Int Urogynecol J (2008) 19:1267–1270 prolapsed in women who met criteria for objective failure (Ba −1 + 1 versus −2.5+ 0.7, P< .0005 and Bp −1.6+ 1 versus −2 +1, P= .038), the difference in point Bp was not clinically significant. No other postoperative or baseline POPQ points were significantly different between cure groups. There were no significant differences in objective cure or overall POPQ stage at 1 year in women who did and did not have a concomitant continence procedure (p = .992 and p =.762, respectively). Both anterior vaginal wall POPQ points were significantly more prolapsed in women who did not undergo a concomitant continence procedure when compared to those who had a Burch or sling (Aa: −1.6+ 1 versus −2.2 +1.1, P= .02; and Ba: −1.6 + 1 versus −2.1 + 1.4, P=.03). Posterior vaginal wall POPQ points were not different in women who did and did not undergo continence procedures (P= .43 and P=.31). Discussion Our data indicate that SC without concomitant posterior repair or perineorrhaphy restores posterior compartment topography in most women. While 61% of women had ≥stage II posterior compartment POP prior to SC, only 8% had ≥stage II posterior POP 1 year after SC without concomitant posterior repair or perineorrhaphy. Only one woman chose reoperation for posterior POP. Our posterior vaginal compartment recurrent or persistent POP rates after SC alone are consistent with those reported after SC and selective posterior repair or perineorrhaphy. Benson et al. reported anatomic outcomes in 38 women who underwent SC with selective posterior compartment repairs as part of a randomized trial of abdominal versus vaginal POP surgery [8]. Sixty-five percent of women had posterior colporrha- phy in addition to SC with two women requiring reoperation for posterior compartment POP at a mean of 22 months after surgery. Similarly, Culligan et al. [17] reported POPQ outcomes for 245 women who had SC with selective concomitant procedures; 25% had concomitant posterior repairs or perineorrhaphies. By 1 year, 6% of subjects had ≥stage II posterior compartment prolapse, similar to 8% in our patients. Maher et al. [10] had similar results in women with vault POP at or beyond the introitus who underwent SC. Seventy-four percent also had a grade II rectocele, and 23% underwent concomitant posterior repair. Postoperatively, 17% had a persistent grade II rectocele. There may be disadvantages to performing concomitant posterior repair. Dyspareunia rates after traditional posterior colporrhaphy have been reported to be as high as 21% [18, 19], although de novo dyspareunia rates after site-specific posterior repair are lower ranging from 1–7% [13, 14]. Most studies are limited by multiple POP procedures being 1269 done, concomitantly making it difficult to determine the precise etiology for new symptoms. However, given the lack of clear advantage to concomitant posterior repair or perineorrhaphy at the time of SC, surgeons should perform these additional procedures judiciously. Genital hiatus size is thought to contribute to posterior compartment symptoms and reflect perineal descent [11, 20]. In a cohort of women with POP, Fialkow et al. [20] found the only difference between women with and without posterior compartment symptoms was genital hiatus size; women with posterior symptoms had a genital hiatus larger than 3 cm, resulting in perineal descent of more than 2 cm. Other investigators have shown a decrease in genital hiatus size of 1–1.5 cm after SC with selective posterior repair and perineorrhaphy without a significant change in perineal body size [11, 17]. They hypothesize that this reflects restoration of perineal descent and may be associated with improvement in posterior compartment symptoms [11]. Our patients had a similar decrease in genital hiatus size without a significant increase in perineal body size without concomitant posterior repair or perineorrhaphy further questioning the benefit of additional posterior vaginal wall repair at the time of SC. We did not collect symptom or quality of life data on women in this cohort as our primary question was simply to address vaginal anatomy, so we cannot comment on the posterior compartment symptomatic improvement after SC alone. The relationship between posterior vaginal compart- ment anatomic defects and posterior compartment symp- toms, such as splinting, straining, constipation, and incomplete evacuation remains unclear. Multiple studies have not found a significant association between posterior compartment anatomy and most bowel symptoms [3, 21, 22]. However, others have reported that difficulty with evacuation [20], splinting [20], and constipation [23] are more common in women with POP. The role of concomitant posterior repair and perineor- rhaphy at the time of apical repair warrants further investiga- tion with randomized trials. Case-series data indicate that posterior topography improves after SC similarly when posterior repairs and perineorrhaphies are done selectively or not at all. Women undergoing SC can be counseled that a discrete posterior vaginal operation is not always necessary for restoration of posterior vaginal topography. Conflicts of interest None. Open Access This article is distributed under the terms of the Creative Commons Attribution Noncommercial License which per- mits any noncommercial use, distribution, and reproduction in any medium, provided the original author(s) and source are credited.