the fascia back out to the arcus (ie ¬fixing the tears or defects) restores support to the bladder thus removing the cystocele or bladder drop.