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Anterior Repair

Prolapsed Bladder Surgery - Cystocele Repair

There are many types of prolapsed bladder surgery or surgery for fallen bladder. When a person has a fallen bladder (bladder prolapses) this simple means the ceiling of the vagina that holds the bladder in its normal position is broken. This condition is called a cystocele.

The patient has options for bladder prolapse treatment and they include: 1) do nothing as this is a quality of life issue and not life threatening 2) use a pessary – a supportive device placed in the vagina 3) surgery.

Two main types of cystocele repair or surgery for fallen bladder exist: 1) Anterior repair and 2) Paravaginal repair. Anterior repair is a vaginal procedure to repair a cystocele (dropped bladder) utilizing the patients own tissue/fascia for the repair. Even though the anterior repair is the most commonly utilized operation (and the oldest) for correction of a cystocele, anterior vaginal wall repair is probably not the most effective, nor is anterior repair the correct operation for restoring a woman's anatomy and maintaining vaginal length and function in many cases of cystocele. Anterior repairs should be used when the ceiling of the vagina (which supports the bladder) is broken in the center of the ceiling (known as midline or central defects. In fact, most prolapsed bladders are not due to central defects but instead because the ceiling of the vagina is broken at its lateral attachment ie the lateral walls of the vagina.

The problem with doing an anterior repair cystocele repair surgery in young, healthy, sexually-active woman with a paravaginal defect (lateral break cystocele) is the surgeon does not really surgically support the bladder, but instead reduces the bulge by "scrunching " the fascia under the bladder together. Most larger, symptomatic bladder prolapse are caused by the anterior vaginal wall tearing away laterally from its support to the pelvic sidewall muscles. This is called a paravaginal defect and this should be repaired laparoscopically when present. Click here to see paravaginal repair.

The anterior repair for a cystocele should or can be utilized in patients with:

  • Midline defects
  • Mild anterior wall relaxation
  • Defects which are not paravaginal
  • Cystocele of any type in patients whose vaginal function and length is not important

Normal SupportNormal Support - side view

CystoceleCystocele


Pictures of Prolapsed Bladders

Prolapsed Bladder 1

Prolapsed Bladder 2

Prolapsed Bladder 3

 

Cystocele Repair - Midline Defect Repair

The following illustrate a sequence of events in the repair of a midline defect cystocele. The patient has a cystocele due to a midline break in the pubocervical fascia.

Skin incisionFig. 1 - Skin Incision - of skin overlying fallen bladder.

Identifying Midline DefectFig. 2 - Identifying Midline Defect The break in the pubocervical fascia break is obvious as the bladder can be seen through the defect., the supporting layer of the bladder, is identified.


Repairing DefectFig. 3 - Repairing Defect - The break in the pubocervical fascia (support layer) is repaired

Closing the VaginaFig. 4 - Closing the Vagina - The covering layer known as the vaginal epithelium (skin) is closed using suture.




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