What is the difference between an anterior and posterior colporrhaphy

This bugle can cause pressure, discomfort, pain and urinary and bowel dysfunction, among other symptoms. Anterior repair is used when the bladder drops and presses against the front of the vagina. This surgical procedure repairs the weakened layers between the bladder and vagina after the bladder drops out of its normal position.

This condition is known as anterior wall prolapse, cystocele or dropped bladder. The procedure to fix a dropped bladder and strengthen the front, anterior, of the vagina is called an anterior vaginal wall repair or anterior colporrhaphy. The patient will be given a liquid diet until normal bowel function returns. The patient will be instructed to avoid activities for several weeks that will cause strain on the surgical site, including lifting, coughing, long periods of standing, sneezing, straining with bowel movements, and sexual intercourse.

Anterior Colporrhaphy Cystocele Repair is a relatively safe procedure. However; with all surgeries carry some risks. You will need to sign a consent form that explains the risks and benefits of the surgery. There may be other risks, depending on your specific medical condition. Be sure to discuss any concerns with your surgeon before the procedure. Tel: Fax: Home » Services » Colporrhaphy Colporrhaphy. Bethesda Fernwood Rd. Rockville Medical Center Dr. Call Us: Bethesda Rockville.

Israel Alter, M. Jacqueline Apgar, M. Iralia Georgiou, M. The ureters may be palpated at this point Fig. The first row of sutures is then placed through the vesicovaginal connective tissues. These are set approximately 1. Success depends on the creation of a broad plate of vesicovaginal connective tissue beneath the bladder.

Altering the direction of the suture path in the region of the urethrovesical junction and bladder pillars may give additional length to the plate of connective tissues underneath the bladder Fig. Sharp separation of bladder from vaginal apex. Separation of bladder pillars to promote bladder advancement. Palpation of ureter. First plication suture at the urethrovesical angle. Arrows indicate the varying path of the imbrication sutures.

After completion of the first row of sutures, the surgeon's index fingers are used to press between the vaginal flaps and the connective tissue plate to provide access to the more lateral and denser layers of connective tissue Fig.

The second and third layers of sutures further reduce the cystocele, buttress the repair, and promote hemostasis Fig. Additional dissection upward behind the pubic bone facilitates further retropubic urethral suspensions or the placement of paravaginal sutures.

In most instances, sutures should not be placed directly into the wall of the urethra. Care must be taken not to straighten the urethrovesical junction, because such a maneuver can distort these tissues and result in urinary incontinence.

Elliptical excisions of the anterior vaginal wall must be done carefully to avoid a persistent bulge or undesirable stenosis Fig. Only after the first layer of imbrication sutures is in place does blunt dissection extend further laterally, exposing denser layers of connective tissue. Additional layers of plication may be appropriate.

Excision of redundant anterior vaginal wall. At this stage, it is helpful to grasp each vaginal flap at the apex with an Allis clamp and to push them back in toward the lower sacrum Fig. With the vagina temporarily replaced to its normal position, one can estimate more accurately to what degree the vaginal flaps must be trimmed, because lengthening of the upper paracolpia may have caused a telescoping and redundancy of the vaginal cylinder, resembling a true cystocele.

If the vaginal wall is not long enough to span comfortably between the pubic symphysis and posterior supports, attaching the apex of the vagina posteriorly pulls the urethra away from the symphysis, and may cause incontinence. Should this be recognized, additional length should be contributed to the anterior vaginal apex from the posterolateral fornices. Interrupted sutures are used to close the anterior wall, helping to preserve the length of the repaired connective tissues Fig.

The vaginal vault is pushed back to its normal location, allowing evaluation of vaginal length and caliber. Posterior rotation of the urethra as a result of tension of the anterior vaginal wall can be assessed at this point.

Completion of anterior colporrhaphy with interrupted sutures of polyglycolic material. Intra-abdominal pressure usually suffices to obliterate the space between the repaired vesicovaginal connective tissues and the vaginal wall without the need to suture these structures together. A vaginal pack is used only when an anterior repair is combined with a posterior repair, to keep the opposing suture lines from adhering to each other and obliterating the vaginal canal.

To guarantee an adequate repair, as much of the vesicovaginal connective tissues as possible should be left in contact with the bladder muscularis. On occasion, the thick bands of connective tissue exposed laterally may be lost, or perforated, as one dissects bluntly further laterally. Plication in several layers may compensate for some deficiencies in the thickness of the connective tissues.

Injury to surrounding structures, such as the bladder, ureter, or urethra, diminishes as the surgeon gains experience. Shortening of the anterior plate of vesicovaginal connective tissues results in a shortened vagina, preventing efficient overlap between the anterior and posterior valve leaves. Shortening of the anterior vaginal wall also results in a more anterior cul-de-sac, increasing the likelihood of an enterocele.