Name of the Procedure:

Combined Anteroposterior Colporrhaphy, including cystourethroscopy

Summary

Combined anteroposterior colporrhaphy is a surgical procedure that repairs both the anterior and posterior walls of the vagina. It often includes cystourethroscopy, a procedure that involves examining the interior of the bladder and urethra using a specialized scope.

Purpose

This procedure corrects vaginal prolapse, a condition where the vaginal walls weaken and bulge into the vaginal canal. The goal is to restore the normal structure and function of the vaginal walls, reduce symptoms like discomfort or urinary issues, and improve the patient's quality of life.

Indications

• Bulging or protrusion in the vaginal area
• Discomfort or pain in the pelvic region
• Urinary symptoms such as incontinence or difficulty urinating
• Specific conditions such as cystocele (anterior prolapse) or rectocele (posterior prolapse)
• Patients who have not responded to conservative treatments like pelvic floor exercises or pessaries

Preparation

• Patients may be instructed to fast for several hours before the procedure
• Medication adjustments, such as stopping blood thinners
• Preoperative assessment including physical examination and imaging studies
• Instructions to avoid smoking and alcohol before surgery

Procedure Description

1. Anesthesia is administered, typically general or regional.
2. The surgeon makes incisions in the vaginal walls.
3. Excess tissue is removed, and the weakened tissues are tightened and sutured to restore normal structure.
4. Cystourethroscopy is performed to examine the bladder and urethra for any abnormalities.
5. The incisions are closed with sutures that are often absorbable.

Duration

The procedure typically takes between 1 to 2 hours.

Setting

This surgery is usually performed in a hospital or a surgical center.

Personnel

• Surgeons specialized in gynecology or urogynecology
• Anesthesiologist or nurse anesthetist
• Surgical nurses and operating room staff

Risks and Complications

• Possible risks include bleeding, infection, and pain
• Rare complications may include damage to surrounding organs (such as the bladder or rectum), urinary retention, or recurrence of prolapse
• Management of complications may require additional treatment or surgery

Benefits

• Relief from symptoms like discomfort, pain, and urinary issues
• Improved pelvic floor function
• Enhanced quality of life following the recovery

Recovery

• Post-procedure care includes pain management, avoiding strenuous activities, and possibly using a catheter temporarily
• Patients can usually return to normal activities within 4 to 6 weeks
• Follow-up appointments to monitor healing and ensure proper recovery

Alternatives

• Non-surgical treatments: pelvic floor exercises (Kegels), pessary devices
• Minimally invasive procedures may be an option in certain cases
• Pros and cons should be discussed with the healthcare provider to make an informed decision

Patient Experience

• During the procedure, patients under anesthesia will not feel pain
• Post-surgery discomfort is managed with pain medications
• Some may experience temporary swelling or bruising
• Close monitoring and support from healthcare providers throughout the recovery process