Cystocele Repair

Cystocele repair is typically done to correct bulging of the front wall of the vagina. This bulging can cause symptoms such as the sensation of sitting on a ball, incomplete emptying of the bladder, overactive bladder symptoms, recurrent urinary tract infections, and pelvic discomfort. The surgery is usually done through a vaginal approach, but in some circumstances a combined abdominal and vaginal approach to the repair is made. Surgery typically starts by making an incision along the vaginal skin overlying the bladder. If other surgeries for relaxation of pelvic tissues are being done, other incisions may be made. The tissue covering the bladder is assessed for areas of weakness or broken fascia tissue. These breaks and weaknesses are repaired with suture and sometimes covered with a graft or mesh. If there is any bulging of the rectum into the vagina, this will also be repaired at the same time- this is called a posterior repair or rectocele repair. The most common postoperative symptom after vaginal cystocele repair is pelvic pressure and discomfort. This should resolve over several weeks as the tissue heals. The success for this procedure to correct the bulge is over 85-90% depending on the technique used. Symptoms that may be from the cystocele, such as voiding difficulties or ugency, improve or resolve between 60-80% of the time. Some light vaginal bleeding is common for 4-6 weeks as the incision heals.

The risks of the procedure are those general risks of any major pelvic surgery, which include the risks of an anesthetic, the risk of blood clots, as well as infection and bleeding. With any surgery there is always the risk of dying, although this is very rare with benign (non-cancer) gynecologic surgery. Other possible complications are injury to the bladder, urethra, bowel, ureters, blood vessels and nerves. Injury to the bladder, urethra and ureters can occur during these surgeries, but fortunately is uncommon. Patients with any previous surgeries may be at greater risk of injury to the bladder, urethra and ureter. We look inside the bladder and urethra with a cystoscope during the surgery to make sure no injuries have occurred. Nerve injury is rare, but may result from longs surgeries, and usually resolves with time.

It is possible that a graft or mesh may be used during the surgery to help in the long term success of the repair. The possible types of grafts/meshes we use include cadaveric fascia (Tutoplast), cadaveric dermis (Repliform), or polypropylene (Polyform). With any type of graft of mesh there is the possibility of rejection or exposure of the graft/mesh, such that the vaginal incision opens up partly. The more common exposure may be able to be treated with observation or a minor procedure in the office. Extremely rarely, this mesh/graft could erode into the bladder requiring more extensive surgery.

Other risks, common to all pelvic surgery, include the possibility of clot formation in the legs or lungs, which can be a life threatening condition. Prevention includes use of compression stockings during surgery, and early walking the day after your surgery. Anesthetic risk includes collapse of a portion of the lung, pneumonia, and very rarely, death. Prevention of complications includes early walking after the operation, deep breathing exercises and coughing, and use of an incentive spirometer. Pre-operative medical conditions such as diabetes, high blood pressure, lung disease, and heart disease increase the risk associated with surgery, as does advanced age. Obesity is an additional risk factor, and along with diabetes can affect the healing of the incision. Smoking can also affect healing. Possible long term complications from vaginal cystocele repair include narrowing or shortening of the vagina due to the repair and healing process. This could cause difficulty or pain with intercourse and may require dilation or a minor surgery to correct the narrowing.

It is of critical importance that you do not do any heavy lifting (over 5-10 pounds) after surgery, as part of the success of the procedure relies on good scarring around the repair site. Also, we recommend no intercourse, douching or tampons for the first 4-6 weeks. You will go home with pain medicine and a stool softener, as excess straining can affect the repair. Please call us if you have a fever over 100.5 F consistently at home, pain that worsens or is not controlled by medicines, excess discharge or concerns for wound infection, heavy vaginal bleeding or discharge, nausea or vomiting, leg pain or swelling, or new shortness of breath.

Immediately after Surgery:
You will wake up with a catheter in your bladder and possibly a pack in your vagina, as well as those compression stockings.
On the first day after your surgery the packing and catheter usually come out. The nurse may check to see if you have emptied your bladder all the way with an ultrasound scanner or by passing a catheter after you try to void. For patients who cannot empty their bladder completely, the nurse will teach you to pass the catheter on your own (self-cath). Your diet is generally started as only liquids and advanced as you are able. Most often, you can be switched from IV pain medications to oral medications. Also, you will be encouraged to sit in a chair, go for some short walks, and generally increase your activity. Most patients go home on the day after their surgery.
Week 1:
Rest at home; not responsible for making meals for other, or major care of children, or relatives.
Up and around the house as desired including stairs if necessary; do not become overtired, take an afternoon nap.
May shower.
Stick to a simple diet (light foods and liquids) until your first bowel movement, and then you may eat what you like.
Refrain from intercourse for six weeks.
Use either the prescription for pain, or Tylenol or Advil (ibuprofen) equivalent for pain.
Weeks 2 & 3:
Increase your activity as desired, but avoid all major housekeeping chores.
Walking inside or outside is encouraged, but do not become overtired.
Rest for one hour each afternoon.
You may drive a car when you have no pain.
Weeks 4-12:
All activities are OK except heavy housework or exercise.
Discuss return to work with your doctor.
It remains important not to become overtired or to perform any heavy lifting, strenuous exercise or physically demanding duties for a total of six weeks from the date of operation. Healing is not complete for 12 weeks (3 months) from the time of surgery.

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