Vaginal hysterectomy and repair is the most commonly used
operation to correct a prolapse or 'dropped' uterus caused by
weakness in the muscles of the pelvic floor. Prolapse causes the
uterus, bladder and sometimes the rectum (or back passage) to
'drop' through the vagina.
In this operation, the uterus and cervix are
removed through the vagina rather than through an abdominal
incision. The bladder and rectum are also restored to their
normal positions and sometimes the top of the vagina (called the
vaginal vault) is lifited in a procedure called a sacrospinous
fixation. The vagina is closed off and remains its
normal length. The ovaries are usually left intact.
The operation is carried out under a general or spinal
anaesthetic and takes about 1 to 2 hours.
During the operation, a catheter may be passed up the urethra
into the bladder to drain off the urine. A vaginal pack made of
gauze may also be inserted to prevent postoperative
bleeding.
There will be some discomfort following surgery which will
be controlled with pain killers. Some postoperative bleeding and
discharge should be expected.
The average hospital stay is 2 days and normal activities
can usually be resumed within six weeks.
It is important not to left anything heavier than a full kettle
of water for six weeks.
The Manchester method or uterine prolapse repair is
performed to correct a prolapsed or 'dropped' uterus,
caused by weakness in the muscles of the pelvic floor.
Prolapse causes the uterus, bladder and sometimes the rectum (or
back passage) to 'drop' through the vagina. This
operation is performed only when the patient does not wish,
or is not sufficiently fit, to have a vaginal hysterectomy.
The operation is performed through the vagina. Only the cervix
is removed. The uterus, bladder and rectum are stitched back
into their normal positions.
The operation is performed under a general anaesthetic and
takes about one hour.
During the operation, a catheter may be passed up the urethra
into the bladder to drain off the urine. A vaginal pack,
made of gauze, may also be inserted to prevent postoperative
bleeding.
There will be some discomfort following surgery which will
be controlled with pain killers.
The average hospital stay is two days and normal activities can
usually be resumed within 6 weeks.
Any subsequent pregnancy will have to be delivered by caesarean
section to avoid stretching the previous repair.
Insertion of a ring pessary is an alternative to surgery to
correct a prolapsed or 'dropped' uterus caused by weakness
in the muscles of the pelvic floor. Prolapse causes the uterus,
bladder and sometimes the rectum (or back passage) to
'drop' through the vagina.
This treatment is most suitable for women who are not
sufficiently fit to undergo a general anaesthetic or surgery or
for those who haven't completed theri family.
The ring pessary is a ring of plastic which is
inserted into the vagina to support the bladder and uterus.
Assessment and fitting are carried out in an out-patient
clinic.
The ring remains in the vagina, but must be changed every 6
months to prevent infection.
Cystocele (anterior) and rectocele (posterior) repair
A cystocele occurs when the bladder and/or urethra prolapses or
'drops' into the front wall of the vagina. A rectocele occurs
when the rectum prolapses or 'drops' into the back wall of
the vagina.
Repair involves removing a piece of vaginal skin, then stitching
the bladder and urethra, or the rectum, back into their normal
positions and repairing the vagina.
Both types of repair and vaginal hysterectomy may be undertaken
at the same time.
The operation is carried out under a general
anaesthetic and takes 40-60 minutes.
During the operation, a catheter may be passed up the urethra
into the bladder to drain off the urine. A vaginal pack,
made of gauze, may also be inserted to
prevent postoperative bleeding.
There will be some discomfort following surgery which will
be controlled with pain killers.
The average hospital stay is 2 days and normal activities
can usually be resumed within 6 weeks.
During recovery it is important not to left anything heavier
than a full kettle of water.
The vagina may be left slightly narrowed, but this does not
usually interfere with sexual intercourse.
Colposuspension is an operation for urinary stress incontinence,
which is caused by a weakness in the bladder neck and
pelvic floor, usually as a result of pregnancy. Stitches are
placed around the bladder neck in order to raise the
bladder and urethra.
The operation is performed under a general anaesthetic and is
performed via laparoscopic (key-hole) surgery or with an open
abdominal incision. It usually takes 1-2 hours to complete.
At the end of the operation, a catheter is inserted into
the bladder to drain off the urine. This is usually brought
out through the abdomen rather than the urethra.
The catheter is 'clamped off' daily to allow the bladder to fill
so that the patient can attempt to pass urine normally. If this
is not possible, the clamp is released to drain the urine and
the process repeated the following day. Once urine is being
passed normally, the catheter is removed.
There will be some discomfort following surgery which
will be controlled with pain killers.
The average hospital stay is 2-3 days and normal activities
can usually be resumed within 6 weeks.
