The anterior vaginal wall is the most common site of repair compared with apex and posterior vaginal wall, and is also the site with the highest recurrence rate after surgery. The aim of this study was to evaluate the anatomical location of apex in patients with cystocele staged 2-3 (POP-Q), to correct all anatomical defects and to improve cystocele repair results.

This was a single-center prospective study of women with cystocele of stage 2-3 with and without apical prolapse who underwent combined surgical treatment. The authors performed combined surgical procedures in women with apical prolapse, including pectopexy. Clinical and anatomical follow-ups were carried out at least in 12 months.

All patients revealed good to excellent results, with a high rate of satisfaction. There were no significant differences in recurrence among women with and without apical prolapse. Of the 22 women after pectopexy, the only one had apical prolapse of grade 1. The median cystocele recurrence rate was 3.8% in group without apical prolapse (grade 1), and 4.5% (grade 1) in pectopexy group. Sexual matters, incontinence score and QoL were significantly improved in both groups. The main reason for cystocele low recurrence rate is defect-oriented multicompartment strategy in all cases including patients with and without apical defect.

Pectopexy can be a good choice for prolapse surgery, including the positive effect in cases of lateral anterior wall defect. Using this strategy, it becomes possible to perform native tissue vaginal repair with encouraged long-term follow-ups.