Urogynaecology is a branch of gynaecology dealing with the diagnosis and treatment of pelvic floor dysfunction.
Women with pelvic floor dysfunction may experience bladder problems, urinary and faecal incontinence, and genital prolapse. When physiotherapy and medication are not effective, surgery could be an option.
Here are the surgical treatments that can be carried out at National Womens’ facilities. Our surgeons will be happy to discuss them in detail and provide more specific advice.
Urodynamics bladder test
This is a test to assess female urinary incontinence and lower urinary tract dysfunction. It helps to provide patients and doctors with an accurate diagnosis. After the diagnosis is established, the doctor can advise on recommended next steps for treatment.
- The test is uncomfortable, but not painful.
- Soft, fine tubes are placed into the bladder and back passage to record pressure readings in the bladder through the test.
- Bladder is filled with sterile water.
- Patient is asked to cough at various stages during the test.
- At the end of the test the patient is asked to empty her bladder.It takes about 30 minutes to complete the test.
This operation, which takes about 60 minutes to complete, requires a transverse incision below the pubic hairline or three small incisions for keyhole surgery. Permanent stitches are placed near the neck of the bladder and fixed to the back of the pubic bone.
The hospital stay following surgery is usually two days. Once the woman feels well and can pass urine without difficulty, she can be discharged.
This is a minor surgery that is usually performed as a day procedure. An overnight stay in hospital might be required in some cases. Two small incisions are made in the skin of the abdomen or groin and one incision in the vagina, just beneath the urethra. A small channel is cut on each side of the urethra and a prolene tape is placed under the urethra. The tape will rest like a hammock under the urethra, supporting it during straining to prevent leakage of urine. A cystoscopy is carried out to ensure the tape is placed in the correct position. If the woman can pass urine comfortably a few hours following the procedure, she can be discharged.
Anterior repair is the most common surgery used for repair of cystocele, which is when the bladder is dropping down onto the front of the vagina, making a weakness or bulge. The prolapsed bladder may not empty properly when passing urine and causes an uncomfortable feeling in the vagina. It also gives a feeling of a full bladder at all times.
A cut is made through the lining of the anterior wall (front) of the vagina. The support to the bladder is shortened with stitches and the bulging part cut away. This repairs the weakness. The wound in the vagina is then stitched up.
Most women stay in hospital up to two days following anterior repair surgery. Once the woman feels well and can pass urine with no difficulty, she can be discharged.
Posterior Repair is a surgery used for repair of rectocele, which is when the rectum is dropping down onto the back of the vagina, making a weakness or bulge. The prolapsed rectum may not empty properly and gives an uncomfortable feeling in the vagina. A small cut is made through the lining of the posterior wall (back) of the vagina. The supports to the rectum are shortened with stitches and the bulging part of the vagina cut away. This repairs the weakness.
Most women stay in hospital for up to two days following posterior repair surgery.
Vaginal repair with mesh
Prolapse is a weakness of the supporting structures of the vagina, allowing the pelvic organs to press against the vaginal wall, producing a bulge. This can cause pressure, discomfort, change in bladder or bowel function and sometimes pain. Prolapse is not dangerous or life threatening but it can be distressing and bothersome, limiting physical and sexual activity.
Repair using mesh
Vaginal prolapse repair using mesh is only used for severe prolapse or where prolapse has recurred after a traditional repair. Vaginal mesh can be placed in any area of the vaginal walls, depending on the prolapse. This is usually done under a general anaesthetic or regional block such as a spinal anaesthetic. It involves making an cut in the vaginal skin so the mesh can be inserted. The vaginal wall is then closed with dissolvable stitches. A catheter is placed in the bladder and a pack or large tampon in the vagina to apply pressure to the wound(s). Vaginal mesh surgery is only performed by surgeons who specialize in this technique or by a gynaecologist supervised by a doctor with the necessary training and experience.
Prolapse Repair using vaginal mesh - ADHB Information
Vaginal Repair Surgery using mesh patient information leaflet.
Royal Australian and New Zealand College of Obstetrics and Gynaecology additional information:
Additional Women's Health information can be found on our A-Z Fact Sheets page