Learn something new every day More Info Anterior repair is a surgery that involves reconstructing the front wall of the vagina in order to provide better support for the bladder. This type of surgery, also called a colporrhaphy or a cystocele repair, is used to correct a situation where the bladder or urethra has lowered into the area of the vagina.
After this procedure, patients can expect to be told to rest and avoid strenuous activity for a period of about six to eight weeks. The first several days of the recovery period are often spent with a catheter in place, and some cases require catheter use for an extended period while the tissues heal.
Some types of anterior repair can lead to unfamiliar sensations like tugging in the area of the bladder, and complications are occasionally experienced. An anterior repair can be as simple as gathering the stretched skin of the anterior vaginal wall and stitching it together. The skin can also be cut so that the excess is removed before stitching to provide added support for the bladder. Anterior repairs seem to have a higher rate of success when a mesh support is used to hold the pelvic organs in place.
Immediately following the anterior repair surgery, the patient will usually experience bleeding for several days and will have a catheter in place for removal of urine. The hospital stay usually lasts two to three days but sometimes longer. After a week or two, most patients are able to return to work as long as there is no physical labor involved. Strenuous activity is off limits for six to ten weeks, and sex is not advised until the patient makes a full recovery.
Similar to any other surgery, there is some risk of infection or of the surgical wound reopening. In rare cases, excessive bleeding or pulmonary embolism — a blood clot that travels to the lungs — may occur. Risks that are specific to anterior repair surgeries include nerve or muscle injury to the bladder, urethra, or vagina. There is a very small chance that the incontinence and frequency of urination symptoms may not be corrected or may worsen after the surgery.
In patients who have the variation of the surgery that includes the use of a mesh support, some discomfort may be felt when bending or twisting. Many patients, however, find that they have a significant or even complete reversal of the urinary and sexual problems that led them to seek the surgery in the first place. One of our editors will review your suggestion and make changes if warranted. Note that depending on the number of suggestions we receive, this can take anywhere from a few hours to a few days.
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This Day in History. You might also Like. What is Vaginal Vault Prolapse? What is a Vaginal Prolapse? What is Colporrhaphy?To function normally, the vagina must have adequate length, elasticity, a well-estrogenated lining, and rest upon a responsive levator muscle plate. Symptoms of vaginal relaxation may include a sense of pelvic heaviness, recognition by the patient of a bulge or protrusion from the vagina, urinary incontinence, and dyspareunia. Surgically correctable complications of vaginal anatomy include relaxation or widening of the vaginal caliber, narrowing of the upper vagina, iatrogenic shortening of the vagina, stricture of the introitus, or complete absence of the vagina.
Uncommonly, there may be duplications of the vaginal canal. A partition, or septum, may run the full length of the vagina and one side or the other may be obstructed.
Despite minor improvements in vaginal support resulting from atrophy and narrowing of the vaginal introitus, once established a cystocele will not improve. More commonly today, incisions of the anterior vaginal wall may be required to reduce the vaginal caliber for improved coital comfort.
Incisions may be indicated for drainage of a hematoma in the retropubic space or wall of the vagina. The degree of severity of the cystocele must be evaluated with the patient at rest and during a forced increase in intra-abdominal pressure, as with a Valsalva maneuver. If a woman's symptom of a vaginal protrusion cannot be confirmed during examination in the lithotomy position she should be examined while standing, with her legs slightly apart.
The size of the cystocele or vaginal protrusion may bear no relation to the sense of pelvic heaviness, or severity of urinary stress incontinence.
Some women are oblivious to large protrusions from the vagina. Before surgery the routine steps taken before any operative procedure should be carried out. The gynecologist should determine:.
The principal aim of any surgical repair of the anterior vaginal compartment includes restoration of adequate vaginal length and caliber, maintenance or restoration of urinary continence, and repair of the pelvic valvular mechanism.
See elsewhere  Informed consent should touch not only on possible complications, but as well on the patient's expectations. In many elderly women marked atrophy of the vaginal wall may accompany a cystocele.
Presurgical treatment with estrogen should be carried out. The subject of this chapter concerns the correction of a cystocele, with or without accompanying urinary incontinence.
