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Vaginal Hysterectomy for Prolapse

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Vaginal Hysterectomy for Prolapse with prolapse repairs of the bladder and/or bowel and sling procedures for urinary incontinence. How is a vaginal hysterectomy performed? The operation is performed in a hospital setting and can be performed under general or spinal anesthesia (with or Vaginal Hysterectomy for without sedation). A cut is made around the cervix. The surgeon then carefully pushes the bowel and bladder away Prolapse from the uterus. The blood vessels supplying the uterus and surrounding tissue are then clamped, cut and tied. After A Guide for Women checking there is no bleeding the surgeon then removes the uterus and closes the top of the vagina, now known as the 1. What is a prolapse? vaginal vault. Many surgeons will choose to add additional 2. What is a vaginal hysterectomy? support stitches to the vaginal vault at the time of surgery either to the uterosacral ligaments that support the uterus 3. How is a vaginal hysterectomy performed? (this is called a uterosacral ligament suspension) or to sup- 4. What will happen to me before the operation? port structures to the side of the uterus, (sacrospinous liga- 5. What will happen to me after the operation? ment suspension or ileococcygeus suspension.) Please see 6. Are there any complications? plan to do. The ovaries can be removed during a vaginal 7. What are the chances of success? leaflethysterectomy on this ifsubject. needed. Your doctor can explain what they 8. When can I return to my usual routine? What will happen to me before the operation? history and medication that you are taking. Any necessary What is a prolapse? Youinvestigations will be asked (for aboutexample your blood general tests, health, ECG, chestpast medicalX –ray) Prolapse of the uterus (womb) and/or vaginal walls is a common condition with up to 11% of women requiring sur- your admission, hospital stay, operation and pre- as well as gery during their lifetime. Prolapse generally occurs due to willpostoperative be organized. care. You Mention will also to yourreceive doctor information if your are about on damage to the supporting structures of the uterus or vagi- blood thinning agents such as aspirin, as these can lead to na. Weakening of the supports can occur during childbirth, an increased risk of bleeding and bruising during and after as a result of chronic heavy lifting or straining e.g. with con- stipation, chronic cough, obesity and as part of the ageing medications 7 to 10 days prior to surgery. Some surgeons process. In some cases there may be a genetic weakness of surgery.recommend Your bowel doctor preparation may ask you prior to stop to surgery. the blood thinning the supportive tissues. What will happen to me after the operation? Prolapse of the uterus can cause an uncomfortable dragging sensation or feeling of fullness in the vagina. In more ad- you may have a catheter in your bladder. Often the surgeon vanced prolapse the cervix can extend beyond the entrance Whenwill also you have wake placed up you a vaginalwill have pack a drip to toreduce give you the fluidschance and of to the vagina. bleeding. Generally the pack, catheter and drip are removed What is a vaginal hysterectomy? This is a procedure in which the uterus is surgically removed eat and drink almost immediately after surgery. Pain and through the vagina. The operation is frequently combined inanti the nausea first 24 medication to 48 hours. is givenIn most when cases needed you will either be able intra to- Normal uterus and vagina, no prolapse venouslyProlapse or of by the intramuscular uterus, bladder, (IM) and injection rectum or (bowel) pill. rectum uterus bladder IUGA Office | [email protected] | www.iuga.org ©2011 Keeping mobile after surgery is important to reduce com- • Infections plications such as clots in the legs. Walking and light house- surgery and all attempts are made to keep surgery sterile there. Although is a small antibiotics chance of aredeveloping given just a vaginal before - or pelvic infection. This will usually present with an holderatively. duties It is are normal fine to however feel tired heavy following lifting surgery (more so makethan unpleasant smelling vaginal discharge and or fever. 10kgs/25lbs) is not advisable in the first 6 weeks postop- 6-20% of women having vaginal surgery develop a gery. urinary tract infection, The risk is highest if you have sure you schedule rest times in the first few weeks after sur had a catheter. Symptoms include burning and sting- It is normal to get a creamy/brownish or bloody discharge ing when passing urine and frequency. If you think you Youfor 4 can - 6 weeksexpect after to stay surgery. in the This hospital is due between to the presence 1-3 days. of have an infection after surgery contact your doctor. stitches in the vagina. As the stitches absorb, the discharge • Injury to adjacent organs. Up till to 2% of vaginal will gradually reduce. hysterectomies are complicated by either damage to the bladder, the ureters or rectum. A very rare compli- What are the chances of success? • Urinary retention 85% of women having a vaginal hysterectomy for uterine cation is the occurrence of a vaginal fistula. prolapse are cured permanently. About 15% of women de- . In the first few days after surgery velop a further prolapse of the vaginal vault months or years difficultyfor a few days passing after urine surgery can until occur you in areup toable 10-15% to easily of cases.pass urine. You may need to have a catheter or catheterise on the severity of your original prolapse. after their first surgery. These figures may vary depending Are there any complications? With any operation there is always a risk of complications: When can I return to my usual routine? - with modern anesthetics and • Anesthetic problems tivities such as short walks within a few weeks of surgery. monitoring equipment complications due to anesthe- YouWe adviseshould you be toable avoid to drive heavy and lifting be fitand enough sport forfor at light least ac 6 sia are very rare. weeks to allow the wounds to heal. It is usually advisable to • Clots (embolism). After any pelvic surgery clots can plan to take 2 to 6 weeks off work (depending on the type of form in the legs or lungs. This is a rare complication surgery you have had and the type of work you do). which is minimised by using support stockings and Sexual activity can usually be safely resumed after 6 weeks. blood thinning agents. • Severe blood loss and hematoma. The risk of blood loss requiring blood transfusion is small (0-10%) and will in part vary on what other surgery you are hav- ing. About 10% of women develop a small collection of blood at the vaginal vault (a haematoma) this usually drains spontaneously after 7 to 10 days. Occasionally it will require surgical drainage. Appearance after hysterectomy rectum bladder vaginal vault The information contained in this brochure is intended to be used for educational purposes only. It is not intended to be used for the diagnosis or treatment of any specific medical condition, which should only be done by a qualified physician or other health care professional. IUGA Office | [email protected] | www.iuga.org ©2011.
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