Type of Surgery
Information
Last updated: 02/17/2009
The goals of cystocele repair are to relieve a patient's symptoms, to improve or maintain urinary and sexual function, to return pelvic structures to their original position, and to prevent the formation of new defects. The anatomical structures involved...
in a cystocele may be approached vaginally, abdominally, or laparoscopically.
Vaginal repair
Anterior colporrhaphy is the most common procedure to repair a central defect. The patient is first given general or regional anesthesia. A speculum is inserted into the vagina to hold it open during the procedure. An incision is made into the vaginal skin and the defect in the underlying fascia is identified. The vaginal skin is separated from the fascia and the defect is folded over and sutured (stitched). Any excess vaginal skin is removed and the incision is closed with stitches.
Lateral defects may be repaired vaginally or abdominally. During a vaginal paravaginal repair, the approach and initial incision are similar to anterior colporrhaphy. The defect to the fascia is located and reattached to the arcus tendineus using sutures. The incision may then be stitched closed.
Abdominal and laparoscopic repair
A cystocele caused by a lateral defect may be treated through an abdominal incision made transversely (from side to side) just above the pubic hairline. The space between the pubic bone and bladder is identified and opened and the pubocervical fascia reattached to the arcus tendineus using methods similar to the vaginal paravaginal repair. In some cases, a retropubic colposuspension is performed during the same surgery. Also called a Burch procedure, colposuspension treats urinary incontinence by suspending the bladder neck to nearby ligaments with sutures. Other surgical treatments for incontinence may be combined with paravaginal repair.
A lateral defect may also be repaired by laparoscopy, a surgical procedure in which a laparoscope (a thin, lighted tube) and various instruments are inserted into the abdomen through small incisions. A patient's recovery time following laparoscopic surgery is shorter and less painful than following a traditional laparotomy (a larger surgical incision into the abdominal cavity).
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Other Information
Definition
A cystocele is the protrusion or prolapse of the bladder into the vagina. A number of surgical interventions are available to treat cystoceles.
Purpose
A prolapse occurs when an organ falls out of its normal anatomical position. The pelvic organs normally have tissue (muscle, ligaments, etc.) holding them in place. Certain factors, however, may cause those tissues to weaken, leading to prolapse of the organs. A cystocele may be the result of a central or lateral (side) defect. A central defect occurs when the bladder protrudes into the center of the anterior (front) wall of the vagina due to a defect in the pubocervical fascia (fibrous tissue that separates the bladder and vagina). The pubocervical fascia is also attached on each side to tough connective tissue called the arcus tendineus; if a defect occurs close to this attachment, it is called a lateral or paravaginal defect. A central and lateral defect may be present simultaneously. The location of the defect determines what surgical procedure is performed.
Other Information
In 2000, the estimated number of doctor visits and outpatient hospital visits by patients aged 20 or older with UTI or cystitis listed as a diagnosis was of 8.27 million visits (1.41 million men; 6.86 million women) with UTI as the primary diagnosis.
From: NKUDIC
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