See elsewhere in these volumes. After a vaginal hysterectomy is completed, four Allis clamps are used to stretch the anterior vaginal wall into a diamond shape. With one stroke of a fresh scalpel, an incision is made through the full thickness and length of the anterior vaginal wall from cm posterior to the external urethral meatus almost to the vaginal vault Fig. A scalpel is preferred because electrocautery can produce variable damage to tissues beyond the point of contact of the electrode.
Tension on the four Allis clamps will cause the edges of the incision to separate readily. The bladder also can be separated from the vagina by tunneling between the two with closed scissors, a method slightly more tedious and less elegant than incision with a scalpel. The two lateral Allis clamps then are reapplied to the cut edges of the vaginal epithelium.
The knife is drawn along the inner cut edge of the vaginal wall, loosening with one or two strokes the vesicovaginal connective tissues from the vaginal wall Fig. The surgeon's index finger, wrapped with a single layer of dry gauze, then is used to press and rotate against the vaginal flap, further separating these connective tissues Fig.
As much of the vesicovaginal connective tissues as possible should remain attached to the base of the bladder. The separation of the connective tissues from the flaps of the vagina should proceed laterally only for approximately 1 inch on each side.About 1 in 10 women who have had children require surgery for vaginal prolapse.
What can I Expect After Anterior Repair?
A prolapse of the front anterior wall of the vagina is usually due to a weakness in the strong tissue layer fascia that divides the vagina from the bladder. This weakness may cause a feeling of fullness or dragging in the vagina or an uncomfortable bulge that extends beyond the vaginal opening.
It may also cause difficulty passing urine with a slow or intermittent urine stream or symptoms of urinary urgency or frequency. Another name for an anterior wall prolapse is a cystocele.
Normal anatomy, no prolapse left and Anterior wall prolapse right. An anterior repair, also known as an anterior colporrhaphy, is a surgical procedure to repair or reinforce the fascial support layer between the bladder and the vagina. The surgery can be performed under general, regional or even local anesthetic. Your doctor will discuss which is best for you. There are many ways to perform an anterior repair.
Below is a general description of a common repair method. When you wake up from the anesthetics you will have a drip to give you fluids and may have a catheter in your bladder.Cystocele + Rectocele Repair
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. 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. With any surgery there is always a small risk of complications.
The following general complications can happen after any surgery:.
Posterior Colporrhaphy : Rectocele repair by Dr.Avijit Basak
In the early post-operative period, you should avoid situations where excessive pressure is placed on the repair, i.
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. You should be able to drive and be fit enough for light activities such as short walks within 2 to 3 weeks of surgery.
You should wait five to six weeks before attempting sexual intercourse. Some women find using additional lubricant during intercourse is helpful. Lubricants can easily be bought at supermarkets or pharmacies. Anterior Vaginal Repair Introduction About 1 in 10 women who have had children require surgery for vaginal prolapse.
What is anterior repair? Why is it performed? How is the surgery performed? What will happen to me after the operation? How successful is surgery?
Are there any complications? When can I return to my usual routine? 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.This surgical procedure should be tailored to the specific site s of anterior compartment defect, and is most suited for the central midline defect. For example, if a patient has both a midline and paravaginal defect, correcting only the central compartment has high likelihood of recurrence because the lateral defect remains unaddressed.
Regarding vaginal native-tissue anterior repairs, patients should be informed of potential complications including but not limited to: recurrence of prolapse, de novo or occult stress urinary incontinence, de novo overactive bladder, urinary retention, significant bleeding, infection, bladder or ureteral injury, vesicovaginal fistula, dyspareunia, vaginal shortening, and de novo apical or posterior prolapse.
Risk factors for prolapse recurrence include increasing age and vaginal parity, smoking, conditions that impair wound healing diabetes mellitus and steroid useand conditions that could strain the repair constipation, chronic pulmonary disease, heavy lifting, and obesity. Additionally, patients with more severe initial prolapse have higher likelihood of recurrence. Some surgeons suggest mesh-augmented repairs in appropriately counseled patients with recurrent or Stage 3 or higher prolapse [ 7 ].
Patients undergoing concomitant sacrospinous ligament suspensions for apical prolapse have an increased risk of recurrent anterior vaginal prolapse. It is unknown whether this is due to the retroflexion of the vaginal axis or simply due to a predisposition to failure after pelvic surgery [ 8 ]. This risk can be reduced by preoperative detection of occult SUI with reduction of prolapse and performing a simultaneous anti-incontinence procedure.
