Anterior vaginal wall repair

Description

This procedure may be done while you are under general or spinal anesthesia. Under general anesthesia, you will be asleep and unable to feel pain. With spinal anesthesia, you will be awake, but you will be numb from the waist down and you will not feel pain.

You will be given medicines to help you relax.

Usually, a surgical cut is made through the front wall of your vagina.

• Your bladder is moved back to its normal location.
• Your vagina wall may be folded, or part of it may be cut away.
• Sutures (stitches) are made in the tissue between your vagina and bladder. These will hold the walls of your vagina in the correct position.
• Your doctor may place human-made (synthetic) material between your bladder and vagina.
• If needed, sutures will attach the walls of the vagina to the tissue on the side of your pelvis.

Sometimes, your doctor will also make a surgical cut in your belly. This cut may be up and down or across.

Why the Procedure is Performed

This procedure is used to repair sinking of the vaginal wall (prolapse) or bulging that occurs when the bladder or urethra sink into the vagina.

Symptoms of prolapse include:

• You may not be able to empty your bladder completely.
• Your bladder may feel full all the time.
• You may feel pressure in your vagina.
• You may be able to feel or see a bulging at the opening of the vagina.
• You may have pain when you have sex.
• You may leak urine when you cough, sneeze, or lift something.
• You may get bladder infections.

This surgery by itself does not treat stress incontinence (leaking urine when you cough, sneeze, or lift). It may be performed along with other surgeries.

Before doing this surgery, your health care provider may have you learn pelvic floor muscle exercises (Kegel exercises), use estrogen cream in your vagina, or try a device called a pessary in your vagina to hold up the prolapse.

Risks

Risks for any surgery are:

• Infection at the site of the surgical cut
• Opening of the surgical cut
• Another prolapse
• Blood clots in the legs that may travel to the lungs
• Breathing problems
• Bleeding
• Other infection

Risks for this surgery are:

• Damage to the urethra, bladder, or vagina
• Irritable bladder
• Changes in the vagina (prolapsed vagina)
• Urine leakage from the vagina or to the skin (fistula)

Before the Procedure

Always tell your health care provider or nurse what drugs you are taking, even drugs, supplements, or herbs you bought without a prescription.

During the days before the surgery:

• You may be asked to stop taking aspirin, ibuprofen (Advil, Motrin), warfarin (Coumadin), and any other drugs that make it hard for your blood to clot.
• Ask your health care provider which drugs you should still take on the day of your surgery.

On the day of your surgery:

• You will usually be asked not to drink or eat anything for 6 - 12 hours before the surgery.
• Take the drugs your health care provider told you to take with a small sip of water.
• Your health care provider or nurse will tell you when to arrive at the hospital.

After the Procedure

You may have a catheter to drain urine for 1 or 2 days after surgery.

You will be on a liquid diet right after surgery. When your normal bowel function returns, you can return to your regular diet.

Outlook (Prognosis)

This surgery will usually repair the prolapse and the symptoms will go away. This improvement will often last for years.

Alternative Names

A/P repair; Vaginal wall repair; Anterior and/or posterior vaginal wall repair; Colporrhaphy - repair of vaginal wall; Cystocele repair

References

Winters JC, Togami JM, Chermansky CJ. Vaginal and abdominal reconstructive surgery for pelvic organ prolapse. In: Wein AJ, ed. Campbell-Walsh Urology. 10th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 72.

Maher CM, Feiner B, Baessler K, Glazener CMA. Surgical management of pelvic organ prolapse in women: the updated summary version. Cochrane review. Int Urogynecol J. 2011;22:1445-1457.

Update Date: 6/18/2012

Updated by: Linda J. Vorvick, MD, Medical Director and Director of Didactic Curriculum, MEDEX Northwest Division of Physician Assistant Studies, Department of Family Medicine, UW Medicine, School of Medicine, University of Washington; and Scott Miller, MD, Urologist in private practice in Atlanta, Georgia. David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc.