Is Cystocele Repair a Major Surgery?

Reviewed on 11/10/2020

Cystocele (bladder prolapse) repair is major surgery.
Cystocele (bladder prolapse) repair is major surgery.

Yes, cystocele (bladder prolapse) repair is major surgery. Even if your surgery is done through a less invasive way, surgeries to repair prolapse tend to be major surgery. Any surgery that requires general or regional anesthesia, overnight stay at the hospital and removal or repair of an organ is classified as major surgery.

Other things to note about these surgeries are as follows:

  • Failure rate: None of these procedures has a 100% successful rate. According to studies, 5-15% of women may have to face failure even after a prolapse repair surgery. Usually, there is a partial failure in these cases and requires no treatment or sometimes pessary (device placement in the vagina) or less extensive surgery than originally may help.
  • Risk of the graft material: Grafts used in prolapse repair are made up of medical-grade polymer called polypropylene, which is also used for hernia repair. Around 90% of women do very well with this material. However, 5-10% of women may experience exposure of the material into the vagina and vaginal discharge or spotting. Then the mesh material will be removed.
  • Other risks: Other less common complications associated with these mesh grafts include infection that can be well managed with antibiotics. Sometimes, another surgery may require removing the graft. Smoking tobacco may increase the risk of mesh exposure in women. Every woman has a different risk or benefit response to graft repairs.

The good thing is that bladder prolapse (cystocele) is generally not life-threatening, and it can be fixed with many non-surgical methods.

If you are bothered enough by your symptoms and now want surgery to fix them, then you should follow the recommended restrictions and instructions given by your doctor after the surgery even if you feel okay so that the chances of achieving permanent success can increase. Currently, women with severe or recurrent prolapse who want to retain sexual function are highly benefited by mesh reinforcement procedures.

What does cystocele mean?

Cystocele means a prolapsed or dropped/fallen bladder (urine pouch). It is the bulging or dropping of the bladder into the woman’s vagina (the tube that connects the womb to outside the woman’s body).

It mostly occurs when the wall between a woman’s bladder and her vagina weakens due to

Mild prolapse often may not show any symptoms. However, if you have severe bladder prolapse, then you may experience

  • A bulge in the vagina.
  • Heaviness or fullness in the pelvic (groin) area.
  • Difficulty starting a urine stream.
  • Frequent or urgent urination.
  • Urine leakage during sneezing or coughing.
  • Incomplete emptying of the bladder.
  • Discomfort while walking and standing for a long time.

Mild bladder prolapse can be treated with conservative therapies such as

Surgery is the last option for women who are bothered by prolapse.

QUESTION

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What does cystocele repair mean?

Cystocele repair is a surgical procedure that is performed to repair the sinking of the vaginal wall or bulging of the bladder into the vagina.

The surgery may help to restore the normal position of your bladder and may reduce the pressure caused due to the bulging bladder onto your vagina. These surgeries are generally recommended in severe prolapse cases when physical therapy and medications do not resolve the condition. Surgery is generally done by taking a cut on the vagina or belly with basic three methods:

  • Anterior colporrhaphy: In this, the prolapsed bladder is repaired by making a cut on the vaginal surface and stitching the internal surface to strengthen the area.
  • Paravaginal repair: It repairs the prolapsed bladder by attaching it to the pelvic sidewalls.
  • Anterior colporrhaphy with graft: In this, a tissue graft is placed (if the tissue lining is very thin) along with stitches on the internal surface of the vagina.

What happens during the procedure?

Before the surgery,

  • Your gynecologist (women’s specialist)/urologist (urine specialist) will examine your condition and identify the fallen bladder.
  • They may discuss the symptoms to confirm the exact reason and may order some additional tests to assess any more damage to the urinary system.

During the surgery,

  • Under general anesthesia, an incision is made in the vaginal wall.
  • The tissue between the bladder wall and the vaginal wall is tightened with stitches to allow the strengthening of the muscles and ligaments.
  • Sometimes, extra tissue may be removed, or tissue grafts are used (if the tissue lining is very thin).

What to expect after the surgery?

What to expect:
  • You may be required to stay in the hospital for one to two days.
  • You will be discharged with a catheter in place for some time.
  • You will be able to pee normally after two to six weeks.
  • You can resume your normal activities in about six weeks.
  • You may be able to resume sexual intercourse in less than six weeks.
  • You will be informed to
    • Avoid strenuous activities such as lifting heavy weights and standing for long periods for at least the first three months.
    • Increase your activity level gradually.
    • Avoid straining during defecation.

What are the possible complications?

Complications include:
  • Bladder infection
  • Bladder injury
  • Leakage of urine
  • Inability to pass urine
  • Painful sex
  • Formation of an opening between the vagina and bladder
  • Surgery failure

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References
American Urogynecologic Society https://www.voicesforpfd.org/pelvic-organ-prolapse/faqs/

Journal of Reproductive Medicine Vetere PF, Putterman S, Kesselman E. Major reconstructive surgery for pelvic organ prolapse in elderly women, including the medically compromised. J Reprod Med. 2003 Jun;48(6):417-21. PMID: 12856511. https://pubmed.ncbi.nlm.nih.gov/12856511/

Medscape https://emedicine.medscape.com/article/1848220-overview

Mayoclinic https://www.mayoclinic.org/diseases-conditions/cystocele/diagnosis-treatment/drc-20369457

Clevelandclinic https://my.clevelandclinic.org/health/diseases/15468-cystocele-fallen-bladder/management-and-treatment

University of Michigan https://www.uofmhealth.org/health-library/tv1498

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