Obstetrics/Gynecology (Ob-Gyn)

Anterior vaginal wall repair (surgical treatment of urinary incontinence) - series

Normal anatomy

Normal anatomy
The vaginal opening lies just below the urethral opening, and just above the anal opening. The urethral opening, through which urine passes, leads to the bladder. The anus leads to the rectum. The vaginal opening leads to the vaginal canal, which leads to the uterus.

Indications

Indications
This procedure is used to repair the vaginal wall herniation that occurs with urethrocele, cystocele, or rectocele. This is occasionally performed to treat stress incontinence in women by supporting the bladder and urethra in its proper position, so it can function properly. As with most other surgical procedures, it is advised that you try medication and bladder retraining therapy first, before resorting to surgical treatment.

Procedure

Procedure
To perform the anterior vaginal repair, an incision is made through the vagina to release a portion of the anterior (front) vaginal wall that is attached to the base of the bladder. The bladder and urethra are then stitched into the proper position. There are several variations on this procedure that may be necessary based on the severity of the dysfunction. This procedure may be performed using general or spinal anesthesia. You may have a foley catheter in place for 1 to 2 days after surgery. You will be given a liquid diet immediately after surgery, followed by a low residue diet when your normal bowel function has returned. Stool softeners and laxatives may be prescribed to prevent straining with bowel movements since this can cause stress on the incision.

Aftercare

Aftercare
Women treated with this procedure have approximately a 60% rate of success in relieving symptoms. You should avoid activities that cause an increase in abdominal pressure, such as straining, sneezing, and coughing. Try to tighten your pelvic muscles when coughing or sneezing to support the bladder. You may need to urinate at least every 2 to 3 hours, or perform clean intermittent self catheterization (CISC), to keep your bladder from getting too full and putting pressure on the stitches. You should avoid any activities that require lifting or straining. You may need to take stool softeners or gentle laxatives to prevent constipation and straining with bowel movements.

Review Date: 6/18/2012
Reviewed By: Linda J. Vorvick, MD, Medical Director and Director of Didactic Curriculum, MEDEX Northwest Division of Physician Assistant Studies, Department of Family Medicine, UW Medicine, School of Medicine, University of Washington; and Scott Miller, MD, Urologist in private practice in Atlanta, Georgia. David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc.
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