Why is it performed? The aim of surgery is to relieve the symptoms of vaginal bulge and/or laxity and to improve bladder function with- out interfering with sexual function

Anterior Vaginal Repair How is the surgery performed? The surgery can be performed under general, regional or (Bladder Repair) even local anaesthetic: your doctor will discuss which is best for you. There are many ways to perform an anterior A Guide for Women repair below is a general description of a common repair 1. What is anterior repair? method. 2. Why is it performed? An incision is made along the center of the front wall of the vagina starting near the vaginal entrance and 3. How is the surgery performed? • 4. How successful is surgery? The vaginal skin is then separated from the underly- 5. Are there any complications? ingfinishing supportive near the fascial top of layer. the vagina. The weakened fascia is 6. Do’s and don’ts after surgery • then repaired using absorbable stitches, which will absorb over 4 weeks to 5 months depending on the type of stitch (suture) material used. Anterior vaginal wall prolapse Sometimes excessive vaginal skin is removed and the About 1 in 10 women who have had children require sur- vaginal skin is closed with absorbable sutures, these gery for vaginal prolapse. A prolapse of the front (anterior) • usually take 4 to 6 weeks to fully absorb. wall of the vagina is usually due to a weakness in the strong tissue layer (fascia) that divides the vagina from the blad- Reinforcement material in the form of synthetic (per- der. This weakness may cause a feeling of fullness or drag- manent) mesh or biological (absorbable) mesh may ging in the vagina or an uncomfortable bulge that extends • be used to repair the anterior vaginal wall. Mesh is usually reserved for cases of repeat surgery or severe passing urine with a slow or intermittent urine stream or prolapse. beyondsymptoms the of vaginal urinary opening. urgency Itor mayfrequency. also cause Another difficulty name for an anterior wall prolapse is a cystocoele. appearance inside the bladder is normal and that no • Ainjury cystoscopy to the bladdermay be orperformed ureters has to confirmoccurred that during the surgery. What is an anterior repair? An anterior repair also known as an anterior colporrhaphy A pack may be placed into the vagina and a catheter is a surgical procedure to repair or reinforce the fascial sup- into the bladder at the end of surgery. If so, this is usu- port layer between the bladder and the vagina. • ally removed after 3-48 hours. The pack acts like a compression bandage to reduce vaginal bleeding and bruising after surgery.

Normal anatomy, no prolapse Anterior wall prolapse

uterus uterus rectum

bladder

perineal body vagina

IUGA Office | [email protected] | www.iuga.org ©2011 Commonly anterior vaginal repair surgery is com- in the future, or another part of the vagina may prolapse for bined with other surgery such as vaginal hysterec- which you need further surgery. • tomy, posterior vaginal wall repair or incontinence surgery. These procedures are covered in detail in Are there any Complications? section. With any surgery there is always a small risk of complica- other leaflets in this series in the patient information tions. The following general complications can happen after any surgery: What will happen to me after the operation? Anesthetic problems. With modern anesthetics and When you wake up from the anesthetics you will have a drip monitoring equipment, complications due to anesthe- • sia are very rare. The surgeon may have placed a pack inside the vagina to toreduce give anyyou bleedingfluids and into may the have tissues. a catheter Both the in yourpack bladder.and the Bleeding. Serious bleeding requiring blood transfu- catheter are usually removed within 48 hours of the opera- sion is unusual following vaginal surgery (less than tion. • 1%). It is normal to get a creamy discharge for 4 to 6 weeks after Post operative infection. Although antibiotics are surgery. This is due to the presence of stitches in the vagina; often given just before surgery and all attempts are as the stitches absorb the discharge will gradually reduce. • made to keep surgery sterile, there is a small chance If the discharge has an offensive odor contact your doctor. of developing an infection in the vagina or pelvis. You may get some blood stained discharge immediately Bladder infections (cystitis) occur in about 6% of after surgery or starting about a week after surgery. This women after surgery and are more common if a cath- blood is usually quite thin and old, brownish looking and is • eter has been used. Symptoms include burning or the result of the body breaking down blood trapped under stinging when passing urine, urinary frequency and the skin. sometimes blood in the urine. Cystitis is usually eas- How successful is the surgery? ily treated by a course of antibiotics. Quoted success rates for anterior vaginal wall repair are 70-90%. There is a chance that the prolapse may come back anterior vaginal wall repair. The followingConstipation complications is a common are morepostoperative specifically problem related and to your doctor may prescribe laxatives for this, try to •

uterus A) anterior vaginal wall prolapse

A B B) repairing the fascial layer

uterus

C) repairing vaginal skin layer

bladder bladder

fascia

vagina

C

stitch vaginal skin

IUGA Office | [email protected] | www.iuga.org ©2011 help as well. Painmaintain with a highintercourse fibre diet (dyspareunia). and drink plenty Some of fluidswomen to develop pain or discomfort with intercourse. Whilst • every effort is made to prevent this happening, it is - tercourse is more comfortable after their prolapse is sometimesrepaired. unavoidable. Some women also find in Damage to the bladder or ureters during surgery is an uncommon complication which can be repaired dur- • ing surgery. Incontinence. After a large anterior vaginal wall re- pair some women develop stress urinary inconti- • nence due to the unkinking of the urethra (tubefrom the bladder). This is usually simply resolved by plac- ing a supportive sling under the urethra (see the leaf- let on stress urinary incontinence in the patient infor- mation section). Mesh Complications. If mesh is used for reinforce- ment there is a 5-10% risk of mesh extrusion requir- • to theatre. Rarely pain can develop associated with ingthe trimmingmesh requiring as an officepart orprocedure all of the or mesh a brief to returnbe re- moved.

When can I return to my usual routine? In the early postoperative period you should avoid situa- tions where excessive pressure is placed on the repair, i.e. lifting, straining, vigorous exercise, coughing and constipa- tion. Maximal strength and healing around the repair oc- curs at 3 months and care with heavy lifting >10kg/25lbs needs to be taken until this time. It is usually advisable to plan to take 2 to 6 weeks off work, your doctor can guide you as this will depend on your job type and the exact surgery you have had. - ties such as short walks within 3 to 4 weeks of surgery. You should be able to drive and be fit enough for light activi

Youduring should intercourse wait five isto sixhelpful. weeks Lubricants before attempting can easily sexual be intercourse,bought at supermarkets some women or pharmacies. find using additional lubricant

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