The vaginal approach is used for prolapse and continence surgery. Sometimes the two are done together. The currently favoured method of repair uses your own tissues (Native tissue repair). There is a lot of media attention about the use of mesh for prolapse surgery and the current thinking is it is not appropriate to use for everyone and the small number of women who do need it will be best managed by a surgeon who specialises in this type of surgery. If appropriate I would refer you to a specialist who concentrates on this type of surgery.
Repairs can involve the front wall of the vagina, the back wall of the vagina, the top of the vagina or a combination of these. Results after surgery can vary and are affected by things like your type of prolapse, your weight, other medical conditions you may have which affect healing and tissue strength, hormone levels, constipation and previous surgery in this area. Heavy lifting, pregnancy and childbirth are risk factors and best avoided after this type of surgery.
What is done with this operation?
The area which is prolapsing is opened and supportive sutures are placed to recreate the strengthening tissues between the organ and the vaginal wall for example in the front this is the bladder and the back this is the bowel. The sutures dissolve slowly on purpose so that this repair has time to heal. If you have repair of the front and back then a vaginal pack is put into the vagina at the end of surgery to prevent the two suture lines sticking together. This is removed the next day. A catheter is placed in the bladder as it can be difficult to pass urine straight away and it will usually be removed one or two days later depending on what you had done and how mobile you are. Once it is removed we go through a period of monitoring your urine output and checking you are emptying your bladder properly as it is possible to have trouble with this initially. Avoiding constipation is very important and I will prescribe you medication to help with this which you should continue after going home. It is important in your recovery to avoid lifting and straining particularly in this healing phase which takes 6 weeks, but also in the long term if you want to avoid a recurrence.