Cystocele

I have a cystocele that will be repaired when I have a TAH/BSO. I have not talked to the doc yet about how she wants to do this. I went through urologic testing which showed I do NOT need a sling procedure. I have read up on this repair and seem to get the idea that if the procedure is done without mesh, it has a high failure rate. And if it is done with mesh, there is a chance of tissue erosion. Can anyone give me some advice as to what I should ask the doc or what procedure may be the best?

otter48, this is a decision you have to make for yourself. If you've read up on it, then you know some of the risks. The old-fashioned anterior colporrhaphy does have a higher risk of failure over the long haul than does using a graft of some sort. Statistics differ according the studies you read. However, the polypropylene mesh has a risk which I've personally read is anywhere between 3-17% of eroding through the vaginal wall and causing its own set of problems. As one who has personally suffered through mesh erosion of an anterior polypropylene mesh, I would never get it again. There are other grafts that can be used such as autologous (your own) body tissue, or porcine, bovine, or cadaverous body tissue and those don't seem to have as high a risk of erosion as does the polypropylene mesh graft.

You can ask your doctor about the other types and whether those would be a possibility instead of the polypropylene which seems to have a higher erosion rate. It's what I would do if I were going into it now knowing what I do in hindsight.

Hope you can make the best decision for you....

Thanks for your advice, I'm kind of nervous about having the mesh!

Otter48,
After having my cystocele repair fail after my hysterectomy, I discussed all the 'other' things used to help hold it. The normal repair has a high failure rate as your vaginal tissue has already let your bladder come through and putting it back, the bladder may very well find another weak area and come out again. This is what I learned, all the things that Orahdeb mentioned are available to try to prevent the repair and also what I used was available - a dissovable mesh made of Vicryl stitch material. The idea of using a mesh or other tissue is to create an irritated area that will form scar tissue and the scar tissue will hold the repair. Unfortunately all of the above are absorbed into your body and last maybe 4-6 weeks. Now the problem, scar tissue starts to form about 3 months post-op. So I here I am at 2 1/2 months praying that my bladder repair will continue to hold - so far so good and lots of scar tissue will form. This is a much harder recovery than the permanent mesh, not pain wise, being careful wise. I am still not doing anything but walking and I didn't do that at all for the first 6 weeks. Good Luck with your decision. I wasn't willing to take the risk of the permanent mesh, but the temptation of a 'permanent fix' was certainly there.
Hugs.

You are wise to start researching methods of repair now. I always feel that knowledge is power. If this is your first repair Drs usually use standard anterior colpporaphy for repair. The Dr pushes the bladder back into place and uses sutures to close the vaginal tissue holding the bladder in place. As both OrahDeb and Bowlinggrl have said there is a higher rate of failure with colpporaphy over a mesh repair but the risks and complications of using mesh are just as risky. This is a decision you have to make on your own and sadly there is no perfect fix without the possibility of complications or failure. My new mantra is Less is More and I would always start with the least complex repair and keep your fingers crossed that you are one of the lucky ones whose surgery is a complete success the first time!
Michelle