Anterior vaginal wall repair is surgery that tightens the front (anterior) wall of the vagina. It is done to help with the sinking of the bladder into the vagina (cystocele), or the sinking of the urethra into the vagina (urethrocele or urethral hypermobility).

This procedure may be done while you are under general or spinal anesthesia. Under general anesthesia, you will be unconscious and unable to feel pain. With spinal anesthesia, you will be awake, but you will be numb from the waist down and you will not feel pain.

Usually, an incision (cut) is made through the front wall of your vagina.

• Your bladder is moved back to its normal location.
• Your vaginal wall may be folded, or part of it may be cut away.
• Sutures (stitches) are made in the tissue between your vagina and bladder. These sutures will hold the walls of your vagina in the correct position.
• Your doctor may place synthetic (man-made) material between your bladder and vagina.
• If needed, sutures attach the walls of the vagina to the tissue on the side of your pelvis.

Sometimes, your doctor also makes an incision in your belly. This incision may be up and down or across.

This procedure is used to repair the sinking of the vaginal wall (prolapse) or bulging that occurs when the bladder or urethra sink into the vagina.

Symptoms of prolapse that you may have include:

• You may not be able to empty your bladder completely.
• Your bladder may feel full all the time.
• You may feel pressure in your vagina.
• You may have pain when you have sex.
• You may leak urine when you cough, sneeze, or lift something.
• You may get bladder infections.

This surgery by itself does not treat stress incontinence (leaking urine when you cough, sneeze, or lift). It may be performed along with other surgeries.

Before doing this surgery, your doctor may have you learn pelvic floor muscle exercises (Kegel exercises), use estrogen cream in your vagina, or try a device called a pessary in your vagina to hold up the prolapse.

Risks for any surgery are:

• Incision infection or the incision opens up
• Blood clots in the legs that may travel to the lungs
• Breathing problems
• Bleeding
• Other infection

Risks for this surgery are:

• Damage to the urethra, bladder, or vagina
• Irritable bladder
• Changes in the vagina (prolapsed vagina)
• Urine leakage from the vagina or to the skin (fistula)

Always tell your doctor or nurse what drugs you are taking, even drugs, supplements, or herbs you bought without a prescription

During the days before the surgery:

• You may be asked to stop taking aspirin, ibuprofen (advil, Motrin), warfarin (Coumadin), and any other drugs that make it hard for your blood to clot.
• Ask your doctor which drugs you should still take on the day of your surgery.

On the day of your surgery:

• You will usually be asked not to drink or eat anything for 6 to 12 hours before the surgery.
• Take the drugs your doctor told you to take with a small sip of water.
• Your doctor or nurse will tell you when to arrive at the hospital.

You may have a foley catheter to drain urine for 1 or 2 days after surgery.

You will be on a liquid diet right after surgery. When your normal bowel function returns, you can return to your regular diet.

This surgery will usually repair the prolapse, and most times symptoms of prolapse will go away. This improvement will often last for years.

Herschorn S. Vaginal reconstructive surgery for sphicteric incontinence and prolapse. In: Wein AJ, ed. Campbell-Walsh Urology. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 66.

Maher C, Baessler K, Glazener CM, Adams EJ, Hagen S. Surgical management of pelvic organ prolapse in women. Cochrane Database Syst Rev. 2007;3:CD004014.