a more successful outcome when mesh or sutures are used for the repair. vaginal thickness increases after estrogen therapy. another review on the surgical management of cystocele describes a more successful treatment that more strongly attaches the ligaments and fascia to the vagina to lift and stabilize it. post surgical complications can develop. the complications following surgical treatment of cystocele are: side effects or reactions to anesthesia bleeding infection painful intercourse urinary incontinence constipation bladder injuries urethral injuries urinary tract infection. vaginal erosion due to mesh after surgery, a woman is instructed to restrict her activities and monitor herself for signs of infection such as an elevated temperature, discharge with a foul odor and consistent pain. clinicians may recommend that sneezing, coughing, and constipation are to be avoided. splinting the abdomen while coughing provides support to an incised area and decreases pain on coughing. this is accomplished by applying gentle pressure to the surgical site for bracing during a cough. recurrent surgery on the pelvic organs may not be due to a failure of the surgery to correct the cystocele. subsequent surgeries can be directly or indirectly relating to the primary surgery. prolapse can occur at a different site in the vagina. further surgery after the initial repair can be to treat complications of mesh displacement, pain, or bleeding. further surgery may be needed to treat incontinence. one goal of surgical treatment is to restore the vagina and other pelvic organs to their anatomically normal positions. this may not be the outcome that is most important to the woman being treated who may only want relief of symptoms and an improvement in her quality of life. the international urogynecological association (iuga) has recommended that the data collected regarding the success of cystocele and pelvic organ repairs include the presence or absence of symptoms, satisfaction and quality of life. other measures of a successful outcome should include perioperative data, such as operative time and hospital stay. standardized healthcare quality of life should be part of the measure of a successful resolution of cystocele. data regarding short- and long-term complications is included in the recommendations of the iuga to better assess the risk–benefit ratio of each procedure. current investigations into the superiority of using biological grafting versus native tissue or surgical mesh indicates that using grafts provides better results. epidemiology a large study found a rate of 29% over the lifetime of a woman. other studies indicate a recurrence rate as low as 3%. in the us, greater than 200,000 surgeries are performed each year for pelvic organ prolapse and 81% of these are to correct cystocele. cystocele occurs most frequently compared to the prolapse of other pelvic organs and structure. cystocele is found to be three times as common as vaginal vault prolapse and twice as often as posterior vaginal wall defects. the incidence of cystocele is around 9 per 100 women-years. the highest incidence of symptoms occurs between ages of 70 and 79 years. based on population growth statistics, the number of women with prolapse will increase by a minimum of 46% by the year 2050 in the us. surgery to correct prolapse after hysterectomy is 3.6 per 1,000 women-years. history the ancient greek method for treating cystocele notable is the mention of cystocele in many older cultures and locations. in 1500 b.c. egyptians wrote about the "falling of the womb". in 400 b.c. a greek physician documented his observations and treatments: "after the patient had been tied to a ladder-like frame, she was tipped upward so that her head was toward the bottom of the frame. the frame was then moved upward and downward more or less rapidly for approximately 3–5 min. as the patient was in an inverted position, it was thought that the prolapsing organs of the genital tract would be returned to their normal position by the force of gravity and the shaking motion." hippocrates had his own theories regarding the cause of prolapse. he thought that recent childbirth, wet feet, 'sexual excesses', exertion, and fatigue may have contributed to the condition. polybus, hippocrates's son-in-law, wrote: "a prolapsed uterus was treated by using local astringent lotions, a natural sponge packed into the vagina, or placement of half a pomegranate in the vagina." in 350 a.d., another practitioner named soranus described his treatments which stated that the pomegranate should be dipped into vinegar before insertion. success could be enhanced if the woman was on bed rest and reduced intake of fluid and food. if the treatment was still not successful, the woman's legs were tied together for three days. in 1521, berengario da carpi performed the first surgical treatment for prolapse. this was to tie a rope around the prolapse, tighten it for two days until it was no longer viable and cut it off. wine, aloe, and honey were then applied to the stump. in the 1700s, a swiss gynecologist, peyer, published a description of a cystocele. he was able to describe and document both cystocele and uterine prolapse. in 1730, halder associated cystocele with childbirth. during this same time, efforts began to standardize the terminology that is still familiar today. in the 1800s, the surgical advancements of anesthesia, suturing, suturing materials and acceptance of joseph lister's theories of antisepsis improved outcomes for women with cystocele. the first surgical techniques were practiced on female cadavers. in 1823, geradin proposed that an incision and resection may provide treatment. in 1830, the first dissection of the vagina was performed by dieffenbach on a living woman. in 1834, mendé proposed that dissecting and repair of the edges of the tissues could be done. in 1859, huguier proposed the amputation of the cervix was going to solve the problem for elongation. in 1866, a method of correcting a cystocele was proposed that resembled current procedures. sim subsequently developed another procedure that did not require the full-thickness dissection of the vaginal wall. in 1888, another method of treating anterior vaginal wall manchester combined an anterior vaginal wall repair with an amputation of the cervix and a perineorrhaphy. in 1909, white noted the high rate of recurrence of cystocele repair. at this time it was proposed that reattaching the vagina to support structures was more successful and resulted in less recurrence. this same proposal was proposed again in 1976 but further studies indicated that the recurrence rate was not better. in 1888, treatments were tried that entered the abdomen to make reattachments. some did not agree with this and suggested an approach through the inguinal canal. in 1898, further abdominal approaches were proposed. no further advances have been noted until 1961 when reattachment of the anterior vaginal wall to cooper's ligament began to be used. unfortunately, posterior vaginal wall prolapse occurred in some patients even though the anterior repair was successful. in 1955, using mesh to support pelvic structures came into use. in 1970, tissue from pigs began to be used to strengthen the anterior vaginal wall in surgery. beginning in 1976, improvement in suturing began along with the surgical removal of the vagina being used to treat prolapse of the bladder. in 1991, assumptions about the detailed anatomy of the pelvic support structures began to be questioned regarding the existence of some pelvic structures and the non-existence of others. more recently, the use of stem cells, robot-assisted laparoscopic surgery are being used to treat cystocele.