Cystocoele repair

Cystocele Repair (Anterior Vaginal Wall Repair)

Cystocele repair is a surgical procedure to correct a condition where the bladder bulges into the vaginal wall. This condition, also known as a prolapsed bladder, occurs due to weakened or stretched pelvic floor muscles and tissues. It is most commonly caused by childbirth, aging, or strain on the pelvic floor.

Types of Cystocele

1. Mild (Grade 1): The bladder droops slightly into the vagina.
2. Moderate (Grade 2): The bladder prolapses to the opening of the vagina.
3. Severe (Grade 3): The bladder bulges out through the vaginal opening.

Indications for Cystocele Repair

Surgical repair is recommended if:

• Symptoms are severe and affect quality of life.
• Non-surgical treatments (e.g., pelvic floor exercises, pessary use) fail.
• Symptoms include:
  • Urinary incontinence or difficulty urinating.
  • Frequent urinary tract infections.
  • Pressure, discomfort, or a bulging sensation in the pelvic area.

Procedure

1. Pre-Surgery Preparation:

   • Comprehensive medical evaluation.
   • Stopping certain medications (e.g., blood thinners).
   • Fasting as directed by the surgeon.

2. During the Surgery:

   • Anesthesia: General or regional anesthesia is administered.
   • Incision: A small incision is made in the vaginal wall.
   • Bladder Support: Excess or weakened tissue is removed, and the remaining tissue is tightened. In some cases, a synthetic mesh may be used to reinforce the repair.
   • Closure: The incision is closed with dissolvable sutures.

3. Duration: The surgery typically takes 1-2 hours.

Post-Surgery Recovery

1. Hospital Stay:

   • May last 1-2 days, depending on recovery and any complications.

2. Activity Restrictions:

   • Avoid heavy lifting, strenuous activities, and sexual intercourse for 6-8 weeks.
   • Gradually increase physical activity as advised by the surgeon.

3. Pain and Swelling:

   • Mild discomfort and swelling are normal; manage with prescribed pain medications.

4. Bladder Care:

   • A catheter may be placed temporarily to help with urination.
   • Follow-up appointments are necessary to monitor healing.

Risks and Complications

1. Short-Term Risks:

   • Bleeding, infection, or pain at the surgical site.
   • Difficulty urinating.

2. Long-Term Risks:

   • Recurrence of the prolapse.
   • Urinary incontinence or overactive bladder symptoms.
   • Vaginal scarring or discomfort during intercourse.

Alternatives to Surgery

1. Pelvic Floor Exercises (Kegels):

   • Strengthen pelvic floor muscles and support the bladder.

2. Pessary Use:

   • A removable device inserted into the vagina to support the bladder.

3. Lifestyle Changes:

   • Weight loss, avoiding heavy lifting, and managing chronic coughing or constipation.

Outlook

Most women experience significant symptom relief and improved quality of life after cystocele repair. However, adherence to post-surgery care and lifestyle changes is crucial for long-term success.