Dr Jo Schoeman
Urological Surgeon

        

Cystocoele Repair (Surgisis)

Product Summary: AMA rates

Repair of an anterior / bladder prolapse using porcine dermis and repair of introitis

Item Number: 35570, 35569, 36812, 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.
  • Used where own natural tissue is too weak to use.

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 with the help of local anaesthetic and saline.
  • 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 biological (absorbable) mesh may be used to repair the anterior vaginal wall.
  • 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.

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 less than 30% in the next 3 years.

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

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).
  • Mesh Complications. If mesh is used for reinforcement there is a 5-10% risk of mesh extrusion requiring trimming.
  • Pain can develop associated with the mesh requiring part or all of the mesh to be removed.

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