Accuracy of Preoperative Assessment of Paravaginal Defects: A Correlation with Intraoperative Findings
Drs.  J. R. Miklos¹, N. Kohli², R. Moore^2
1Northside Hospital
Atlanta, GA
²Harvard Medical School
Cambridge, Massachusetts

Objective:   To determine the accuracy of preoperative clinical assessment of paravaginal defects in women with anterior vaginal wall prolapse. 

Methods: A retrospective chart review of all women undergoing surgery for anterior vaginal wall prolapse between June 1997- March 2001 was performed.   273 patients underwent laparoscopic assessment  with subsequent repair of their anterior vaginal wall prolapse.  Laparoscopic paravaginal repairs were performed for lateral defects and traditional vaginal anterior colporrhaphy for midline defects. Intraoperative findings of paravaginal defects were compared to preoperative clinical assessment. Patients with previous space of Retzius surgery were also identified. 

Results: Of the 273 patients suspected of having lateral defects preoperatively, 246 (90%) were noted to have paravaginal defects on laparoscopic assessment. Intraoperative confirmation of suspected paravaginal defects in patients with previous retropubic anti-incontinence surgery was 62% (21/34) and 93% (223/239) in patients without previous retropubic surgery.  Bilateral defects were identified in 97% of patients.   The sensitivity for clinical assessment was greater than 90%

Conclusion: Preoperative identification of lateral vaginal wall defects has a high correlation and positive predictive value with the intraoperative confirmation of paravaginal defects. Previous retropubic anti incontinence surgery appears to significantly reduce the identification of anterior vaginal wall paravaginal defects.