Impact of Cystocele Classification and Surgical Method on Treatment Outcome - A Defect-Oriented Surgical Treatment for Cystocele

Sep 30, 2026

Cystocele is a common condition that shows high recurrence after conventional native tissue repair. Mesh-based approaches may lower anatomic recurrence but increase complications and face regulatory constraints. This study evaluates a defect-oriented strategy for individualized cystocele repair, testing whether defect type–guided surgery improves outcomes, especially recurrence. A single-center retrospective cohort of 317 women (2019–2020) classifies defects into five groups and tailors surgical techniques accordingly, then measures postoperative outcomes and recurrence during follow-up.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages13

Reading Time33 min

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Abstract

Background/Objectives

Methods

Results

Conclusions

Introduction

Classification systems for pelvic organ prolapse

Level I–III support defects and anterior compartment subtypes

Recurrence after native tissue anterior colporrhaphy

Article Impact of Cystocele Classification and Surgical Method on Treatment Outcome: A Defect-Oriented Surgical Treatment for Cystocele Pawel Szymanowski 1, *, Wioletta Katarzyna Szepieniec 1, Andrzej Kuszka 1 and Esra Bilir 1,2,3 Academic Editor: Eyal Sheiner Received: 9 November 2025 Revised: 7 December 2025 Accepted: 24 December 2025 Published: 26 December 2025 Copyright: © 2025 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license. 1 Department of Gynecology and Urogynecology, Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski Krakow University, Gustawa Herlinga-Grudzi ´nskiego 1, 30-705 Krakow, Poland 2 Department of Gynecologic Oncology, Koç University School of Medicine, Istanbul 34450, Türkiye 3 Department of Gynecology and Obstetrics, University Medical Center Göttingen, 37075 Göttingen, Germany * [Correspondence: pszymanowski@afm.edu.pl](Correspondence: pszymanowski@afm.edu.pl); Tel.: +48-604-607-976 Abstract Background/Objectives: Cystocele remains a prevalent condition with high recurrence rates following conventional native tissue repair. While mesh-based techniques may reduce anatomical recurrence, they are associated with increased complications and regulatory limitations. Our study proposes a defect-oriented approach to cystocele repair to assess whether individualized surgical management based on defect type can improve outcomes, particularly recurrence rates. Methods: A single-center retrospective analysis of 317 women undergoing cystocele repair (2019–2020) was performed. Patients were classified into five groups according to defect type: lateral defect at level II, central defect at level II, apical defect, mixed apical and lateral defects at level II, and mixed apical and central defects at level II. Surgical techniques, including vaginal mesh repair, laparoscopic or pre-peritoneal Richardson repair, sacropexy, lateral suspension, and combined procedures, were tailored to the identified defect. Postoperative outcomes and recurrence rates were assessed during follow-up visits. Results: The most common defect was apical defect at level II (35.6%) followed by lateral defect (32.8%), mixed apical and lateral (17.7%), central (8.5%), and mixed apical and central (5.4%) . The most frequent procedures were vaginal mesh repair (33.8%) and laparoscopic sacropexy (28.7%) . In our cohort, the overall recurrence rate was 6.3%, with the highest recurrence observed in the central defect group (11.1%) and lowest in the mixed apical and lateral defect group (0%) . Conclusions: A defect-oriented classification and individualized surgical approach for cystocele enables effective, durable repair with low recurrence rates. Precise identification of the anatomical defect, rather than the routine use of hysterectomy or mesh, should guide surgical planning to optimize functional and anatomical outcomes. Keywords: cystocele; pelvic organ prolapse; recurrence; sacropexy; apical defect; lateral defect; central defect 1. Introduction Pelvic organ prolapse (POP) remains a significant and growing clinical challenge in the field of urogynecology, owing to demographic shifts and increasing life expectancy. Among its various forms, cystocele constitutes the most frequent anterior compartment prolapse; in the Women’s Health Initiative Hormone Replacement Therapy Clinical Trial (n = 27,342), the prevalence of cystocele was found to be 34.3%[1] . The pathogenesis of POP is complex and multifactorial, encompassing anatomical, genetic, obstetric, and lifestyle-related risk factors including age, parity, weight, and obstetric history [2] . POP can be classified using either the Baden–Walker halfway system, the Pelvic Organ Prolapse Quantification (POP-Q) system, or DeLancey’s three-level system [3–5] . According to the Baden–Walker halfway system, POP is classified

FAQs

What problem does the study address about cystocele treatment outcomes?

Cystocele has high recurrence rates after conventional native tissue repair. The study focuses on improving outcomes by tailoring surgery to the anatomical defect type.

How were patients classified in the study?

Patients were classified into five groups based on defect type, including lateral, central, apical, and mixed apical-and-lateral or apical-and-central defects at level II.

What were the main findings on recurrence rates?

The overall recurrence rate was 6.3%. Recurrence was highest in the central defect group (11.1%) and lowest in the mixed apical and lateral defect group (0%).

What is the proposed rationale for defect-oriented surgical planning?

The approach emphasizes precise identification of the anatomical defect to guide individualized surgical selection, rather than routine reliance on hysterectomy or mesh, aiming to optimize functional and anatomical outcomes.

Sep 30, 2026

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