APR surgery

APR surgery to treat bladder prolapse

APR surgery Anterior and Posterior Vaginal Wall Repair This treatment is a type of surgery that restores the natural support of the vaginal walls. During this surgery, the surgeon makes an incision (incision) in the upper or lower wall of the vagina and then sticks together the stronger tissues that are under the soft skin and inside the vagina. The skin is then repaired and sewn together. This surgery does not use artificial mesh. Tissue transplantation may be used if you and your doctor have discussed this and made it part of your surgical plan.

Cystocele and rectocele repair or APR (cystocele or prolapse of the bladder and rectocele or prolapse of the rectum)

What is bladder prolapse?

Prolapse, or anterior bladder prolapse, known as cystocele, occurs when the supporting tissue between the bladder and the vaginal wall in women weakens and stretches, leading to the protrusion of the bladder into the vagina. This type of protrusion is also called bladder prolapse. Stretching of the muscles that support the internal organs of the pelvis may lead to anterior prolapse. Causes of muscle strain can include natural childbirth or with chronic constipation, severe coughing, or lifting heavy objects. Postmenopausal prolapse also causes problems when estrogen levels fall.

When the supporting tissue between the bladder and the vaginal wall is weakened and stretched in women, prolapse or anterior prolapse of the bladder occurs, leading to the protrusion of the bladder into the vagina.

Non-surgical treatment is often effective in treating mild to moderate sagging; But in severe cases with surgery, the vagina and other organs in the pelvis are placed in the right place.

Mild or grade 1 sagging is when the bladder is slightly raised toward the vagina. In grade 2 sagging, the bladder protrudes into the vaginal opening, and grade 3 sagging, which is the most advanced type, occurs when the bladder comes out of the vaginal opening.

What are the symptoms of bladder prolapse?

In mild cases, the signs and symptoms may not be obvious, but if they do occur, the signs and symptoms may include the following:

  • Feeling of fullness of the bladder or feeling of pressure on the pelvis and vagina
  • Feeling uncomfortable when stretching, coughing, carrying or lifting objects
  • Feeling of full bladder from urination
  • Recurrent bladder infections
  • Pain or leakage of urine during sexual intercourse
  • In some cases, a lump of tissue protruding from the opening of the vagina, which may be like sitting on a tennis ball.
  • Signs and symptoms usually appear after standing for a long time and may disappear when lying down.

What causes bladder prolapse?

The pelvic floor is made up of muscles, ligaments, and connective tissues that support the bladder and other pelvic organs.

The connections between the pelvic floor muscles and the ligaments can weaken over time. This weakness can be the result of an injury during a normal birth or a chronic strain on the pelvic floor muscles.

In this case, the bladder tends to be lower than normal and protrudes into the vagina (anterior prolapse). Possible causes of anterior prolapse include the following:

  • Pregnancy and natural childbirth
  • Being overweight or obese
  • Frequent lifting of heavy objects
  • Pressure during defecation
  • Chronic cough or bronchitis

These factors may increase the risk of anterior prolapse:

giving birth

Vaginal or natural childbirth increases the risk of bladder prolapse.

age increasing

The risk of anterior fall increases with age. Especially after menopause, when the production of estrogen, which strengthens the pelvic floor muscles, decreases, the risk of bladder prolapse increases.

Hysterectomy or removal of the uterus

Removal of the uterus may lead to weakening of the pelvic floor muscles.


In some women, connective tissue is genetically weak; This makes them more prone to bladder prolapse.


Women who are overweight or obese are at higher risk for anterior prolapse.

How to prevent this disease?

To reduce the risk of bladder prolapse , do the following:

  • Do Kegel exercises regularly. These exercises can strengthen the pelvic floor muscles, especially after the baby is born.
  • Treatment and prevention of constipation; High-fiber foods can help.
  • Avoid lifting heavy objects. When lifting objects, use your legs instead of your back.
  • cough treatment; Treat a cough or chronic bronchitis and do not smoke.
  • Prevent weight gain; If necessary, consult your doctor to determine your proper weight and weight loss strategies.

How is bladder prolapse diagnosed?

A specialist doctor can diagnose grade 2 and grade 3 sagging based on symptoms and clinical vaginal examinations, because the sagging part of the bladder is visible. Other tests may be needed to find or rule out problems in other parts of the urinary tract.

When to see a doctor?

