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Oral Presentations The graft was placed without the traditional midline plication of the pubocervical fascia. Measurements and Main Results: Pre-operatively, all patients showed evidence of stage II prolapse or greater. A total of 30 patients underwent transvaginal repair with porcine dermis graft fixation. Postoperatively, 27 patients (90%) had no recurrent cystocele prolapse and 3 patients (10%) had recurrent cystocele, all with stage II recurrence (Ba 0). Two of the three patients with recurrent cystoceles had pre-operative stage IV cystoceles. In addition, one patient developed a new onset symptomatic rectocele one year later. The follow up ranged from 10 –36 months, with a mean follow up of 19.4 months. The complication rate was 10%. All three complications involved postoperative granulation tissue formation secondary to erosion of the braided permanent suture knots through the anterior vaginal compartment. There were no intraoperative complications and there was no occurrence of vaginal wound separations or graft erosions. Conclusion: The surgical technique of transvaginal cystocele repair using porcine dermal graft is a safe, efficacious, and durable alternative in the management of advanced anterior compartment defects. The use of braided permanent suture should be avoided in graft fixation.

S73 patients was 36 years, ranging from 20 to 60 years. In 92 patients, the laparoscopic procedure revealed that 87 (95%) had gynecologic pathology. Among these, endometriosis was found to be the most common with 81 (88%) patients. Laparoscopic evaluation revealed that 34 (38%) of the patients had bladder serosal involvement with endometriosis in addition to endometriosis of the other pelvic organs. In 26 (28%), cystoscopy revealed interstitial cystitis. In further subgroup analysis, 24 of the 26 (92%) patients had endometriosis. Bladder serosal involvement with endometriosis was positive in 7 (27%) of the patients diagnosed with interstitial cystitis. Conclusion: Although endometriosis was the most frequent pathology in our patient population, interstitial cystitis was a significant finding in patients with chronic pelvic pain and urinary symptoms, not simply manifestations of the same disorder. Therefore, if might be helpful to further evaluate the bladder of patients presenting with chronic pelvic pain and urinary symptoms. FRIDAY, NOVEMBER 11, 2005 (4:33 PM– 4:39 PM) Open Communications 8 —Urogynecology 178

FRIDAY, NOVEMBER 11, 2005 (4:27 PM– 4:33 PM) Open Communications 8 —Urogynecology 177 Interstitial Cystitis in the Setting of Chronic Pelvic Pain Syndrome Shahmohamady B, Berker B, LaShay N, Saberi N, Kazerooni T, Nezhat C. Palo Alto, California Study Objective: To elucidate the presence of interstitial cystitis in patients with chronic pelvic pain and urinary symptoms. Design: Retrospective chart review. Setting: Center for special minimally invasive surgery Stanford university medical center. Patients: Ninety-two patients with chronic pelvic pain and urinary symptoms were included in this study. Patients with positive urine analysis or congenital anatomical disorders or medical conditions predisposing to urinary symptoms were excluded from the study. All the patients underwent diagnostic laparoscopy and cystoscopy for the evaluation and workup of their complaints. After the completion of the endoscopic procedure, the bladder was evaluated for evidence of interstitial cystitis by cystoscopy. If interstitial cystitis was diagnosed, treatment included hydrodistention for 10 minutes’ duration. Intervention: The bladder was evaluated for evidence of interstitial cystitis by cystoscopy. If interstitial cystitis was diagnosed, treatment included hydrodistention for 10 minutes’ duration. Measurements and Main Results: The mean age of the

Laparoscopic Site-Specific Repair of Pelvic Floor Defects Jain N. Vardhman Infertility & Endoscopy Centre, Muzaffar, Nagar, U.P., India Study Objective: To study the efficacy of laparoscopic management of significant utero vaginal prolapse and posthysterectomy vault prolapse (POP). Design: Retrospective analysis of 105 cases of pelvic organ prolapse done over the three years. Setting: Tertiary care referral centre for advanced laparoscopic surgery. Patients: Thirty-five cases of post hysterectomy vault prolapse and other 70 cases were various grades of prolapse. Intervention: Site specific repair employing permanent sutures was done. Endopelvic fascia along with levator ani muscles form the main support of the pelvic organs. Cullen Richardson pointed out that prolapse was not caused by stretching of the supports of the pelvic organs but by breaks in the endopelvic fascia. These breaks usually occurred at the attachment of endo pelvic fascia to arcus tendines white line. These defects can be readily identified and repaired judiciously using the laparoscopic route. Non-absorbable suture materials are used to approximate the torn rectovaginal septum. Interrupted suture are placed from arcus tendinus ligament to recto vaginal septum. Stitches are passed through utero sacral ligament then anteriorly through pubocervical fascia, then posteriorly through the RV septum and then back to uterosacral ligament. Thus fixation of vagina or vaginal vault to the proximal ends of utero sacral ligaments at level of pericervical ring is carried out. Vault prolapse