Anterior vaginal wall or cystocele repair is an operation to correct prolapse of the bladder into the vagina. Aging, childbirth, obesity and heredity are contributing factors for this condition, which may be characterized by difficulty urinating, feelings of pressure, discomfort during sex and frequent infections. Non-surgical treatments include strengthening the pelvic muscles with Kegel exercises, using hormone creams, or wearing a pessary, which is similar to a diaphragm, to hold the bladder in place. All surgeries involve risks of infection and bleeding, formation of blood clots in the legs and anesthesia complications.
Reccurrence
Cystocele repair is accomplished through an incision in the anterior wall of the vagina. The bladder is lifted to a normal position and the vaginal wall folded or trimmed and sewn into place. Mesh material may be used to add strength, and the vagina may be attached with sutures to pelvic structures. Repair may alternatively be done through an abdominal incision. Although improvement of symptoms may last for years, bladder prolapse can reoccur and require repeated surgery. An analysis of studies of the surgical management of pelvic organ prolapse in women, published in the "Cochrane Database Systematic Reviews," concluded that the use of mesh inlays at the time of anterior vaginal wall repair reduces the risk of recurrent prolapse. Although absorbable mesh does not reduce this risk as much as nonabsorbable materials, the latter can cause foreign body reactions and erosion, according to a clinical study conducted in Egypt and published in "Advances in Urology" in 2009. In some cases, additional surgery may be needed to remove the mesh.
Poor Resolution of Symptoms
The patient's age, sexual activity, severity of symptoms and likelihood of future childbirth are taken into account when deciding the appropriateness of surgery to repair bladder prolapse. The American Congress of Obstetricians and Gynecologists (ACOG), in a patient education pamphlet, notes that no surgery or treatment is guaranteed to solve the entire pelvic support problem. According to ACOG, "Symptoms such as back pain, pelvic pressure, and painful sex may not be relieved by surgery to repair the prolapse."
New Symptoms
The urethra, bladder or vagina may be injured during surgery. The top of the vagina may fall, resulting in a different type of prolapse. The National Institutes of Health list these complications, along with irritable bladder and fistula, as risks of anterior vaginal wall repair. Irritable bladder is the involuntary contraction of muscles that causes a sudden, uncontrollable urge to urinate which leads to large volume accidents. The condition may be caused by damage to the nerves that control bladder function. A fistula is an abnormal opening that causes urine to leak through the vagina.
References
- "Cochrane Database Systematic Reviews", Surgical Management of Pelvic Organ Prolapse in Women, Maher C, et. al., Apr. 14, 2010, 4
- "Advances in Urology", Outcome of Treatment of Anterior Vaginal Wall Prolapse and Stress Urinary Incontinence with Transobturator Tension-Free Vaginal Mesh (Prolift) and Concomitant Tension-Free Vaginal Tape-Obturator, Abou-Elela A, et.al., 2009
- ACOG: Pelvic Support Problems
- Medline Plus: Anterior Vaginal Wall Repair