Severe bladder prolapse can be annoying, causing the bladder not to empty completely and resulting in infection; Therefore, in case of any annoying symptoms, see a specialist .

How is bladder prolapse treated?

Selective treatments for bladder prolapse include no need for treatment for mild prolapse until surgery for advanced prolapse. If the condition is not bothersome, your doctor will advise you to avoid lifting heavy objects or stretching too much.

If the symptoms are relatively bothersome, your doctor may recommend a device called a boy , a device that is inserted into the vagina to hold the bladder in place.

This device is available in different shapes and sizes for patient comfort. To prevent infection or wounding, the hair follicle should be removed regularly .

In advanced falls, surgery may be needed to move and keep the bladder in a normal position. This procedure is performed by obstetricians or urologists.

In the most common surgical procedure to repair a sagging bladder, the surgeon makes an incision in the vaginal wall and strengthens the tissue layers that separate the limbs, supporting the bladder. The patient may be hospitalized for several days and the healing process is complete. It takes up to 6 weeks .


APR surgery Treatment of bladder prolapse: What is vaginal wall repair?

APR surgery Treatment of bladder prolapse: When is this surgery used?

Anterior vaginal wall repair

It is used to treat a sagging vaginal wall under the bladder, also called a cystocell or sagging bladder. Posterior repair treats sagging vaginal wall on the rectum, also called the rectum.
Your doctor will decide if you need one or both vaginal walls. Sometimes this decision is best made during surgery.

How do I prepare for surgery?

  • 2 to 3 weeks before the operation, you will visit one of the preoperative clinics. At this visit, you will review and sign the consent form, blood will be taken for preoperative testing, and you may have an ECG (ECG) to check for signs of heart disease . You will also receive more detailed training, including whether you need to stop your medication before the operation.
  • You may also check with your doctor or cardiologist before surgery, especially if you have heart disease , lung disease or diabetes . This is done to ensure that you are as healthy as possible before the operation.

When do you go home after surgery?

Most women can go home the same day they have surgery. However, depending on your general health and condition at the end of surgery, you may need to spend 1 night in the hospital.

If you go home the same day :

  • You need to arrange for someone to come with you, stay while you have surgery, and then take you home.

If you stay overnight in the hospital:

You need to plan so that the person you are discharging from at 10am is in the hospital so he or she can help you get ready to leave and then take you home.

Do I need someone to be with me after the operation?

If you live alone , we recommend that you ask a friend or relative to stay with you at least until noon the day after you return home.

It’s good to have someone who plans to check in person or on your phone every day for the first week you are at home. You need to prepare your house with food before you go to the hospital, but you may still need someone to buy for you or take you to the store in the first week.

What can be expected during surgery?

  1. In the operating room, you will receive general anesthesia (medicine for deep sleep, loss of sensation and muscle relaxation) or spinal anesthesia (medicine injected near the spinal cord to lose sensation from the abdomen to the toes). The choice of anesthesia is a decision made by the anesthesiologist based on the planned surgery, your history and your wishes. Most women do general anesthesia.
    2. A tube (catheter) is inserted into your bladder to drain urine and control the amount of urine that comes out during the operation. The catheter is usually removed before going home.
    3. Compression socks are placed on your feet to prevent blood clots in the legs during the operation. You will use a blood thinner called heparin with a small needle under your skin.
    4. At the end of the surgery, some gas may be inserted into your vagina, somewhat like a large tampon. This helps prevent bleeding immediately after surgery. You may feel pressure in the vagina this way. It is usually removed about 6 hours after surgery.

What happens after surgery?

  • If you go home the day of surgery, you will go to the recovery room and be monitored until you are ready to go home.
    You will be checked to see if your bladder is emptying naturally. You usually have trouble temporarily emptying your bladder completely after this surgery.

If you can not empty your bladder normally,

Do one of the following:

  •  You will have the catheter inserted again in a few days and then you will go to the obstetrics and gynecology clinic for a re-examination.
  •  You will be taught how to catheter yourself with a short, straight and narrow tube. Do this after each urination (or after 4 hours if you can not go) so that you can empty your bladder normally. For most women, this may take a few days, but for some it may take weeks.
  •  We know that no one wants to go home with a catheter, but bladder protection is very important. Use Miralax to keep your stools soft like toothpaste. You should not strain or upset your bowel movements.

 If you do not go home on the day of surgery 

You stay in the hospital overnight. If your doctor determines that this is needed, you may stay longer.

