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Master class: anterior repair redux.

Approximately 1 in 10 women will suffer from bladder prolapse in their lifetime. Moreover, nearly 1 in 3 of the 300,000-400,000 surgeries performed for pelvic floor dysfunction are due to recurrence (Am. J. Obstet. Gynecol. 2005;192:1488-95). The annual cost of ambulatory care of pelvic floor disorders in the United States from 2005 to 2006 was $412 million (Am. J. Obstet. Gynecol. 2010;202: 483.el). Surgical repair of prolapse was the most common inpatient procedure performed in women older than 70 years from 1979 to 2006 (Obstet. Gynecol. 2010;116:926).

Despite the known potential high risk of failure, cystocele repair using the traditional anterior colporrhaphy procedure developed by Kelly a century ago (Kelly plication) remains a popular method of repair.

It would appear that the lack of progress in surgical correction of bladder prolapse has been in part due to the insufficient understanding as to the anatomic defects leading to the bladder prolapse itself.

After reading through this excerpt of the Master Class in Gynecologic Surgery, with the author's firm understanding of anatomy--especially the anatomic concerns associated with bladder prolapse--I believe the repair of the transverse defect caused by the separation of the pubocervical fascia from the pericervical ring championed by Dr. S. Robert Kovac, will prove to be a successful addition to the surgical treatment of bladder prolapse.

Dr. Kovac is very well published on vaginal and gyneurologic surgery. He is emeritus distinguished professor of gynecologic surgery at Emory University, Atlanta.

It is truly a pleasure and honor to welcome Dr. Kovac to this edition of the Master Class in Gynecologic Surgery.

Caption: DR. MILLER


Dr. Miller is clinical associate professor at the University of Illinois at Chicago, immediate past president of the International Society for Gynecologic Endoscopy (, and a past president of the AAGL ( He is a reproductive endocrinologist and minimally invasive gynecologic surgeon in private practice in Naperville, Ill., and Schaumburg, Ill; the director of minimally invasive gynecologic surgery at Advocate Lutheran General Hospital, Park Ridge, Ill; and the medical editor of this column. Dr. Miller said he is a consultant and a speaker's bureau member for Ethicon.

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Title Annotation:GYNECOLOGY; pelvic floor dysfunction
Author:Miller, Charles E.
Publication:OB GYN News
Geographic Code:1USA
Date:Oct 1, 2013
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