Name of the Procedure:

Paravaginal Defect Repair (including repair of cystocele, if performed); Vaginal Approach

Summary

Paravaginal defect repair is a surgical procedure aimed at correcting defects in the vaginal wall, which may include the rectification of a cystocele (a condition where the bladder prolapses into the vagina). This procedure is performed through the vaginal canal and involves stitching supportive tissues back into place.

Purpose

The procedure addresses pelvic organ prolapse conditions, primarily to repair the vaginal wall and correct cystoceles. The goal is to restore normal pelvic anatomy, relieve symptoms such as urinary incontinence or discomfort, and improve the quality of life.

Indications

• Presence of a significant cystocele, often characterized by a noticeable bulge in the vagina.
• Symptoms like urinary incontinence, frequent urinary tract infections, or difficulty emptying the bladder.
• Sensation of pelvic pressure or fullness.
• Patients for whom non-surgical treatments have been ineffective.

Preparation

• Patients may be advised to fast for several hours before the surgery.
• Medications such as blood thinners might need to be adjusted or halted temporarily.
• Preoperative assessments could include a physical exam, pelvic ultrasound, or urodynamic studies.

Procedure Description

• The patient is placed under regional or general anesthesia.
• A surgical incision is made inside the vagina.
• The surgeon identifies the paravaginal defect and mobilizes the affected tissues.
• Sutures are used to attach the support tissues back to their normal anatomical positions.
• If addressing a cystocele, the bladder is re-positioned, and any excess vaginal tissue is trimmed.
• The vaginal incision is closed with absorbable sutures.

Duration

The procedure typically takes 1 to 2 hours, depending on the extent of the repair needed.

Setting

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

Personnel

• A gynecologist or urologist specialized in pelvic reconstructive surgery usually performs the procedure.
• An anesthesiologist oversees anesthesia and patient sedation.
• Surgical nurses assist during the operation.

Risks and Complications

• Common risks: Pain, infection, bleeding, and urinary issues.
• Rare risks: Damage to surrounding organs (bladder, rectum), blood clots, anesthesia complications.
• Management: Prophylactic antibiotics, careful surgical technique, and postoperative monitoring.

Benefits

• Alleviation of symptoms related to cystocele.
• Improved bladder function and reduced urinary tract infections.
• Enhanced quality of life and comfort.

Recovery

• Patients may stay in the hospital for a day or two.
• Pain management will involve prescribed medications.
• Instructions might include avoiding heavy lifting, straining, or sexual activity for 6-8 weeks.
• Follow-up appointments are needed to monitor healing and resolve any issues.

Alternatives

• Non-surgical options: Pelvic floor exercises, pessary devices.
• Other surgical options: Abdominal or laparoscopic approaches to paravaginal defect repair.
• Pros and cons: Non-surgical treatments are less invasive but may be less effective for severe cases. Alternative surgeries might offer different recovery times and risk profiles.

Patient Experience

• During the procedure, the patient will not feel pain due to anesthesia.
• Postoperatively, there might be discomfort or mild pain, manageably with medications.
• Patients often feel a significant improvement in symptoms within a few weeks to months.
• Support and reassurance from the medical team are provided to ensure a comfortable recovery process.