Surgical Treatment of a Prolapsed Bladder

Prolapsed bladder, also known as cystocele, is a condition in which a woman's bladder intrudes abnormally into the vagina as a result of weakening tissue between the two organs. It is a possible consequence of several factors, including chronic constipation, onset of menopause, straining during childbirth and lifting of heavy objects. Unlike minor or moderate prolapses, severe cases may require surgical repair.

Assessing the Need for Surgery

• If you have a case of a prolapsed bladder that warrants surgery, your main symptom will be a bladder intrusion severe enough to reach or push through the opening of your vagina. You may also require surgery if your prolapse is less pronounced but causes significant discomfort that is not improved through other treatment options. If you plan to have a child in the future, you might consider delaying prolapse surgery until afterward, since tightening of vaginal tissue during the procedure may rule out the possibility of natural childbirth. Consult your doctor or gynecologist to determine if surgery is the best option for your circumstances.

Surgery

• Prolapse surgery can be performed by a urologist (urinary tract specialist) or by a gynecological surgeon. During the procedure, your surgeon will gain access to your bladder through either your abdomen or the wall of your vagina. She will then return the bladder to its normal location and secure it in place by shortening and tightening the ligaments and muscles that form the floor of your pelvis. If the tissue between your bladder and vagina is particularly stretched or worn, its damaged sections may be removed and the remaining tissue sewn together to create a new, stronger structure.

  If your bladder prolapse is causing symptoms of incontinence (partial or total loss of bladder control), your surgeon may also raise your bladder at the point where it meets your urethra.

  Bladder prolapse repair may be performed as a conventional open surgery or as a minimally invasive procedure called laparoscopy. Typically, open surgery requires a longer hospital stay and recovery time. Laparoscopy, which is performed through small incisions with the aid of a tiny camera and an external monitor, involves a shorter hospital stay and recovery, balanced against longer surgery times and lengthened exposure to anesthesia.

Potential Outcomes and Complications

• The results of prolapsed bladder surgery are typically good, and once your procedure is done you may gain permanent or long-term relief from your symptoms. However, the structures of the pelvic floor weaken naturally with age, and it is possible that your bladder prolapse will return at some point in the future. As a rule, making needed repairs a second time is much more challenging, and your doctor may need to patch your existing structures with donor tissue to achieve satisfactory results.

  In some cases, bladder prolapse happens along with prolapse of the uterus. If this is true for you, your surgeon will try to secure your uterus back in place. If this is not possible, she may recommend its surgical removal (hysterectomy). Consult your gynecologist or surgeon for the details of all bladder and uterus prolapse procedures.