Peer-reviewed veterinary case report
How cystocele type and surgery affect repair success
By Szymanowski P et al.·2025·Department of Gynecology and Urogynecology·View original on Europe PMC →
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Original publication title: Impact of Cystocele Classification and Surgical Method on Treatment Outcome: A Defect-Oriented Surgical Treatment for Cystocele.
Plain-English summary
Cystocele is a condition where the bladder bulges into the vagina, and it can often come back after surgery. This study looked at how different types of cystocele defects affect the success of surgery. Researchers analyzed the records of 317 women who had surgery for cystocele and found that the most common type was an apical defect, where the bladder drops down at the top of the vagina. They used various surgical methods tailored to the specific type of defect, and overall, only 6.3% of the women had their cystocele come back after surgery. The results suggest that using a personalized approach based on the type of defect can lead to better long-term outcomes.
Abstract
<b>Background/Objectives:</b> Cystocele remains a prevalent condition with high recurrence rates following conventional native tissue repair. While mesh-based techniques may reduce anatomical recurrence, they are associated with increased complications and regulatory limitations. Our study proposes a defect-oriented approach to cystocele repair to assess whether individualized surgical management based on defect type can improve outcomes, particularly recurrence rates. <b>Methods:</b> A single-center retrospective analysis of 317 women undergoing cystocele repair (2019-2020) was performed. Patients were classified into five groups according to defect type: lateral defect at level II, central defect at level II, apical defect, mixed apical and lateral defects at level II, and mixed apical and central defects at level II. Surgical techniques, including vaginal mesh repair, laparoscopic or pre-peritoneal Richardson repair, sacropexy, lateral suspension, and combined procedures, were tailored to the identified defect. Postoperative outcomes and recurrence rates were assessed during follow-up visits. <b>Results:</b> The most common defect was apical defect at level II (35.6%) followed by lateral defect (32.8%), mixed apical and lateral (17.7%), central (8.5%), and mixed apical and central (5.4%). The most frequent procedures were vaginal mesh repair (33.8%) and laparoscopic sacropexy (28.7%). In our cohort, the overall recurrence rate was 6.3%, with the highest recurrence observed in the central defect group (11.1%) and lowest in the mixed apical and lateral defect group (0%). <b>Conclusions:</b> A defect-oriented classification and individualized surgical approach for cystocele enables effective, durable repair with low recurrence rates. Precise identification of the anatomical defect, rather than the routine use of hysterectomy or mesh, should guide surgical planning to optimize functional and anatomical outcomes.
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Search related cases →Original publication on Europe PMC: https://europepmc.org/article/MED/41517450