How to treat anterior vaginal wall bulge

The surgical treatment of anterior wall bulge must take into account the different locations of injury and specificity in order to achieve a better repair effect. Generally, this type of surgery is required for patients with stress urinary incontinence, recurrent cystitis, and severe bulge. If there is a need to have children, or if the patient is middle-aged or elderly with serious medical diseases, conservative treatment can be adopted. So besides these anterior wall bulges, what other treatments are there?

1. Non-surgical treatment: Mild prolapse does not require treatment. Moderate or even severe prolapse can be treated with conservative treatment if the patient needs to have children or is elderly and has serious medical diseases. Conservative treatment includes the use of pessaries, 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 protruding bladder and vagina to their normal positions. In many cases, whether the patient has urinary incontinence is not taken into consideration. The folding and suture at the bladder-urethra junction is used to strengthen the posterior urethral support tissue to ensure that patients who do not have stress urinary incontinence during surgery will not have it after surgery. If there are symptoms of stress urinary incontinence, auxiliary 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 method or retropubic method.

(3) Surgical complications: Complications of anterior vaginal wall prolapse repair are relatively rare. Common complications include hematoma of the anterior vaginal wall and damage to the urethra or bladder during separation. Repair of bladder injury often requires a urinary catheter to be left in place for 7 to 14 days, which is beneficial to the healing of the bladder. Other rare complications include suture of ureteral injury to the bladder or urethra (with related bladder symptoms), and fistula formation such as urethrovaginal fistula, vesicovaginal fistula, etc. If the sutures during repair are permanently non-absorbable or mesh-like, the suture material will erode the sinus tract and chronic granulation tissue will form in the vagina. The actual incidence of these complications is unknown; urinary tract infections are common, but other infections such as pelvic or vaginal abscesses are uncommon.

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 until the natural emptying function is restored, which takes about 6 weeks. Some women also experience sexual problems after surgery. Some of them have improved sexual life after surgery, while others are affected. The former is common in patients with stress urinary incontinence and the latter is seen in patients undergoing vaginal perineal repair.