Conversely, Weber et al. Patients undergoing concomitant anti-incontinence procedures are more likely to develop postoperative urinary retention. Retention is often transient, and patients should be taught clean intermittent self-catheterization.
Anterior and Posterior Repair (Colporrhaphy)
The majority of patients have return of spontaneous voiding within 6 weeks of self-catheterization. Bladder or ureteral injuries are rare with native-tissue anterior colporrhaphy. Altman et al reported a rate of 0. The risk is higher in women with atrophic tissues and may occur during dissection of vaginal flaps. Cystoscopy should be performed intraoperatively to rule out bladder or ureteral injury.
Indigo carmine or methylene blue can be administered to assist with identification of ureteral jets.
If efflux is not visualized, evaluate for kinking or ligation with ureteral catheterization or retrograde pyelography. If obstruction is suspected, the plication sutures should be taken down. Sutures should also be immediately removed if inadvertently placed within the bladder or urethra.
If a bladder injury occurs, repair this intraoperatively with an absorbable suture in two layers and leave an indwelling catheter for 7—14 days. Sexual function can improve, remain unchanged, or worsen after anterior repair. Most studies demonstrate modest improvement in sexual function scores post-operatively. Care should be taken to avoid excessive trimming of vaginal edges at the conclusion of the procedure. This decreases risk for vaginal narrowing and stenosis that can cause dyspareunia.
Missed or de novo apical or posterior prolapse may occur after anterior compartment repair. However, this risk is increased in repairs augmented with mesh [ 12 ]. Surgical Technique Preoperative Evaluation Patients should be evaluated for loss of apical support, which should be repaired simultaneously to reduce the risk of prolapse recurrence.
Occult stress urinary incontinence should also be ruled out by reducing the prolapse on exam.Learn something new every day More Info The organs and other structures of the pelvis are held in place with connective tissue such as ligaments and muscles.
If these connective tissues are torn or become weak, one or more organs might prolapse, meaning that it has dislodged from its original anatomical location. Sometimes, a prolapse causes the bladder, rectum or another structure of the pelvis to protrude through the vaginal wall. This type of prolapse is treated with a colporrhaphy procedure in which the organ is returned to its proper location.
There are several types of prolapse that can be treated with colporrhaphy. A prolapse of the urethra into the vagina is called urethroceleand a prolapse of the bladder into the vagina is a cystocele. A prolapse of the small intestine into the vagina is an enteroceleand a prolapse of the rectum is a rectocele. In the case of a urethrocele or cystocele, the cause is a defect in the fibrous tissue located between the bladder and vagina, called pubocervical fascia. A defect in the the rectovaginal fascia, the connective tissue that separates the rectum and vagina, can cause a rectocele.
Women have an increased risk of prolapse of one or more pelvic organs as they age. Other risk factors include childbirth, physical activity and hysterectomy. In addition, hormone deficiency also can increase the risk of prolapse. A woman who experiences a pelvic organ prolapse might have symptoms such as incontinenceback pain and painful bowel movements or urination.
Sexual intercourse might be painful or difficult, and the walls of the vagina might bulge because of pressure from the prolapsed organ. Colporrhaphy surgery can be performed in either of two ways, depending on the type of prolapse involved. In an anterior colporrhaphy, the surgery is performed at the front of the vaginal wall to repair a urethrocele or cystocele. In a posterior colporrhaphy, the procedure is carried out on the rear vaginal wall to repair a rectocele.
Enterocele surgery can be posterior or anterior, depending on the nature of the intestinal prolapse. In most cases, the patient will receive a general anesthetic, but if a woman is unable to receive general anesthetic for medical reasons, she can undergo local anesthesia.
At the beginning of the procedure, the surgeon inserts a speculum into the vagina. This device holds the vaginal walls open to allow the surgeon to view and repair the vaginal walls more easily. The skin of the vagina is then incised so that the surgeon can locate the defect in connective tissue that is causing the prolapse.
Once the defect is located, the surgeon folds and stitches the connective tissue to tighten and strengthen it, thus preventing prolapse. Recovery time for the procedure is approximately four weeks. Depending on the nature of the prolapse, a woman might need to maintain a liquid diet for several days.
