Hysterectomy for cystocele?

My primary problem is a cystocele requiring an A&P repair of the vagina. Dr also recommends TVH due to pelvic relaxation. I am postmenopausal also. Dr states recommends doing TVH now rather than when I am older (am now 47) when uterine prolapse would become a big problem. What do you ladies think?

Hi Reesey! My candid reaction is that you'd do well to get a second opinion, maybe a couple of them. A urologist and/or a urogynecologist would be good choices.

A cystocele is caused by the ligaments that support the bladder loosening, often in response to hormonal changes that accompany menopause. The bladder drops and starts to push in on the vagina. This can sometimes result in stress incontinence (do you pee when you sneeze, laugh, cough, jump, etc.?) and sometimes be uncomfortable, especially during sex (but not always).

Often DRs see a patient with a cystocele and rush to do a hysterectomy with A&P repair and bladder suspension. That is what I had done about ten months ago, at age 45. I had no choice, however; I had a very severe uterine prolapse. If I hadn't had the hysterectomy done it would have "done" itself pretty soon

In the surgery, the bladder is lifted to get it off the vagina. The anterior repair (the "A" part of A&P) is done to strengthen the front wall of the vagina where it had been caved in by the bladder resting on it. The uterus is removed to prevent that weight from also pushing down, on the idea that if one organ has dropped, they're all going to. That may or may not be true, and if it isn't, then you've just bought yourself a life changing surgery with all kinds of far reaching consequences unnecessarily. If you want to get an idea of what those might be, take a look at the Hormone Jungle forum on this site (those are the more likely consequences) or the Road Less Traveled forum (lower probability but more serious complications).

One possible consequence that no one I know was ever warned about was the development of adhesions. This is scar tissue that forms in the pelvis (in this case) and can attach itself to any or all organs there. Almost everyone who has abdominal surgery (and yes, even if it's done vaginally, it's still abdominal surgery) develops adhesions. For some of us they can be painful, even debilitating. I am lucky, mine are not painful, just noticeable sometimes, and a reminder to me that if I need to consider another surgery in the future I'd better be darn sure I need it before risking the development of even more adhesions.

There are other methods of treatment that can be tried before resorting to a hyst/A&P repair. (Do you really need the "P" repair? Do you have a rectocele as well?) You might ask your DR about HRT and kegels as a way to strengthen those ligaments that hold up the bladder. Some ladies are able to take care of the problem that way and avoid surgery.

Another option would be to have just the repair and bladder lift and leave the uterus where it is. I had two surgeries this year; the hyst/A&P/BSO/bladder lift and another vaginal surgery. The non-hyst vaginal surgery was a piece of cake compared with the hyst. If I could have avoided the hyst I would have opted just for the repair to see how that would do, then gotten on HRT to try to prevent the uterine prolapse.

I am glad you found us, and hope that you'll take your time and research all your options before making a decision to have a hysterectomy. I'm not trying to talk you out of the surgery; if it's the right choice for you, then you should do it. But you shouldn't do it until you are SURE it's the right choice. You need to be completely committed to your decision in order to have the will and stamina to work through the post surgery issues.

If you decide to have the surgery, you need to plan for about a year's disruption in your life. That doesn't mean you'd be home in bed for a year, just that it takes about that long to recover, get back to normal activities and work through longer term HRT issues and/or complications that might develop.

There are a lot of ladies here with tons of experience. Ask us anything! We are here to help you, and to hold your hand. We will support you whatever you decide to do.
s,
-Linda

Hi Reesy

Here are some links that will give you more info on prolapse:

http://groups.msn.com/choiceforprola...pgmarket=en-au

http://www.wdxcyber.com/nurine08.htm

http://www.pelvicfloor.com/

Get smart about your symptoms and your options, and make the best choice for YOU!

I am sending huge cyberhugs

Hey Surfergirl and Twysmiling,,,,,,thank you so much for your advice and websites. I return for a doctor's visit tomorrow and am scheduled for surgery next Monday. However, after reading your posts, I have many questions. I have a grade III cystocele. However, I still have no problems with incontinence or pain. My present physician is the second physician I have seen about this. The other one was a few years ago - who recommended cystocele repair IMMEDIATELY. My present physician said it was up to me. At the time,I decided to go ahead with the surgery for I plan on changing jobs and moving as soon afterwards that I can.
He also says I am a prime candidate for a vaginal hysterectomy as my uterus is sitting "right there!" hmmmmm

After reading your posts, I now see that moving would definitely be out of the question. My physician told me I could go back to work in 2 weeks if all went smoothly as I have a desk job.

I do not know,,,,,,,my only complaint is that I can feel a bulge which rubs against my panties if I lift anything heavy or do anything strenuous. Being a single woman, I also feel less feminine knowing that my vagina must feel like a boggy marsh! Ha! As a result, I am self-conscious in the relationship field even though DB reassures me everything feels fine. (Sorry for my crudeness). However, if it ain't broke, don't fix it! I have no pain and if I would concentrate on losing 30 pounds, I would probably be fine for a very long time.

In summary, due to no pain, my plans for relocation soon, AND your excellent advice,I will talk with my DR tomorrow and probably cancel my surgery.

I will keep you posted! Thank you so much for your help!

Hi again, Reesy

It sounds like you are not ready for any surgical intervention. 85% of hysterectomies are done for quality of life reasons, not to SAVE a life. Perhaps you can ask your doc about using a pessary to assist in holding the uterus in place. Many women do fine with it, altho I don't know if it is a valid long-term solution.

Losing your extra weight will take some pressure off your lower torso (that dang gravity!!!), and if you are not doing kegel exercises daily, now is a good time to start. My doc had a drawing showing the bladder supported by strong ligaments & weak ligaments... the weak ligaments let drips come out, in other words, stress incontinence. Daily kegel exercises make for strong ligaments to support the bladder & other pelvic areas, and are recommended for all women (hysterectomy or not).

Go to this link, you will see the ligaments image and learn more than you ever wanted to know about kegels. The drawing shown here speaks volumes:

http://www.universityobgyn.com/kegal.htm

Kegels can also enhance your activities under the sheets

Keep us posted on the outcome of your doc appointment tomorrow.

Sending huge cyberhugs,

The only thing that concerns me is that if you let this go, prolonged prolapse can cause nerve damage. If I were in your situation, I would get fitted for a pessary. (espically if you are going to be moving and lifting) I had a mild prolape before moving (last September) after that everything got so much WORSE. You still shouldn't be lifting anything heavy with a prolapse. But if you have too, get a pessary please. I have paid the price for letting mine go for soooo long. Also an A&P repair is a cystocele and rectocele repair (hernia in the top and the bottom) anterior is top..posterior is bottom Also you don't need your uterus removed unless that is prolapsed as well. Is your doctor a Urogyncologist? They specialize in pelvic surgery. If not. I would recommend going to one. The first option you should have been offered is a pessary. Then maybe surgery

Best wishes

Anne Marie