Vaginal Repair and Urethral Slings

Vaginal repair is performed for women with symptomatic vaginal prolapse. Vaginal prolapse is often associated with dragging pelvic discomfort, urinary incontinence, constipation and faecal or flatal incontinence.

Urethral slings are performed for women who have urinary stress incontinence but may not have overt signs of anterior vaginal prolapse.

Some women with urinary stress incontinence can have a vaginal repair, sub urethral sling or both procedures performed at the same time.

Types of vaginal prolapse

• Anterior vaginal wall usually involves a prolapse of the bladder (Cystocoele).
• Posterior vaginal prolapse involves prolapse of the rectum (Rectocoele).
• Vaginal vault behind the cervix, involves prolapse of the bowel (Enterocoele).

Symptoms

Symptoms experienced by patients will depend on the type of prolapse present.

Most patients will experience a dragging sensation in the vagina. Some may have prolapse bad enough to notice a lump protruding through the vagina when bearing down. More specifically patients with a cystocoele are likely to have urinary incontinence. Women with a rectocoele and are likely to have constipation.

Treatment

Repair of a vaginal prolapse involves excision of redundant vaginal epithelium and placement of supporting sutures into tissues beneath the vaginal skin.

Vaginal repair may be performed in conjunction with a vaginal hysterectomy if there is uterine prolapse. Insertion of a sub urethral sling can also be performed if urinary incontinence is present.

The underlying cause for genital prolapse is that the vaginal and uterine supports are weak and as a result repairing the prolapse by buttressing these supports may ultimately fail if they weaken further over the years.

It has recently become practice to insert synthetic material below the skin to provide extra support. This material (mesh) has the capacity to erode through the skin and require piece meal resection if erosion occurs.

Mesh erosion can be quite distressing for patients and as a result.

I do not use mesh in my vaginal repair.

Women recover from vaginal surgery and can resume normal activities quickly.

Heavy lifting should be avoided until healing is complete and this can take up to twelve weeks.