Pelvic floor repair

Question 1

What are repair operations?

Answer 1

Colporrhaphy is an attempt to repair pelvic organ prolapse (nb - there are a lot of variations on prolapse repair, ref urogynae)

Question 2

What is involved in repair operations?

Answer 2

Colporrhaphy attempts to rectify prolapse by excising redundant mucosa and repairing underlying fascia
May be combined with vaginal hysterectomy
The more mucosa removed, the tighter the vagina

Question 3

What are the indications for repair operations?

Answer 3

Pelvic organ prolapse (resolution/easing of symptoms of prolapse)

Question 4

What are the risks associated with repair operations?

Answer 4

Big four
Injury to surrounding tissues (bladder, bowel, ureters, vessels)
Dyspareunia
Recurrence of prolapse
Urinary infection, retention and/or frequency
Overtightening of vagina

Question 5

What additional procedures may be necessary due to complications of repair operations?

Answer 5

Blood transfusion
Repair to bladder, bowel etc
Conversion to laparotomy
Abx may be given

Question 6

What should be considered when consenting for repair operations?

Answer 6

Is the pt sexually active

This is not a procedure for urinary incontinence

Question 7

Can the patients for repair operations be managed as day cases?

Answer 7

Some can (e.g. anterior repair)
Posterior repair carries higher risk of haematoma formation, so surgeon may insert vaginal pack and catheterize overnight

Question 8

Should vaginal mesh be used?

Answer 8

No

Question 9

What is the cure rate for repair surgery?

Answer 9

90%