June 3, 2022 Author : Leonor Santos Vaginal prolapse is common, around 10% of women who have had children need surgery to correct it. When it affects the anterior vaginal wall - prolapse of the anterior vaginal wall or cystocele - it is usually due to the weakening of the tissues that separate the vagina from the bladder and can go beyond the vaginal introitus. Woman can have a feeling of heaviness or a ball in the vagina. They also can have difficulty urinating, with a slower or intermittent stream of urine, or symptoms of urgency and/or increased urinary frequency. Correction of the anterior vaginal wall, or anterior colporrhaphy , is a surgery in which the supporting tissues (fascia) between the vagina and bladder are reinforced. The purpose of this surgery is to relieve symptoms of heaviness/ball sensation in the vagina, as well as improve bladder function and relieve urinary symptoms. How is the anterior vaginal wall repair performed? This surgery can be performed under general or locoregional anesthesia . A cut is made in the anterior wall of the vagina, from the entrance of the vagina to the vaginal vault (top of the vagina). The innermost tissue layer of the vagina (mucosa) is separated from the underlying supporting tissue (fascia). Stitches are applied to reapproximate the edges of the fascia. Its material is resorbable, so it is not necessary to remove the stitches, they will be resorbed over 4-6 weeks. Excess vaginal mucosa is removed and this is also closed with absorbable stitches. The anterior vaginal wall can also be reinforced with synthetic or biological meshes . This is more common when the surgery needs to be repeated or when the prolapse is large. At the end of the surgery, a compression tampon is placed in the vagina to prevent bleeding and a urinary catheter is maintained. Both are removed, as a rule, the day after the surgery. Surgery success rate Anterior vaginal wall correction has a high success rate of 70%-90% . Risks and complications of anterior vaginal wall repair All surgical interventions have potential risks or complications , both associated with the surgery itself and with anesthesia. The risks and complications of anterior vaginal wall repair are: Severe bleeding < 1%; Pelvic and vaginal infections are rare; Bladder infection (cystitis) 6%. Cystitis causes burning when urinating, increased urination, sometimes blood in the urine. Whenever necessary, it is treated with antibiotics; Constipation. To avoid it, a diet rich in fiber and increased fluid intake should be followed. The use of laxatives must be done by medical indication; Pain during sexual intercourse (dyspareunia); Bladder/ureter injury; Stress urinary incontinence may arise due to repositioning of the urethra; Complications associated with meshes being used, eg exposure, infection, withdrawal, pain, sexual dysfunction. Postoperative recovery and return to normal life After a correction of the anterior vaginal wall, it is normal to have a vaginal discharge for 4-6 weeks after the surgery, which is related to the stitches in the vagina. The discharge decreases as the stitches are reabsorbed. If this vaginal discharge has an unpleasant odor, medical attention should be sought. There may still be a slight bloody discharge right after surgery and/or it may appear brownish in color about a week after surgery. Postoperatively, it is important to avoid: Carrying weights; Do physical exercise; Having sex within 6 weeks of the surgery date. It is important to promote good intestinal functioning with a fiber-rich diet and increasing fluid intake . Depending on the professional activity, the period of leave after a correction of the anterior vaginal wall varies between 2 and 6 weeks . In general, healing is complete by 3 months after surgery. Sources International Urogynecologial Association. Anterior vaginal repair . Meet the obstetrics-gynecology clinical team drom Hospital da Luz network and book your consultation . The content published in the Health Guide is intended for the general public and is provided for informational and educational purposes only. It does not replace individual medical assessment, diagnosis, or personalized clinical advice from a qualified healthcare professional. The content is produced or reviewed by physicians and other healthcare professionals at Hospital da Luz and is based on the knowledge available at the time of publication or the most recent update, as indicated at the beginning of each item.
