A cystocele or bulge of the front wall of the vagina, also known as fallen bladder, usually results in loss of support to the bladder that rests upon this part of the vagina. The goal of a cystocele repair is to elevate the anterior vaginal wall back into the body and support the bladder. This can be done either vaginally called an anterior colporrhaphy or through an minimally invasive abdominal approach at the time of a sacralcolpopexy.
Anterior colporrhaphy is a commonly performed repair of a cystocele. In an anterior colporrhaphy an incision is made in the front wall of the vagina. The vaginal skin is separated from the bladder wall behind it. The weak or frayed edges of the deep vaginal wall are found and the strong tissues next the edges are sutured to each other lifting the bladder and recreating the strong vaginal wall underneath it. The vaginal incision is then closed with dissolving stitches. To reduce the recurrence of prolapse, a surgeon may chose to place a patch or graft over the repair line to reinforce the repair. This can improve long-term success from 50% without a graft to 90% with a graft. Studies are in progress to help us learn more about the risks and benefits of using graft materials.
Most insurance companies will cover this type of repair and our staff will help obtain authorization and schedule the surgery in a hospital for you. Many times this surgery is done in conjunction with other pelvic reconstructive surgeries or even cosmetic surgeries. Most patients will stay overnight in the hospital but some can leave the same day if they are doing well and ready to go home. Decreased activities for the first two weeks postoperatively are recommended. No heavy lifting or straining activities are recommended for a full three months after surgery. Postoperatively, most patients not only recognize the absence of a vaginal bulge, but also an improvement in their urinary habits and overall quality of life.
Click here to see Before and After pictures for this procedure.