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Operations: Vaginal operations to support outlet of female bladder

Insurance code: M5300

Introduction: This information is written by John Fairbank and is provided for the benefit of his patients. Additional information will be given during consultation in the clinic and during the pre-operative discussion. It is not appropriate for all surgeons’ individual practice or for all patients.

Purpose of operation: This vaginal operation is carried out to support the urethra or outlet of the female bladder. It is very similar to a similar operation called an anterior repair. It is carried out to correct a bulge in the front wall of the vagina or to help urinary incontinence although there are different operations that are often chosen in preference if incontinence is the main indication.

Description of procedure: The vaginal skin is opened and reflected off the bladder and cervix. The anterior vaginal wall and bladder base are supported with some stitches before the vaginal skin is closed. A vaginal pack and catheter are inserted to remain in place overnight.

Anaesthetic: This operation can be carried out under either a general anaesthetic or with a spinal anaesthetic that uses local anaesthetic and a slight sedative.

Length of stay: The length of stay depends on post-operative recovery but three nights stay would be typical.

Post-operative management: A vaginal pack is left in the vagina overnight to reduce bruising. A catheter is left in the bladder overnight and removed the following morning. The catheter is then left our provided bladder function is normal.

Potential complications
Complications at the time of surgery include peri-operative bleeding, and damage to structures such as the bladder. These complications are rare but require corrective surgery immediately or as soon as a problem is recognised. Venous thrombosis (DVT) can follow any pelvic surgery. Stockings are therefore worn and heparin injections given each day to reduce the risk. Early mobilisation and early discharge from hospital reduce the risk of thrombosis. Infection in the vaginal skin is common because of proximity to the bowel and anti-biotics are given at the time of surgery to reduce risk of infection. If offensive discharge, increasing pain or unusual bleeding are noted during the post-operative phase a course of anti-biotics may be necessary.

Post-operative consultation
A routine appointment is normally booked for three weeks or six weeks to ensure the vagina is well healed although other appointments may be necessary to ensure the post-operative course goes smoothly.

Other considerations
Sex is best avoided until the skin has healed and sutures have dissolved. This may take up to nine weeks. Heavy lifting is best avoided for three months to prevent stitches giving way but light lifting is not a problem. Driving short distances is practical once comfortable and strong sedative pain killers are no longer being taken.

Relevant websites
Guidelines on management of urinary incontinence. Requires Adobe acrobat reader.

Good information from the Royal College of Obstetricians and Gynaecologists on surgery for urinary incontinence.