How to perform anterior wall bulge surgery

Anterior wall bulge is the bulging of the anterior vaginal wall. There are many factors that lead to this phenomenon, including tearing of the pelvic floor muscles, fascia and uterine ligaments due to injury, or it may occur during normal delivery. If the anterior wall prolapse is mild, the symptoms are not very obvious, but if it is serious, it will have a significant impact on women's health and life, and generally requires surgical treatment. So, how to perform anterior wall bulge surgery? Let’s take a look below.

The surgical indications for 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 colposeruption 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 position.

(2) Paravaginal repair

The purpose of paravaginal defect repair for anterior vaginal wall bulging is to restore the separated vagina on both sides to the level of the arcuate ligament of the pelvic wall (ATFP) connected to it. There are mainly two methods: vaginal method or retropubic method.

Complications of anterior vaginal wall prolapse repair are relatively rare, with the most common being hematoma behind the anterior vaginal wall and damage to the urethra or bladder during separation. Repair of bladder damage often requires a urinary catheter to be placed for 7 to 14 days, which is beneficial for the healing of the bladder. Other rare complications include ureteral injury, suture to the bladder or urethra (with related bladder symptoms), and fistula formation, such as urethrovaginal fistula, vesicovaginal fistula, etc.

Urinary retention and difficulty emptying often occur after anterior vaginal wall repair. This situation is more common in patients who have emptying function disorders before surgery. The treatment is catheter drainage or urinary catheterization. It takes about 6 weeks for the natural emptying function to recover. Some patients experience problems with their sexual life after surgery, some patients' sexual life improves after surgery, and some are affected. The former is common in patients with stress urinary incontinence, and the latter is seen in patients undergoing vaginal perineal repair.