Cystocele Repair

What is a cystocele repair?

A cystocele is a type of hernia in which the urinary bladder pushes against weakened tissue in the front and top wall of the vagina. It causes a bulging into the vagina. Common causes of a cystocele are aging, pregnancy with vaginal delivery, and heavy lifting.

A cystocele repair is an operation that lifts and tightens the tissue around the bladder so that the bladder no longer pushes into the vagina.

When is it used?

Surgical repair is done to relieve symptoms that may be caused by a cystocele.

Symptoms of a cystocele may include the following:

• If the urethra (the tube through which urine drains from the bladder) is pulled out of position, you may leak urine when you cough, laugh, or lift a heavy object. (This is called stress incontinence.)
• Your bladder may not empty completely after you urinate. The urine remaining in the bladder may then become infected, causing frequent and painful urination, or may leak when you cough, laugh or sneeze.
• You may have pressure sensations or bulging in the vagina.
• Sexual intercourse may be painful.

Examples of alternatives to cystocele repair include:

• doing muscle-strengthening exercises, called Kegel exercises
• placing a pessary in the vagina (A pessary is a device that can be put into the vagina to support the vaginal walls. Your healthcare provider can help you choose an appropriate one.)
• placing a diaphragm or tampon in the vagina to support its walls.

You should ask your provider about these choices.

How do I prepare for a cystocele repair?

Plan for your care and recovery after the operation. Allow for time to rest and try to find people to help you with your day-to-day duties.

Follow your healthcare provider's instructions about not smoking before and after the procedure. Smokers heal more slowly after surgery. They are also more likely to have breathing problems during surgery. For this reason, if you are a smoker, you should quit at least 2 weeks before the procedure. It is best to quit 6 to 8 weeks before surgery. Also, your wounds will heal much better if you do not smoke after the surgery.

Follow any other instructions your provider gives you. Eat a light meal, such as soup or salad, the night before the procedure. Do not eat or drink anything after midnight and the morning before the procedure. Do not even drink coffee, tea, or water.

What happens during the procedure?

You are given a regional or general anesthetic. A regional anesthetic numbs part of your body while you remain awake. A general anesthetic relaxes your muscles, puts you to sleep, and prevents you from feeling pain.

Your healthcare provider will make a cut in your vagina and expose the tissue between the vagina and the bladder. He or she will try to support the bladder by bringing more tissue around it. Stretched or extra tissue around the bladder will be removed.

If incontinence is a significant symptom, your provider may also perform an elevation or suspension procedure on the bladder. For the suspension, your provider may use a polyester mesh to cradle and lift the bladder.

The cut in the vagina will be sewn closed. Your provider may put a catheter (tube) into your bladder to drain urine. The tube may pass through the urethra (the tube through which urine normally flows) or your provider may insert it through a cut in the abdominal wall and into the bladder. This will help you pass urine while you are recovering and decrease the pressure inside your bladder.

What happens after the procedure?

You may stay in the hospital about 2 to 6 days. The catheter may stay in your bladder 2 to 6 days or until your bladder is working again, which may take 2 to 4 weeks.

During the first 4 weeks after the operation, you may have some smelly, sometimes bloody drainage from your vagina.

After you leave the hospital, avoid all heavy activity such as lifting for the first 2 weeks. Then follow your provider's recommendations for gradually increasing your activity.

Ask what other steps you should take and schedule follow-up visits with your healthcare provider.

What are the benefits of this procedure?

The procedure should help you to be more active. You might be able to resume your normal level of activity without leaking urine. Bulging and pressure sensations in the vagina will be relieved. Intercourse should be more comfortable and enjoyable.

What are the risks associated with this procedure?

• There are some risks when you have general anesthesia. Discuss these risks with your healthcare provider.
• A regional anesthetic may not numb the area quite enough and you may feel some minor discomfort.
• Your bladder could be punctured. If this happens (and your provider sees it), your provider will try to correct it during the operation.
• You may have infection or bleeding.
• The catheter can become blocked and need to be replaced.
• The ureter, urethra or bladder may be damaged and need more surgery.
• You may keep having leaking of urine.
• The cystocele may come back.

You should ask your provider how these risks apply to you.

When should I call my healthcare provider?

Call your provider right away if:

• The catheter becomes plugged and you stop passing urine.
• You develop a fever over 100°F (37.8°C).
• You have heavy bleeding from your vagina.

Call during office hours if:

• You have questions about the procedure or its result.
• You want to make another appointment.