Health Encyclopedia

Anterior vaginal wall repair

Definition

Anterior vaginal wall repair is a surgical procedure that tightens the front (anterior) vaginal wall to repair the sinking of the bladder into the vagina (cystocele) or the sinking of the urethra into the vagina (urethrocele).

Alternative Names

A/P repair; Vaginal wall repair; Anterior and/or posterior vaginal wall repair; Anterior and/or posterior colporrhaphy

Description

To perform the anterior vaginal repair, the doctor makes a surgical cut through the vagina to release part of the front (anterior) vaginal wall that is attached to the base of the bladder.

Tissue between the vagina and bladder is folded and stitched to bring the bladder and urethra into the right position. There are several different versions of this procedure that may be necessary, based on the amount of bulging or sinking.

This procedure may be performed using general or spinal anesthesia. You may have a foley catheter in place for 1 - 2 days after surgery.

You will be given a liquid diet immediately after surgery, followed by a regular diet when your normal bowel function has returned. Your health care provider may prescribe stool softeners and laxatives to prevent straining with bowel movements, because this can cause stress on the area where surgery was performed.

A similar procedure can be performed on the back (posterior) wall of the vagina to repair a rectocele.

Indications

This procedure is used to repair the vaginal wall sinking (prolapse) or bulging (herniation) that occurs with urethrocele or cystocele. This surgery by itself does not treat stress incontinence. Another procedure is needed in women who have stress urinary incontinence along with a cystocele.

In mild cases of cystocele, your doctor may recommend trying pelvic floor muscle exercises (Kegel exercises) first, before using surgical treatment. In some women, a device placed in the vagina to hold up the prolapse (pessary) can be used to avoid surgery.

Risks

Risks for any anesthesia are:

Problems breathing
Reactions to medications

Risks for any surgery are:

Bleeding
Infection
Injury to surrounding structures

Possible complications from anterior vaginal repair include:

Inability to urinate
Injury to the bladder
Urinary tract infection

Expectations after surgery

Women treated with this procedure for cystocele have an excellent chance that the prolapse will be cured. This improvement will usually last for years -- but in some cases the tissue weakens with time, and other procedures may be necessary to treat the symptoms.

Convalescence

You should avoid activities that cause an increase in abdominal pressure, such as straining, sneezing, and coughing for several weeks to months after your surgery. You should avoid any activities that require lifting or straining.

You may need to take stool softeners or gentle laxatives to prevent constipation and straining with bowel movements. Your doctor may recommend that you avoid sexual intercourse until you have healed.

References

Maher C, Baessler K, Glazener CM, Adams EJ, Hagen S. Surgical management of pelvic organ prolapse in women. Cochrane Database Syst Rev. 2007;3:CD004014.

Holroyd-Leduc JM, Tannenbaum C, Thorpe KE, Straus SE. What type of urinary incontinence does this woman have? JAMA. 2008;299:1446-1456.

Rogers RG. Clinical practice. Urinary stress incontinence in women. N Engl J Med. 2008;358:1029-1036.

Review Date:4/24/2008
Reviewed By:Peter Chen, MD, Department of Obstetrics and Gynecology, University of Pennsylvania Medical Center, Philadelphia, PA. Review provided by VeriMed Healthcare Network. Also reviewed byDavid Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

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