What is an anterior repair?
In this operation a repair of the front of the vagina (the cystocele) is performed to reinforce the underlying vaginal wall tissue (the fascia). There is no vaginal mesh used in this operation. The operation is performed by vaginal incision only and can take about 30 minutes. The operation is usually performed at the same time as a vaginal hysterectomy. The surgery aims to alleviate prolapse symptoms as well as improving urinary function.
What does the operation involve?
An incision is made along the middle of the front wall of the vagina. The vaginal skin is separated from the underlying supporting layer (the fascial layer) and the weakened tissue is repaired with stitches which will be absorbed into the body over six to eight weeks. The time taken to fully absorb the stitches will vary depending on the type used. If there is excessive vaginal skin, this may be removed.
The operation is usually performed under general anaesthetic. Sometimes a cystoscopy may be carried out to check that there is no injury to the bladder. At the end of the operation, a catheter and vaginal pack may be inserted which will normally be removed within 24 hours. The vaginal pack helps to reduce the risk of excessive bruising and bleeding of the vagina.
Prolapse on the front wall of the vagina (the cystocele) commonly exists together with prolapse at other sites, such as the uterus or the back wall of the vagina (the rectocele). If there is a prolapse at any other site, repair of that site may be required at the same time.
What complications can occur?
The following complications can occur:
Urinary retention/voiding difficulty: This is the inability to pass urine. If this occurs, the urine can be drained using a catheter until you are able to pass urine independently, usually within 24 to 48 hours. If the problem persists, you will be taught Intermittent Self Catherisation (ISC). This is a procedure where you need to empty your bladder using a small tube or catheter.
Painful intercourse: Some women have problems with sex after any vaginal surgery because the vagina becomes very tight. While every effort is made to prevent this happening, it is sometimes unavoidable.
Damage to surrounding organs: Risk of damage to the bladder or ureters is low (2 in 1000 cases). Sometimes injury is not detected at the time of surgery and therefore requires a return to the operating theatre.
Urinary incontinence: Unfortunately a small percentage of women develop stress incontinence after this operation even when it is not expected. You may find that you need further physiotherapy treatment or even surgery at a later date.
Recurrence of prolapse: If you have had one prolapse, there is a risk of having another prolapse sometime in your life. This is due to a weakness in the vaginal tissue and means that the repair could fail or may not work.
What is the recovery following the surgery?
Most women stay in hospital for one night following anterior repair. Occasionally a longer stay may be required.
Although vaginal surgery does not produce a visible scar, the healing process still takes time. A creamy, brownish discharge, which is sometimes bloody too, is common for up to six weeks, and will gradually disappear as the stitches begin to be absorbed.
There is a risk of constipation for several weeks after surgery, and we can prescribe laxatives. No stitches will be damaged when the bowels do open, which will usually happen about two to three days after surgery.
You should be able to be fit enough for light activities within a month of surgery. However, we recommend you avoid very heavy lifting, heavy household chores, driving and sport for at least six to eight weeks to allow the wounds to heal. Most people need about six to eight weeks off work.
For many women, sex after the operation is improved because there is no longer any discomfort due to prolapse. However, this may be different. We advise that you avoid penetrative intercourse for about six weeks or until after your check-up with your doctor. You are advised to use a vaginal lubricant (such as K-Y jelly) or vaginal moisturiser (such as Sylk or Replens). These are available to buy over the counter at your chemist. Some women may also benefit from vaginal oestrogen therapy.
How successful is the operation?
The success rates for anterior repair are mainly positive, with most women noticing significant improvement in their symptoms. There is a risk of recurrence of prolapse in 10–30% of women. Factors that increase the chance of recurrence are related to increased pressure on the pelvic floor such as through straining, lifting heavy objects or a high BMI.
