The aim of this study is to present a novel approach for a paravaginal defect treatment. Paravaginal defect is a cause of about  6-80% of anterior compartment prolapse. The origin of paravaginal defect is damage of vesicovaginal fascia, which is detached from its attachment to pubic bone. Classical treatment is Richardson operation, nowadays performed laparosopically. The position of the bladder and vaginal wall is corrected by suturing it to arcus tendineus fasciae pelvis. Intraperitoneal approach requires  Trendelenburg position and pneumoperitoneum, and can be difficult to perofrm or risky in patients with comorbidities.
This extraperitoneal  approach can be performed in patients with comorbidities and on obese patients. The main advantages are: not requiring  the pneumoperitoneum and the Trendelenburg position and the avoidance of peritoneal adhesions.

Material and methods: This study presents the results in 27 patients with cystocele caused by a lateral defect pelvic organ prolapse quantification (POP Q) stage II or higher. The procedure was performed with a modified Richardson and Burch 
technique using a preperitoneal approach. Three follow-up examinations were conducted two, six weeks, and six months 
after the operation. A quality of life assessment was conducted before and after surgery using the short form of the PFIQ‐7.

Results: All patients had a POP Q II cystocele and 59% had concomitant stress urinary incontinence, which is a result of level III deffect, according to de Lancey's classification (i.e. pubourethral ligaments).  In all patients cystocele was reduce to asymptomatic POP Q stage I or 0, and urinary incontinence was either reduced or cured. Mean operation time was approximately 80 minutes. In six months 
post-operation follow up, one case of recurrence was noted. The patients’ quality of life revealed a statistical improvement 
from an average of 6.8 points before, to an average of 0.7 points after the operation (p < 0.05) in the PFIQ-7.

The preperitoneal approach when performing paravaginal repair, is highly effective, equally as the intraperoitoneal approach, while avoids numerous perioperational risks. Thus this approach makes it possible to qualify patienst with comorbidities, in wchich classical, intraperitoneal approach would be hazardous or immposiible to perofrm.

Conclusions: Preperitoneal laparoscopic lateral repair is a relatively fast procedure and it is also feasible for obese women 
and for patients with a cardiopulmonary risk. Neither the Trendelenburg position nor the pneumoperitoneum are required. 
Postoperatively, the patients witnessed a reduction of the cystocele and complaints connected with their previous condition, such as urinary incontinence.