Repair of bladder prolapse (cystocele) or urethra prolapse (urethrocele)

Surgery Overview

Two common forms of pelvic organ prolapse are bladder prolapse (cystocele) and urethral prolapse (urethrocele). A cystocele occurs when the wall of the bladder presses against and moves the wall of the vagina. A urethrocele occurs when the tissues surrounding the urethra sag downward, into the vagina. Both conditions are easy for your health professional to see during a physical examination. They often occur at the same time and are usually caused by damage that happens when a baby is delivered through the mother's birth canal (vagina).

While many women have some degree of bladder and urethral prolapse, few ever have any symptoms, or the symptoms do not appear for years. When symptoms do appear, they may include difficulty urinating, involuntary release of urine (urinary incontinence), and pain during sexual intercourse. Surgery is not required unless your symptoms interfere with daily activities.

Unless another health problem is present that would require an abdominal incision, the bladder and urethra are usually repaired through an incision in the wall of the vagina. This surgery pulls together the loose or torn tissue in the area of prolapse in the bladder or urethra and strengthens the wall of the vagina to prevent prolapse from recurring.

There are several types of surgery to correct stress urinary incontinence. These surgeries lift the urethra and/or bladder into their normal position. To learn more about these surgical procedures, see the topic Urinary Incontinence in Women.

Should I have surgery for pelvic organ prolapse?

What To Expect After Surgery

General anesthesia usually is used during repair of the bladder and urethra. You may stay in the hospital from 1 to 2 days. You may go home with a catheter in place. You can most likely return to your normal activities in about 6 weeks. Avoid strenuous activity, such as heavy lifting or long periods of standing, for the first 3 months and increase your activity level gradually.¹ Straining or lifting after you have resumed normal activities may cause a recurrence of the problem.

Most women are able to resume sexual intercourse in less than 6 weeks. Urinary function usually returns to normal in 2 to 6 weeks.

Why It Is Done

Repair of the bladder and urethra is done to manage symptoms such as pressure on the vaginal wall from the movement of those organs, difficulty urinating, urinary incontinence, and painful intercourse. If you are experiencing involuntary release of urine (urinary incontinence), further testing may be needed to determine what procedure is needed.

Bladder and urethral prolapse often occur with the prolapse of other pelvic organs, so tell your health professional about any other symptoms you have. If your health professional finds a uterine prolapse, rectocele, or small bowel prolapse (enterocele) during your routine pelvic examination, that problem can also be repaired during surgery.

How Well It Works

Experts report good results with both vaginal and abdominal surgery to repair the bladder and urethra, with low recurrence rates (repeated prolapse of a pelvic organ after surgery).

Risks

Risks of cystocele and urethrocele repair include:

• Urinary incontinence.
• Urinary retention.
• Painful intercourse.
• Infection.
• Bladder injury.
• Formation of an abnormal connection or opening between two organs (fistula).

What To Think About

Since pelvic organ prolapse is often caused or made worse by labour and vaginal delivery, you may want to delay surgical repair until you have finished having children.

Surgical repair may relieve some, but not all, of the problems caused by a cystocele or urethrocele. If pelvic pain, low back pain, or pain with intercourse is present before surgery, the pain may persist after surgery. Symptoms of urinary incontinence or retention may return or get worse following surgery.

You can control many of the activities that may have contributed to your cystocele or urethrocele or made it worse. After surgery:

• Avoid smoking.
• Maintain a healthy weight for your height.
• Avoid constipation.
• Avoid activities that put strain on the lower pelvic muscles, such as heavy lifting or long periods of standing.

Complete the surgery information form (PDF)(What is a PDF document?) to help you prepare for this surgery.

Author:	Carrie Henley Monica Rhodes	Last Updated: November 29, 2007
Medical Review:	Adam Husney, MD - Family Medicine Joy Melnikow, MD, MPH - Family Medicine R. Hugh Gorwill, MD - Obstetrics and Gynecology
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