Perigee - TRANSOBTURATOR ANTERIOR VAGINAL MESH REPAIR
- Patient Information Leaflet (Pelvic Health Care)  

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

Updated August 2008  

What is a Transobturator Anterior Vaginal Mesh Repair?

Anterior vaginal prolapse is the commonest form of prolapse of the front wall of the vagina, whereby the bladder descends or drops into the vaginal canal. In this procedure, a piece of permanent mesh is placed under the bladder and then attached to the pelvic sidewall with the transobturator approach. This minimally invasive approach has been successfully and safely used to support the urethra in patients with urinary stress incontinence. The mesh is designed to provide long lasting support and to reduce recurrence of vaginal wall prolapse. This is an operation designed by Professor Rane himself. 

What is involved?

The procedure is usually performed under general anaesthesia. An incision is initially made in the front wall of the vagina, the bladder is then dissected away from the vaginal wall. A small incision is then made on each side of the vulva to create a tunnel that connects to the area immediately beneath the bladder at the front wall of the vagina. A piece of permanent mesh is then passed between these incisions inside the body, through the strong obturator membrane, to create a special bridge to keep the front wall of the vagina elevated. 

Complications

A small number of women may develop difficulty-passing urine following surgery, and this may require the use of a catheter. There is a small chance of mesh rejection after the operation. This is usually in the form of a small piece of mesh coming out of the wound requiring trimming, which is usually done in the outpatient clinic. In very exceptional circumstances the mesh has to be removed if it is completely rejected. Other complications that are extremely rare may include bleeding or infection.

Anaesthesia itself is never without risks and the risks are greater for women, who smoke and are overweight.

Hospitalisation

This procedure is usually performed as day surgery. Remember to bring sanitary napkins into hospital, as you will some have vaginal bleeding post operatively. 

Results

The reported success rates of a standard anterior mesh repair ranged from 75-85% with follow-up of up to 3 years. We expect this new technique to be at least as efficacious as the above, with the added advantage of requiring less operating time. While anterior vaginal mesh repair continues to be evaluated, it is certainly starting to appear better than conventional surgery without mesh. Weight loss if overweight, reducing or quitting smoking, improving Pelvic Muscle tone by doing Pelvic Muscle exercises and continuing 40 per day even after surgery will help to ensure the operation is a success. 

Recovery When you go home you must not lift heavy objects or do strenuous work for a period of 6 weeks. Intercourse must also be abstained from for this period of time. 5 days of antibiotics have to be taken to prevent infection of the mesh.We strongly recommend taking anti-inflammatory medication (Nurofen) for 1 week, twice a day with food post operatively, unless you have a medical reason for not doing so or are already on anti-inflammatory medication.  

Afterwards You will be seen 10 to 12weeks after the operation for further assessment. If everything is well, there is a good chance that the success of your operation will 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. Please do not be alarmed when you see stitches falling out of the vagina during this period. It is a normal process. . 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).

The first week is the most important, where one must rest.
*It is important to check with your insurance company, re driving your car as each company has different policies on driving and surgery.

*The guidelines are minimum time before recommencing these activities

- 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 local Hospital 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 or offensive vaginal discharge
- You develop a temperature or become unwell.