Single Best Answer (SBA) · Pelvic Organ Prolapse
A woman with a symptomatic anterior vaginal wall prolapse (cystocele) and stress urinary symptoms is planned for surgical repair of the anterior compartment defect. Which procedure specifically addresses a cystocele?
Show answer and explanation
Answer: C. Anterior colporrhaphy
Matching the repair to the compartment
Prolapse repair is compartment- and site-specific. A cystocele is a defect of the anterior vaginal wall (bladder base descending), so the repair targets the anterior compartment.
The defects and their repairs
| Compartment | Defect | Repair |
|---|---|---|
| Anterior | Cystocele (upper) / urethrocele (lower) | Anterior colporrhaphy |
| Posterior | Rectocele / enterocele | Posterior colpoperineorrhaphy |
| Apical | Uterine / vault prolapse | Vaginal hysterectomy, sacrospinous fixation, sacrocolpopexy, uterosacral suspension |
Anterior wall terminology
- Upper anterior wall + bladder base = cystocele.
- Lower anterior wall + urethra = urethrocele.
- Both together = cysto-urethrocele.
Why the others are wrong compartment
Posterior colpoperineorrhaphy repairs a rectocele; sacrospinous fixation, McCall culdoplasty and sacrocolpopexy address apical/vault support - none specifically repairs a cystocele. A common exam trap states 'cystocele is treated with posterior colpoperineorrhaphy,' which is false (that treats a rectocele).
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