Anterior Vaginal Repair (colporrhaphy)

Indication

  • Prolapse of the bladder or urethra
  • Sometimes used to treat urinary stress incontinence

Surgical Technique

  • The procedure can be performed under regional or general anaesthesia
  • The vagina overlying the bladder and urethra is incised in the midline (figure 1)
  • Dissection in a plane directly below the vagina allows the damaged fascia supporting the bladder and urethra to be exposed (figure 1)
  • The fascia is plicated in the midline using delayed absorbable or permanent sutures.(figure 2)
  • Sometimes excessive vaginal skin is removed
  • The vaginal skin is then closed. (figure 3)
  • Other sites of prolapse are then repaired as required

Figure 1

Figure 2

Figure 3

Surgery will be covered with antibiotics to decrease the risk of infection and blood thinning agents will be used to decrease the risk of clots forming in the postoperative phase.

For the first 24 hours postoperatively a vaginal pack is often inserted into the vagina to decrease the risk of bleeding and a catheter is used to drain the bladder.

Complications

  • 5-15% women will develop recurrent bladder prolapse
  • 1-5% after a large bladder prolapse is repaired may develop stress urinary leakage that was not present before the surgery.
  • 1-2% have difficulty passing urine necessitating the need for catheters to be used for a prolonged period of time.
  • Inadvertent damage to the urethra or bladder occurs rarely and is usually repaired during the surgery. If the damage is not repaired at the time of the surgery a fistula between the bladder and vagina can occur (1-2/1000 cases)
  • 1-5% develop a urinary tract infection
  • Excessive bleeding after this surgery is uncommon.
  • Clots can form in the legs or lungs after surgery <1%
  • Performed in isolation anterior repair is unlikely to adversely affect sexual function. Confidence and comfort during sexual activity from repair of prolapse or urinary leakage is likely to have a positive effect on sexual function.

In hospital and recovery

You can expect to stay in hospital between 3-6 days. The vaginal pack, if used is removed on the first day and the bladder catheter after the first few days. In the early postoperative period you should avoid situations where excessive pressure is placed on the repair ie lifting, straining, coughing and constipation. Maximal fibrosis around the repair occurs at 3 months and care needs to be taken during this time. If you develop urinary burning, frequency or urgency you should see your local doctor. You will see Dr Maher at 6 weeks for a review and sexual activity can usually be safely resumed at this time. You can return to work at approximately 4-6 weeks depending on the amount of strain that will be placed on the repair at your work and on how you feel.