Anterior vaginal wall repair

Definition

This is a surgical procedure that tightens the anterior vaginal wall to repair a cystocele (the sinking of the bladder into the vagina) or urethrocele (the sinking of the urethra into the vagina). A rectocele (the bulging of the rectum into the vagina) is repaired by tightening the posterior vaginal wall.

Alternative Names

Description

To perform the anterior vaginal repair, an incision is made through the vagina to release a portion of the anterior (front) vaginal wall that is attached to the base of the bladder.

The supportive tissue between the vagina and bladder is folded and stitched to bring the bladder and urethra in proper position. There are several variations on this procedure that may be necessary, based on the severity of the prolapse (bulging or sinking).

This procedure may be performed using general or spinal anesthesia. You may have a foley catheter in place for 1 to 2 days after surgery. You will be given a liquid diet immediately after surgery, followed by a regular diet when your normal bowel function has returned. Stool softeners and laxatives may be prescribed to prevent straining with bowel movements, since this can cause stress on the incision.

A similar procedure can be performed on the posterior (back) wall of the vagina to repair a rectocele.

Why the Procedure is Performed

This procedure is used to repair the vaginal wall prolapse or herniation that occurs with urethrocele or cystocele. This surgery by itself does not treat stress incontinence -- an additional procedure is needed in women who have stress urinary incontinence along with a cystocele.

In mild cases of cystocele, your doctor may recommend trying pelvic floor muscle exercises first, before resorting to surgical treatment. In some women, a pessary (a device placed in the vagina to hold up the prolapse) can be used to avoid surgery.

Recovery

You should avoid activities that cause an increase in abdominal pressure, such as straining, sneezing, and coughing for several weeks to months after your surgery. You should avoid any activities that require lifting or straining.

You may need to take stool softeners or gentle laxatives to prevent constipation and straining with bowel movements. Your doctor may recommend that you avoid sexual intercourse until your incisions are healed.

Outlook (Prognosis)

Women treated with this procedure for cystocele have an excellent chance that the prolapse will be cured. This improvement will usually last for years -- but in some cases the tissue weakens with time, and other procedures may be necessary to treat the symptoms.

Risks

Risks for any anesthesia are:

• Reactions to medications
• Problems breathing

Risks for any surgery are:

• Bleeding
• Infection
• Injury to surrounding structures

Possible complications resulting from anterior vaginal repair include urinary tract infection, injury to the bladder, and inability to urinate.