Prof. Ajay Rane

	Street Address: Mater Misericordiae Hospital, 21-37 Fulham Road, PIMLICO Q 4812 Postal Address: P.O. Box 1417, Thuringowa Central, 4817 Phone: 07 4727 4097 Fax: 07 4727 4099

Anterior Vaginal Repair
- Information for patients (Pelvic Health Care)

Prepared by:
Prof. Ajay Rane, Consultant Urogynaecologist MBBS MD MRCOG FRCS FRANZCOG CU
Audrey Corstiaans ,Urogynaecology Nurse

Updated July 2007

What is an Anterior Vaginal Repair?
Anterior vaginal prolapse or cystocele is a form of prolapse of the front wall of the vaginal, whereby the bladder descends or drops into the vaginal canal. Anterior Vaginal Repair is an operation performed to correct the prolapse by strengthening the supporting tissues between the vagina and the bladder that had resulted in the prolapse with self-absorbable or permanent stitches. The vaginal incision is then closed with self-absorbable sutures. These stitches do not need to be removed after the operation.

What is involved?

The operation is done either under a general or spinal anaesthesia and takes about 30 minutes.
It may be done with other procedures like hysterectomy or incontinence operation.

Complications
There is a 5-10% chance of difficulty-passing urine following surgery, and this may require the use of a catheter for 1 to 2 days. This is mainly related to the inflammation and irritation of the bladder wall and will almost always resolve as time goes by. There is also a 3% chance of heavy bleeding requiring blood transfusion. Occasionally, wound infection can develop after the operation but you will be given antibiotics during the operation to reduce the chances of this happening. Most infection cases can be treated with antibiotics alone. There is a small chance of making sexual intercourse painful after the operation but most patients improve with time. In very, very exceptional circumstances the bladder can be injured during the operation which may require prolonged catheterisation.

Results
The success of the repair is usually around 80 - 90%. Weight loss if overweight, reducing or quitting smoking, improving pelvic muscle tone by doing pelvic muscle exercises and continuing to do them after surgery will ensure that the operation is a success.

Recovery
When you go home you must not lift heavy objects or do strenuous work for about 6 weeks. Avoid intercourse for the same period. You can return to work usually in ten to fourteen days. 5 days of antibiotics have to be taken to prevent infection.

Afterwards
You will be seen in either the clinic or at urodynamics depending on what procedures you have had, 10 to 12 weeks after the operation. If everything is well the success of your operation should be permanent.

Post Operative Instructions

You will have some vaginal discharge for 4 to 6 weeks. This should be light bleeding or spotting only and this may vary during that period of time as healing occurs and your stitches dissolve.
You may feel the vagina to be lumpy or raised, this is vaginal tissue, NOT the return of your prolapse and should improve within 6 months.
We recommend you are not to self examine or self assess your operative site till you have been examined by the doctor post operatively.

Pain should be relieved with Panadol or Panadeine (remember if you take Panadeine, this increases the risk of constipation so ensure you have an adequate intake of fibre and fluids in your diet).

Do not use tampons, pads are better.
Do not drive an automatic car for	1 week*
Do not drive a manual car for	2 weeks*
Do not make a bed for	2 weeks
Do not hang out washing for	4 weeks
Do not use your Vaginal Oestrogen for	4 weeks
Do not stretch upward for	6 weeks
Do not do any lifting for	6 weeks
Do not have sexual intercourse for	6 weeks

The guidelines are minimum time before recommencing these activities.

* It is important to check with your insurance company, re driving your car as each company has different policies on driving and surgery.

- Remember to rest, if you are tired and uncomfortable you have been doing too much and need to slow down.
- Remember when emptying your bladder, sit on the toilet, feet flat and lean forwards.
- Drink 6 - 8 glasses of fluid per day; limit your caffeinated drinks to 3 per day.
- Ensure your fibre intake is 30 grams per day.
- If constipation is a problem, Lactulose, which you can buy from the chemist or another stool softener should be used.

Contact your G.P or your local Hospital Accident and Emergency if you experience any or the following
- Pain that is not relieved by Panadol or Panadeine
- Burning or difficulty passing urine
- Increased vaginal bleeding or passing clots
- Smelly of offensive vaginal discharge
- You develop a temperature or become unwell.