ANTERIOR AND/OR POSTERIOR
Anterior repair: treatment for prolapse of bladder (bladder bulges forward
into the vagina; cystocele) or urethra.
Posterior repair: correction of bowel prolapse (rectum bulges forward into
the vagina; rectocele) Vault repair: treat prolapse of upper vagina
Depending on the side of the defect, the repair can either be anterior, posterior,
vault or total. The repair is achieved by the placement of permanent mesh that
may result in a stronger repair.
The procedure can be performed
under regional or general anaesthesia.
Anterior vaginal repair:
- Midline incision to the vagina overlying the bladder and urethra.
- Dissection in a plane directly below the vagina and lateral of the bladder
allows the damaged fascia supporting the bladder to be exposed.
- The fascia is plicated in the midline using sutures.
- Permanent mesh reinforces the repair and is anchored through the obturator
foramen and exits through small incisions at both sides of your upper inner
- The vaginal skin is closed.
Posterior and vault repair:
- An incision is made to the posterior wall of the vagina.
- Dissection below the vagina identifies the rectovaginal fascia and opens
the space between the rectum and the pelvic floor muscle to the sacrospinous
- Defects in the fascia are corrected by centrally plicating the fascia using
- Permanent mesh reinforces the repair and is anchored bilaterally to the
pelvic side wall and exits through a small incision approximately 3cm lateral
and down from your anus.
- The vaginal skin is then closed.
of the surgery is about 85 - 90%. Serious complications are rare with this type
of surgery. However, no surgery is without risk and the main potential complications
are listed below.
- 5-15% women will develop recurrent prolapse.
- Mesh erosion/infection 5-10%. Simple resuturing is usually sufficient but
if infection persists further surgery may be required to remove the mesh.
- 1-5% develop a urinary tract infection.
- After a large prolapse is repaired urinary leakage may develop that was
not present before the surgery 5%.
- Difficulties passing urine necessitating prolonged self-catheterisation
- 1-5% constipation or failure to correct symptoms like incomplete bowel evacuation.
- Inadvertent damage to bladder, urethra, bowel or ureters occurs rarely and
is usually repaired during surgery but further surgery may be required.
- Very rarely further surgery can be required to close a fistula (false tract
between vagina and bladder or bowel) (1-2/1000 cases)
- Excessive bleeding requiring blood transfusion is uncommon (<1%).
- Clots can form in the legs or lungs after surgery
- Ongoing vaginal pain and/or persistent pain during intercourse (1-5%) that
may require further surgery.
In hospital and recovery
You can expect to stay in
hospital between 3-6 days. The vaginal pack is removed on the first day and
the bladder catheter after the first few days. In the early postoperative period
you should avoid situations where excessive pressure is placed on the repair
ie lifting, straining, coughing and constipation. Maximal fibrosis around the
repair occurs at 3 months and care needs to be taken during this time. If you
develop urinary burning, frequency or urgency you should see your local doctor.
You will see Dr Maher at 6 weeks for a review and sexual activity can usually
be safely resumed at this time. You can return to work at approximately 4-6
weeks depending on the amount of strain that will be placed on the repair at
your work and on how you feel.
Avoiding heavy lifting (>15kg), weight gain and smoking can minimize failure
of the procedure in the long term. If you have any questions about this information,
you should speak to Dr. Maher or his team before your operation.
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