Posterior pelvic floor prolapse and a review of the anatomy, preoperative testing and surgical management

Abstract

The vagina proper extends from the hymen to the cervix and uterus. The anterior wall of the rectum and the posterior vaginal wall are fused for approximately 3 to 4 cm into the vagina. Above this, a plane of dissection is easily created. Plastic repair of the posterior vagina that utilizes ''fascia'' are in fact using the split adventicia and fibromuscular walls of the vagina to support the anterior wall of the rectum. Evaluation of posterior vaginal wall defects requires not only an anatomical description of the prolapse, but also correlation of any functional derangements that may exist. Evaluation may include; defecography, bowel transit studies, manometry, endoluminal ultrasound and magnetic resonance imaging. Surgical correction of posterior vaginal wall prolapse includes vaginal, trans anal and abdominal approaches. Vaginal approaches include site specific repairs and traditional posterior colporrhaphy with levator ani placation. Graft augmentation has been described with both approaches in an effort to improve outcomes and decrease failure rates.