Prolapsed Bladder Surgery

What Is a Prolapsed Bladder Surgery?

A prolapsed bladder (cystocele) is a common condition where the bladder droops or drops from its position as it is no longer supported by the pelvic floor muscles. As the organ prolapses it begins to push into the front wall of the vagina, causing a noticeable and often painful bulge. To read more about bladder prolapses, visit the Types of Prolapse page.

Surgery is usually the last resort to attempt to resolve a bladder prolapse. Reserved for those that have been unable to relieve their symptoms and reduce the prolapse sufficiently through non-surgical treatments.

If you require surgery for a prolapse, then your surgeon will talk you through the process and your options. As with any medical procedure, it’s a good idea to be armed with all the information you need, so that you can prepare any questions you may have beforehand. On this page we have brought together information about the different types of surgeries available to resolve a bladder prolapse, the risks, potential complications, and recovery advice.


Is Surgery Right For You?

You will be a good candidate for a pelvic prolapse surgery if you:

  • have been unable to treat your symptoms sufficiently through non-surgical treatments
  • you no longer want any children - as pregnancy and childbirth can reverse pelvic surgery, and some surgeries even prevent pregnancy
  • do not wish to try a vaginal pessary or have not had success with a vaginal pessary
  • you are happy to take on the potential risks and complications

To read more about the non-surgical treatments available for pelvic organ prolapses, visit our Treating a Prolapse Without Surgery page. If you and your doctor agree that surgery is the best option for you, you will discuss which surgery is likely to be most successful.


What Types of Bladder Prolapse Repair Surgery Are Available?

Bladder prolapse surgery is often called a bladder lift as it involves the movement of the bladder back up into place where it is then stitched. Many of these surgeries can be performed alongside other prolapse repair surgeries, to resolve all prolapses during one operation.

These surgeries do have relatively high initial success rates, however, it is not uncommon for symptoms to return over time, meaning further surgery is required.

Anterior Vaginal Repair (Anterior Colporrhaphy)

The anterior vaginal wall is the wall at the front of the vagina which, alongside the strong pelvic muscles, holds the bladder in place. If the bladder begins to drop, its can prolapse (bulge) into the anterior vaginal wall.

An anterior vaginal repair is often performed through the vagina whilst you are under general, regional or local anaesthetic. The tissue of the anterior vaginal wall is cut from bottom (at the entrance of the vagina) to the top, and then separated from the underlying supportive layer. Dissolvable stitches are then added to encourage scarring as increased support in this area. This surgery has an initial 70-90% success rate in restoring normal bladder function and resolving other symptoms associated with a bladder prolapse.

If this is a repeat surgery to resolve a bladder prolapse, or the prolapse is especially severe, you may have a synthetic mesh fitted as further support for the vaginal wall. This is however, currently only recommended within the context of research as there is insufficient evidence to prove its safety in this use.

Retropubic Bladder Suspension Surgery

This surgery involves lifting the neck of the bladder upwards and attaching it to the tissues or bones of the pelvis with some surgical stitches to hold it in place. This kind of surgery is especially helpful if you’ve experienced a prolapse of the bladder along with the urethra (urethrocele), the tube that takes urine from the bladder to the outside of the body.

It can be performed via an incision in the abdomen, just below the belly button, in an open procedure or through a laparoscopic (keyhole) surgery. Recovery is often faster in laparoscopic (keyhole) surgeries due to the smaller entry wound.

This surgery is also a common treatment for stress urinary incontinence.

Sling Surgery

Sling surgery involves a piece of material, either medical grade or part of your own pelvic tissue, being sewn around the bladder like a sling or a hammock to hold the bladder in place. There are a number of different synthetic materials produced for this purpose, which have varying associated side effects. Similar to the synthetic mesh sometimes used in an anterior vaginal repair, the use of synthetic materials in pelvic surgeries is currently only recommended within the context of research due to the lack of research into its long-term risks and effects.


What Are the Risks and Potential Complications?

