Objective: :To analyze the literature on the role of paravaginal defects in pathophysiology and management of stress urinary incontinence and to formulate an idea on the management according to the underlying pathophysiology in each individual patient with stress urinary incontinence.
Materials and Methods: :This is a clinical review of literature on paravaginal defects. A medline search was performed using the Medical Subject Headings (MeSH) terms “Paravaginal defect”, “stress urinary incontinence”, and “Colposuspension”. Literature from the year 1990 to 2010 is reviewed. Anatomical, clinical, imaging and surgical evidences for the existence and role of paravaginal defects is summarized and analyzed. Role of colposuspension in correcting paravaginal defects and stress urinary incontinence is discussed.
Results: :Paravaginal defects are real entities and play an important role in the patho-physiology of stress urinary incontinence. Current clinical practice ignores the anatomical causes underlying the causation of stress urinary incontinence and instead the use of a single procedure (in most cases mid-urethral slings) for all women with stress incontinence is becoming a trend.
Conclusion: :Evaluation of a woman with stress urinary incontinence should include searching for possible underlying causes (anatomical and functional) and management should be based accordingly. In the presence of paravaginal defect, a colposuspension will be a better management option. Urethral hypermobility (or a hypotonic urethra) in the absence of a paravaginal defect may be treated with mid-urethral slings.
Corresponding Author: ECKHARD P.|