She must avoid activities such as heavy lifting, prolonged standing and sexual intercourse, all of which put strain on the incision site and might cause the wound to reopen.
Risks of the colporrhaphy procedure include infection and bleeding at the incision site and damage to other organs in the pelvis. It is rare for the prolapse to recur after surgery, but it is a possibility if the surgery did not corrected the defect in the connective tissue. One of our editors will review your suggestion and make changes if warranted.A dropped or prolapsed bladder cystocele occurs when the bladder wall bulges into the vaginal space. It results when supporting muscles and tissues for the bladder give way.
Anterior prolapse, also known as a cystocele SIS-toe-seeloccurs when the supportive tissue between a woman's bladder and vaginal wall weakens and stretches, allowing the bladder to bulge into the vagina. Anterior prolapse is also called a prolapsed bladder. Straining the muscles that support your pelvic organs may lead to anterior prolapse.
Such straining occurs during vaginal childbirth or with chronic constipation, violent coughing or heavy lifting. Anterior prolapse also tends to cause problems after menopause, when estrogen levels decrease. For a mild or moderate anterior prolapse, nonsurgical treatment is often effective. In more severe cases, surgery may be necessary to keep the vagina and other pelvic organs in their proper positions. In mild cases of anterior prolapse, you may not notice any signs or symptoms. When signs and symptoms occur, they may include:.
Signs and symptoms often are especially noticeable after standing for long periods of time and may go away when you lie down. A severely prolapsed bladder can be uncomfortable. It can make emptying your bladder difficult and may lead to bladder infections. Make an appointment with your doctor if you have any signs or symptoms that bother you. Your pelvic floor consists of muscles, ligaments and connective tissues that support your bladder and other pelvic organs. The connections between your pelvic floor muscles and ligaments can weaken over time, as a result of trauma from childbirth or chronic straining of pelvic floor muscles.
When this happens, your bladder can slip down lower than normal and bulge into your vagina anterior prolapse. Anterior prolapse cystocele care at Mayo Clinic. Mayo Clinic does not endorse companies or products.
Advertising revenue supports our not-for-profit mission. This content does not have an English version. This content does not have an Arabic version.Colporrhaphy is the surgical repair of a defect in the vaginal wall, including a cystocele when the bladder protrudes into the vagina and a rectocele when the rectum protrudes into the vagina.
In this anterior colporrhaphy, a speculum is used to hold open the vagina, and the cystocele is visualized A. The wall of the vagina is cut open to reveal an opening in the supporting structures, or fascia B. The defect is closed Cand the vaginal skin is repaired D. Illustration by GGS Inc. A prolapse occurs when an organ falls or sinks out of its normal anatomical place.
The pelvic organs normally have tissue muscle, ligaments, etc. Certain factors, however, may cause those tissues to weaken, leading to prolapse of the organs. A cystocele is defined as the protrusion or prolapse of the bladder into the vagina; a urethrocele is the prolapse of the urethra into the vagina.
These are caused by a defect in the pubocervical fascia fibrous tissue that separates the bladder and vagina. A rectocele occurs when the rectum prolapses into the vagina, caused by a defect in the rectovaginal fascia fibrous tissue that separates the rectum and vagina. When a part of the small intestine prolapses into the vagina, it is called an enterocele. Uterine prolapse occurs when the uterus protrudes downward into the vagina. Factors that are linked to pelvic organ prolapse include age, repeated childbirth, hormone deficiency, ongoing physical activity, and prior hysterectomy.
Symptoms of pelvic organ prolapse include stress incontinence inadvertent leakage of urine with physical activitya vaginal bulge, painful sexual intercourse, back pain, and difficult urination or bowel movements. An anterior colporrhaphy treats a cystocele or urethrocele, while a posterior colporrhaphy treats a rectocele. Surgery is generally not performed unless the symptoms of the prolapse have begun to interfere with daily life. The patient is first given general, regional, or local anesthesia.
A speculum is inserted into the vagina to hold it open during the procedure. An incision is made into the vaginal skin and the defect in the underlying fascia is identified. The vaginal skin is separated from the fascia and the defect is folded over and sutured stitched.
Any excess vaginal skin is removed and the incision is closed with stitches.