Vaginal Surgery

It is quite surprising what can be done this way and it is the source of all those jokes about Gynaecologists re-building car engines through the letterbox. In this regard, it can be complex and challenging.
Largely, vaginal surgery is performed for prolapse or urinary incontinence or both. The method of repair will use either your own tissues (Native tissue repair) or Mesh or both. Results also vary based on a patient's weight, age, hormone status, degree of prolapse, constipation, chronic asthma, past surgery, lifestyle etc.

There are 3 areas to operate on, in any combination: 

Front wall prolapse (Anterior Vaginal Repair)

Back wall (Posterior Vaginal Repair)
Vault Suspension (top of the vagina)
Post-op:
An In-Dwelling Catheter (IDC) is often present for 24 - 48 hours depending on the operation. It will remain for 7-10 days if the bladder was opened for any reason or if you do not pass your Trial of Void.
 
Vaginal Pack -
this is a long piece of gauze dressing, used to apply pressure to the vaginal walls and reduce blood loss. It will give you a ‘full bowel' feeling and is usually left in until the next morning unless you find it too uncomfortable. It does not hurt to remove.
 
Pain after surgery varies with the procedure but most women find it tolerable and require little pain relief. Pain in the hips due to positioning on the table or sutures / mesh passed through ligaments is also operation dependent.
 
Bowel
Function is very important. Make sure you continue taking stool softeners and have plenty of fluids. Constipation is a big problem, especially after a Posterior Repair.
 
Urinary Tract Infections occur in about 3% of patients.
 
Recovery is always 6 weeks. Don't do any heavy lifting or straining. If you weigh 100+ kg, this includes heaving yourself up into 4 wheel drives. Take it easy, because if you stretch the newly formed scar tissue, you will get a recurrence.
 
A few words about Continence (urethra and bladder neck) operations:
Sutures are removed the following week and a review performed 4-6 weeks later.

Mesh Repairs for prolapse or incontinence utilize one of a number of commercially available polypropylene products which replace and enhance existing tissue supports. These are often utilized when doing repeat procedures or for the very large prolapse. Continence operations now use these products as a routine first line measure.
The mesh is a permanent structure and there are some complications, specific to these products, which can occur.
Scarring can occur. Either from exposure or shrinkage of the mesh. Again, pain with intercourse would be the most common symptom and the mesh may need to be removed.

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