A vaginal wall repair surgery is to reinstate the muscles that hold the vaginal walls in position, in other words repair vaginal wall prolapse.
This surgery is required under two circumstances:
Anterior vaginal wall repair: It is used to treat the prolapse of the vaginal wall below the urinary bladder (cystocele or dropped bladder)
Posterior vaginal wall repair: The vaginal wall when prolapses over the rectum (rectocele)
The operating surgeon makes the decision if both are needed and it can be a prompt one taken during the surgery.
Diagnosis of anterior prolapse may involve the following examinations:Pelvic exam:
This is done by the doctor while the patient is in a standing position and while lying down. This is to check the bulge of tissue into the vagina and the extent of bulge.
The doctor may also ask the patient to assume a position while bowel movements, to evaluate the extent of hindrance caused by the prolapse.
The patient may also be asked to contract pelvic floor muscles trying to stop a stream of urine.
Some doctors may ask the patient to fill out answers to a questionnaire to understand in retrospect how the prolapse has affected the lifestyle of the patient.
This aids to decide the best treatment protocol for the patient.Urine and bladder tests:
A urine routine may be performed to rule out any infection that results from an infection of the bladder.
The doctor may also perform tests to evaluate how well the bladder empties. The infection could be due to the bladder holding more than normal after urinating.Diagnosis of anterior prolapse may involve the following examinations:
It is done during a pelvic examination of the rectum and vagina.
The doctor may also ask the following questions:
To assume a position while bowel movement to assess the extent of the bulging tissue within.
To tighten pelvic floor muscles as if to stop a stream of urine. This is to assess the strength of the muscles.
And possibly a questionnaire to evaluate the degree to which the patient’s lifestyle has been hindered.
On rare occasions the doctor may also ask to imaging tests:
X-ray or MRI: To assess the bulge of the tissue
Defecography: To assess the efficiency with which the rectum evacuates
A surgery is considered when the conservative noninvasive methods do not seem to give lasting relief and hinder the lifestyle. Most importantly to ward off a medical complication.
Initial stages of the condition are managed with Kegel exercises (pelvic floor exercises), which help strengthen the muscles of the pelvic floor.
The doctor may also use a supportive device called pessary, especially for women where the surgery poses a risk. A pessary is a rubber or plastic ring that fits snugly in the vagina and supports the bladder alleviating the symptoms of the prolapse. The doctor also instructs, such that the patients can do it by themselves.During the surgery:
The surgery is performed mostly under general anesthesia; that means the patient is asleep during the surgery.
Once anesthetized a catheter is inserted into the urinary bladder to drain the bladder and quantify the urine coming to the bladder in the duration of the surgery. The catheter is removed before discharge.
An incision is made on the top or bottom wall of the vagina.
The stronger tissues underlying the soft skin tissue are pulled and stitched together. The stitched tissue is the inner lining of the vagina. The incised skin too is repaired.
No strengthening artificial mesh is used. A tissue graft by an animal donor may be used, but this is with prior discussion and consent of the patient.
After the surgery the patient is monitored in the recovery room.
The patient may stay at the hospital overnight before discharge. In most cases, the discharge may be given the same day.
Depending on the recovery, the doctor decides when to discharge the patient.
Once discharged the patient will be scheduled for a few visits in the subsequent weeks to monitor complete recovery and gradual return to normal lifestyle.
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