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

## TL;DR

This study shows that tailoring cystocele surgery to specific anatomical defects can significantly reduce recurrence rates.

## Contribution

The novel defect-oriented classification system for cystocele repair is shown to improve surgical outcomes.

## Key findings

- The defect-oriented approach achieved a 0% recurrence rate in mixed apical and lateral defect cases.
- Central defect repairs had the highest recurrence rate at 11.1%.
- Vaginal mesh repair and laparoscopic sacropexy were the most commonly used procedures.

## 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.