Dr Jo Schoeman
Urological Surgeon

        

Cystocoele Repair (Natural)

Product Summary: AMA rates

Repair of an anterior / bladder prolapse using natural tissue and repair of introitis

Item Number: 35570, 35569, 18262, 105

Why is it done?

  • The aim of surgery is to relieve the symptoms of vaginal bulge and / or laxity.
  • Improve bladder function without interfering with sexual function.

Pre-requirements

  • An informed consent is required from the patient and a pre-admission clinic will be arranged.• Patients may not eat or drink from midnight the previous evening.
  • Patients are to refrain from smoking before the procedure.
  • Patients allergic to IODINE/CHLORHEXIDINE should clearly state this at the pre-admission clinic as well as to theatre staff and Dr Schoeman.
  • Any anti-coagulants such as Warfarin or Aspirin must be stopped 7 days prior to surgery. This may be replaced by once daily Clexane injections.
  • Pre-operative blood tests are required 4 days prior to surgery.
  • Patients with cardiac illnesses require a cardiologist/ physician report.
  • A chest X-ray is required for patients with lung disease.
  • Be prepared for an 2-3 day stay.

How is it done?

  • This procedure is done under a spinal / general anaesthetic, as decided by the anaesthetist.
  • There are many ways to perform an anterior repair.
  • An incision is made along the center of the front wall of the vagina starting near the vaginal entrance and finishing near the top of the vagina.
  • The vaginal skin is then separated from the underlying supportive fascial layer.
  • The weakened fascia is then repaired using absorbable stitches, which will absorb over 4 weeks to 5 months depending on the type of stitch (suture) material used.
  • Sometimes excessive vaginal skin is removed and the vaginal skin is closed with absorbable sutures, these usually take 4 to 6 weeks to fully absorb.
  • Reinforcement material in the form of synthetic (permanent) mesh or biological (absorbable) mesh may be used to repair the anterior vaginal wall.
  • Mesh is usually reserved for cases of repeat surgery or severe prolapse.
  • A cystoscopy may be performed to confirm that the appearance inside the bladder is normal and that no injury to the bladder or ureters has occurred during surgery.
  • A pack may be placed into the vagina and a catheter into the bladder at the end of surgery.
  • If so, this is usually removed after 3-48 hours. The pack acts like a compression bandage to reduce vaginal bleeding and bruising after surgery.

What to expect after the procedure?

  • When you wake up from the anesthetics you will have a drip to give you fluids and may have a catheter in your bladder.
  • The surgeon may have placed a pack inside the vagina to reduce any bleeding into the tissues.
  • Both the pack and the catheter are usually removed within 48 hours of the operation.
  • It is normal to get a creamy discharge for 4 to 6 weeks after surgery. This is due to the presence of stitches in the vagina; as the stitches absorb the discharge will gradually reduce.
  • If the discharge has an offensive odor contact your doctor.
  • You may get some blood stained discharge immediately after surgery or starting about a week after surgery. This blood is usually quite thin and old, brownish looking and is the result of the body breaking down blood trapped under the skin.

How successful is the surgery?

  • Quoted success rates for anterior vaginal wall repair are 70-90%.
  • There is a chance that the prolapse may come back in the future, or another part of the vagina may prolapse for which you need further surgery.
  • Recurrence rates are as much as 50% in the next 3 years.

Complications?

  • With any surgery there is always a small risk of complications.
  • Anesthetic problems. With modern anesthetics and monitoring equipment, complications due to anesthesia are very rare.
  • Bleeding. Serious bleeding requiring blood transfusion is unusual following vaginal surgery (less than 1%).
  • Post operative infection. Although antibiotics are often given just before surgery and all attempts are made to keep surgery sterile, there is a small chance of developing an infection in the vagina or pelvis.
  • Bladder infections (cystitis) occur in about 6% of women after surgery and are more common if a catheter has been used. Symptoms include burning or stinging when passing urine, urinary frequency and sometimes blood in the urine. Cystitis is usually easily treated by a course of antibiotics.
  • Constipation is a common postoperative problem.
  • Pain with intercourse (dyspareunia). Some women develop pain or discomfort with intercourse.
  • Damage to the bladder or ureters during surgery is an uncommon complication which can be repaired during surgery.
  • Incontinence. After a large anterior vaginal wall repair some women develop stress urinary incontinence due to the unkinking of the urethra (tubefrom the bladder).
  • This is usually simply resolved by placing a supportive sling under the urethra section).

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