A combined hysterectomy and bladder repair is a surgical approach used to correct issues related to pelvic organ prolapse. This procedure involves the removal of the uterus along with the surgical repair of the bladder prolapse, known as a cystocele repair or anterior colporrhaphy. The bladder repair addresses the condition where the bladder falls or bulges into the vagina due to weakened supportive tissues. Patients often undergo both operations simultaneously because prolapse frequently affects multiple organs, requiring comprehensive reconstruction for lasting relief. This dual procedure aims to relieve pelvic pressure, address urinary symptoms like incontinence, and restore the normal anatomy of the pelvis.
Diagnostics and Pre-Surgical Preparation
Before scheduling the combined procedure, a detailed assessment is performed to determine the extent of the prolapse and the function of the bladder. Imaging, such as a pelvic ultrasound, may be used to provide information about the condition of the uterus and ovaries, assisting in surgical planning.
Urodynamic testing evaluates urinary function, especially if symptoms like incontinence or difficulty emptying the bladder are present. These studies measure bladder pressure and urine flow, helping the surgeon identify any underlying bladder-sphincter issues requiring correction. If the patient reports symptoms such as bladder pain, persistent urgency, or frequency that have not responded to medication, a cystoscopy may be requested. This procedure involves inserting a thin scope to visually inspect the bladder lining for any associated pathology.
Pre-operative instructions typically involve medication adjustments, particularly stopping blood-thinning medications seven to ten days before the operation to minimize bleeding. Patients are also instructed to fast for a specific period before surgery and may be required to complete a bowel preparation. These steps are taken to ensure the surgical field is clear and reduce the risk of infection during the procedure.
How the Hysterectomy and Bladder Repair are Performed
The surgery combines two distinct procedures, often performed through a vaginal approach. This method is frequently preferred for prolapse correction because it offers fewer complications and a shorter healing time than an abdominal incision. The vaginal hysterectomy involves making an incision around the cervix, separating the uterus from the surrounding ligaments and blood vessels, and removing it through the vagina. The vaginal approach is particularly beneficial when the uterus is already prolapsed, making it easily accessible.
Following the hysterectomy, the surgeon performs the cystocele repair, achieved through anterior colporrhaphy. This technique involves making an incision in the front wall of the vagina to access the weakened fascia that separates the vagina from the bladder. The surgeon uses sutures to tighten and reinforce this supportive fascia, pushing the bladder back into its correct anatomical position. After the repair, the top of the vagina, or vaginal vault, is often supported by stitching it to strong pelvic ligaments to prevent future prolapse. While native tissue repair is the primary method, synthetic mesh may be used in certain complex cases.
The Immediate Post-Operative Experience
Immediately following the procedure, the patient is moved to a recovery room where nurses monitor vital signs and manage initial pain levels. Pain management is typically aggressive and may involve a patient-controlled analgesia (PCA) pump, allowing the patient to self-administer prescribed medication.
A urinary catheter is placed during surgery to drain urine, allowing the newly repaired bladder and surrounding tissue to rest and heal without strain. This is typically a Foley catheter, though a suprapubic catheter is sometimes used. A gauze pack may be temporarily placed inside the vagina for 8 to 24 hours to help minimize bleeding following the cystocele repair.
Early mobilization is a priority, and patients are encouraged to take short walks as soon as the day after the operation. Walking stimulates blood flow, which aids healing and reduces the risk of developing blood clots. The hospital stay can range from one to five days. Before discharge, the catheter is removed, and the patient must be able to urinate effectively, though temporary difficulty emptying the bladder may occur due to swelling.
Home Recovery Timeline and Long-Term Care
The transition to home recovery requires careful adherence to restrictions to ensure the success of the bladder repair. The initial one to two weeks focus on rest, short walks, and managing fatigue, which is a common side effect of major surgery. During this time, light spotting or a watery, yellowish-white discharge is normal, representing the dissolving of internal stitches.
A major restriction for the first six weeks is the avoidance of heavy lifting, which is necessary to prevent strain on the newly repaired fascia. Surgeons advise against lifting anything heavier than five to ten pounds, roughly equivalent to a gallon of milk. This restriction includes avoiding strenuous activities, intense exercise, and actions that significantly increase abdominal pressure, such as straining during bowel movements.
Driving can typically be resumed once the patient is no longer taking prescription pain medication and feels their reaction time is normal, usually around two to four weeks post-operation. Sexual activity and the insertion of anything into the vagina, including tampons, must be avoided for six weeks to allow the vaginal cuff and repair sites to fully heal. Maintaining sensible activity limits beyond the initial six weeks is advised, as full wound strength may take up to six months to achieve.
Temporary urinary issues are common as the bladder adjusts to its new position; this may include urgency, frequency, or a sensation of slower urine flow. These symptoms usually subside as swelling decreases. Patients should contact their surgeon if they experience an inability to urinate, a fever, or foul-smelling vaginal discharge, as these can be signs of infection. Long-term expectations include a reduction in pelvic pressure and improved urinary function. Some women may benefit from starting pelvic floor muscle exercises around two to three weeks post-surgery once approved by their doctor.