Cystocele & Pelvic floor repair

1. What is it? Any common name for this procedure?

A Cystocele (also known as a prolapsed bladder) occurs when the supportive tissue between a woman's bladder and vaginal wall weakens and stretches, allowing the bladder to bulge into the vagina.

Pelvic Floor Repair (specifically Anterior Colporrhaphy) is the surgery to tighten these supportive tissues, lifting the bladder back into its natural position and reinforcing the vaginal wall.

Common Names:

• Bladder Prolapse Repair
• Anterior Repair
• Vaginal Wall Repair

2. Common Indications: When is it Recommended?

Surgery is usually considered when non-surgical options (like pelvic floor physical therapy or a vaginal pessary) haven't provided enough relief.

• Bulge Sensation: A feeling of fullness, heaviness, or "something falling out" of the vagina.
• Difficulty Voiding: Having to push the bulge back up to start or finish urinating (splinting).
• Incomplete Emptying: Feeling like the bladder isn't empty even after urinating.
• Recurrent UTIs: Stagnant urine in the "dropped" bladder can lead to frequent infections.
• Pain during Intercourse: Physical discomfort caused by the prolapsed tissue.

3. List of Associated Risks and Conditions

• Urinary Incontinence: Sometimes, fixing the prolapse "unmasks" stress incontinence that was being hidden by the bulge.
• Dyspareunia: Pain or discomfort during sexual intercourse due to scar tissue or narrowing of the vaginal canal.
• Recurrence: Because the patient's own tissue is weakened, there is a risk the prolapse could return over time.
• Urinary Retention: Temporary difficulty urinating immediately after surgery due to swelling.

4. List of Screening Tests and Assessment Tools

5. Am I Eligible for This Evaluation?

1. Symptomatic Prolapse: The bulge is causing significant physical discomfort or interfering with your daily life.
2. Completed Childbearing: Future vaginal births can often tear the surgical repair.
3. Failed Conservative Management: You have tried Kegels or a pessary and found them insufficient or uncomfortable.
4. Surgical Fitness: You are in good enough health to undergo anesthesia and heal properly.

6. The Procedure: Anterior Colporrhaphy

• Approach: Most repairs are done transvaginally (entirely through the vagina), meaning there are no external incisions on the belly.
• The Repair: The surgeon makes an incision in the vaginal wall, pushes the bladder back up, and uses strong, dissolvable sutures to tighten the underlying supportive tissue (fascia).
• Mesh vs. No Mesh: In most primary repairs, the patient's own tissue is used. Synthetic mesh is sometimes used for more complex or recurrent cases, though this is carefully considered due to potential complications.

7. Days Required for Hospitalization

• Surgical Time: 45 to 90 minutes.
• In-Hospital Stay: 0 to 1 Day. Many patients go home the same day; others stay overnight to ensure they can urinate comfortably.
• Recovery: You must avoid heavy lifting (over 5kg), straining, and sexual intercourse for 6 to 8 weeks to ensure the sutures don't pop and the tissue heals strongly.
• Hospitalization: 0–1 Day.

8. Benefits of Pelvic Floor Repair

• Symptom Relief: Eliminates the uncomfortable "bulge" and heavy sensation in the pelvis.
• Improved Bladder Function: Makes it easier to empty the bladder completely and naturally.
• Improved Quality of Life: Restores the ability to be active, exercise, and socialize without the constant distraction of pelvic pressure.
• Aesthetic Restoration: Returns the vaginal anatomy to its original, more supported state.