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The necessity of operating for cystocele, either with or without plastic operations, of the female genital tract, is not an infrequent occurrence. The unsatisfactory results of operations usually employed, especially in old women with relaxed and dilated vaginal outlets, are frequent. Usually failure is due to stretching of the newly formed cicatrix, or to imperfect attachment when the base of the bladder is anchored to structures above the plane of the anterior vaginal wall.
In the absence of dense fascia in this part of the genital canal the repair of cystocele must depend upon the fixation of soft yielding structures to similar parts, but should be reinforced by ample support from the posterior vaginal wall and perineum, and in certain cases with ventrosuspension or some similar operation. Even then the results are not invariably good. This, with the fact that extensive operations in old women are objectionable, makes an urgent
NOBLE GH. AN OPERATION FOR CYSTOCELE.. JAMA. 1901;XXXVI(14):963-966. doi:10.1001/jama.1901.52470140033001j