As with all surgeries, bladder surgery for a prolapse comes with some risks. The risks are small, but can include:

  • injury to any of the pelvic organs, not just the bladder
  • bleeding or blood clots
  • infection
  • abscesses
  • pain during sex that does not improve
  • overactive bladder / incontinence
  • difficulty or pain or urination
  • further prolapse of the bladder or other pelvic organ
  • anesthetic issues
  • 6% risk of developing a bladder infection (cystitis)
  • constipation

If you've had a bladder prolapse surgery and you’re experiencing any of the above or something else that’s worrying you, then make an appointment to see your doctor or surgeon straight away.


Mesh Erosion

Synthetic mesh is most commonly used as support in surgeries for severe prolapses. Or in surgeries which are a second or third attempt to repair a prolapse. If a synthetic material is used, you are at a 5-10% risk of experiencing mesh erosion/extrusion, which will require a secondary procedure or surgery to trim or remove the material.


How Long Does it Take to Recover from Bladder Prolapse Repair Surgery?

For your surgery you will have a catheter fitted which will be removed 48 hours after the operation. Once the operation has finished, you will also have had a gauze pack inserted into your vagina to absorb bleeding, which will also be removed after 48 hours. You may have spent those two days in hospital, but it is likely that you will have been at home and be back in hospital only for the follow-up appointment.

As you begin to heal you will experience a creamy discharge and a small amount of blood, but after the first month you will feel much better. As a general rule, you can expect to be back to your normal duties after around six weeks. After 3 months, you should feel capable of continuing with exercise.

It is important to understand that how quickly you recover will depend on your personal circumstances and the type of prolapsed bladder surgery you have. To improve your recovery you can follow these steps:

  • Daily Kegel / pelvic floor exercises - As soon as you are able, you can start to tense those muscles each day.
  • Make lifestyle changes - Following surgery, you will be recommended to follow the non-surgical treatments for prolapses to reduce the risk of further prolapses occurring. This includes treating any persistent coughs and taking steps to avoid constipation and straining.
  • Rest up - Take it easy for the first six weeks or so after surgery. This includes no heavy lifting (not even children or shopping bags), exercise or sex.
  • Maintain a healthy weight – Being overweight or obese puts extra strain on the pelvic floor muscles.
  • Don't rush back to work - Take your recovery at your own pace. You will usually be advised to stay off work for 2-6 weeks, depending on your role.
  • Attend follow-up appointments - It is important that you attend all follow-up appointments to continue to get expert advise on your treatment.

Read more about what to expect following a prolapse repair surgery on the Vaginal Repair Surgery page.


What Are the Alternatives to Surgery?

Your doctor will only recommend surgery as treatment for a bladder prolapse if absolutely necessary. This usually means that non-surgical treatments have been tried and haven’t worked for you. If you want to read more about non-surgical treatments for bladder prolapses, visit our Treating a Prolapse Without Surgery page.


Sources

Cody, J. D. Lapitan, M. Mashayekhi, A. (2017). Open retropubic colposuspension for urinary incontinence in women [online] Cochrane, 2017 [viewed 26/03/2018]. Available from: http://www.cochrane.org/CD002912/INCONT_open-retropubic-colposuspension-urinary-incontinence-women

International Urogynecological Association, IUGA. (2011). Anterior Vaginal Repair (Bladder Repair). [online] International Urogynecological Association, IUGA, 2011 [viewed 26/03/2018]. Available from: http://thepelvicfloorsociety.co.uk/budcms/includes/kcfinder/upload/files/eng_antvwrepair.pdf

Marinone, M. E. Moldovan, C. P. Staack, A. (2015). International Journal of Women's Health. Transvaginal retropubic sling systems: efficacy and patient acceptability. [online] 7, p 227-737. [viewed 26/03/2018]. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4337501/

NICE. (2015). Urinary incontinence in women: management, 1 Recommendations [online] National Institute for Health and Care Excellence, 2015 [viewed 14/03/2018]. Available from: https://www.nice.org.uk/guidance/cg171/chapter/1-Recommendations#physical-therapies