How to treat anterior vaginal wall bulge

Some people are born with developmental disorders, which cause vaginal prolapse during the process of puberty. This will not only affect their reproductive function in the future, but also cause difficulty in sexual intercourse. Therefore, patients must be treated with external force. Non-surgical treatment and surgical repair methods can be used to achieve the therapeutic effect. It can deal with the disease in patients, while also repairing the vagina and promoting local recovery.

Medication

When treating patients with pelvic organ prolapse or incontinence, it is of utmost importance to consider the supportive pelvic structures. The surgeon needs to analyze the differences and specificities of the injury sites in different patients so as to restore the anatomy and function and achieve the ultimate goal. When urethral sphincter dysfunction occurs, surgery should choose a method that can both resolve the anterior vaginal wall bulge and treat stress urinary incontinence. If no urethral sphincter dysfunction is found, surgery to combat stress urinary incontinence is unnecessary, although the urethra and bladder neck serve as part of the anterior vaginal wall support.

1. Non-surgical treatment Mild protrusion does not require treatment. For moderate or even severe protrusion, conservative treatment can be adopted if the patient needs to have children or is elderly with serious medical diseases. Conservative treatment includes the use of a pessary, Kegel exercises, and estrogen.

2. Surgical repair method The surgical indications for the treatment of anterior vaginal wall prolapse are: ① severe prolapse; ② prolapse leading to urinary retention or recurrent cystitis; ③ accompanied by stress urinary incontinence.

(1) Anterior vaginal wall suture and suburethral plication: The purpose of anterior vaginal wall suture is to fold and suture the vaginal muscles and the fascia on the surface of the bladder (pubocervical fascia) or the vaginal side wall tissue to restore the bulging bladder and vagina to their normal positions. In many cases, regardless of whether the patient has urinary incontinence, a plication suture is placed at the vesicourethral junction to reinforce the posterior urethral support tissue to ensure that patients who do not have stress urinary incontinence at the time of surgery will not develop it after surgery. If there are symptoms of stress urinary incontinence, anti-stress urinary incontinence surgery is required.

(2) Paravaginal repair: The purpose of paravaginal defect repair for anterior vaginal wall bulging is to restore the separated vagina to the level of the arcuate ligament of the pelvic wall (ATFP) that is normally connected to it. There are two main methods: vaginal approach or retropubic approach.