While you are in the hospital, you do the following :

  • Start eating a normal (solid) diet. This may happen later on the day of your surgery or the day after the operation. If you have special nutritional needs, please tell your nurse.
  • Use painkillers and nausea if needed.
  • Use a blood thinner with a small needle under your skin.
  • Start your usual medications again.
  • Start walking as soon as possible to help improve and heal.

 To prevent blood clots 

Wear compression socks on your feet. The stockings will stay on your feet as long as you get up and walk.

Check that

Is your bladder emptying normally or not? You usually have trouble temporarily emptying your bladder completely after this surgery. If you can not empty your bladder normally, do one of the following:

  1.  You will have the catheter inserted again in a few days and then you will go to the obstetrics and gynecology clinic for a re-examination.
  2.  You will be taught how to catheter yourself with a short, straight and narrow tube. Do this after each urination (or after 4 hours if you can not go) so that you can empty your bladder normally. For most women, this may take a few days, but for some it may take weeks.
  3.  We know that no one wants to go home with a catheter, but bladder protection is very important. Use Miralax to keep your stools soft like toothpaste so that at least 6 weeks after surgery you do not have to strain your bowel movements or have discomfort. You will receive a copy for this to be used at home.

 What are the potential risks of APR surgery?

We work very hard to make sure your surgery is as safe as possible, but even when things go according to plan, problems can arise. It is important to be aware of these potential problems, how often they occur, and what steps you can take to correct them.

Possible risks during surgery include :

  • Bleeding : If there is heavy bleeding, a blood transfusion is given. If you have personal or religious reasons for not wanting an injection, you should talk to your doctor before the operation. The risk of blood transfusions is less than 1 in 100.
  • Bladder Injury : The ureter (the tubes that carry urine from the kidneys to the bladder), or the intestines: the risk of injury is less than 1 in 100. In case of injury, if possible, it will be repaired during surgery.
  • Add surgery that requires an abdominal incision : The location and size of the incision depends on the type of extra surgery you have. If you have a cleft palate, you may need to stay in the hospital for two or three nights.
  • Nerve damage : We are very careful to put you in the operating room so that no harmful pressure is applied to your nerves during the operation, but this is unlikely to happen. Your nerves can also be damaged by surgery itself. The overall risk of nerve damage is 2 to 10 per 100. Nerves often heal, but it can take months.
  • Death : All surgeries have a risk of death. Some surgeries are more risky than others. The probability of death due to this type of surgery is less than 1 in 10,000.

Possible risks that may occur a few days to a few weeks after surgery :

  • Blood clots in the legs or lungs: Blood clots in a blood vessel block blood flow and can cause swelling and pain in the legs. It can reach the lungs and cause shortness of breath, chest pain and death. The risk of developing a blood clot after surgery is about 2 in 1000. Intestinal obstruction: Intestinal
    obstructionthat causes abdominal pain, bloating, nausea and vomiting. The risk of intestinal obstruction is less than 5 per 1000. Discomfort during sexual activity: If this happens, we can help you reduce it. The risk of new discomfort after surgery is less than 5 in 100. Infection: Thisincludes an infection of the urinary tract as well as an infection at the surgical site. Infections are treated with antibiotics. The risk of urinary tract infection is about 40 in 100. The risk of other infections undergoing surgery is about 7 in 100.

  • Symptoms of prolapse: The probability of recurrence of prolapse after surgery to repair prolapse is up to 20 per 100 and usually occurs years after surgery.
    Scar tissue : Thicker tissue than normal skin forms where surgery was performed. There may be pain in the scar tissue.
    Urinary symptoms: Tissue scar rarely needs treatment. You can not empty your bladder normally when you urinate. In the first 2 weeks after surgery, the risk of incomplete bladder emptying is up to 40 per 100. If needed, you will be taught how to use the catheter.

When should I call my doctor?

If you notice any of the following symptoms, contact your doctor immediately at any time of the day or night, including weekends and holidays:

  • Temperatures above (38 ° C) If you do not have it, please buy a thermometer before surgery.
    Severe bleeding (wetting a regular pad for an hour or less)
    • Severe pain in the abdomen or pelvis that painkillers do not help.
    • Chest pain or difficulty breathing
    • Swelling, redness or pain in your legs

Also when :

  • Incision that opens
    • Incision that is red or hot
    • Fluid or blood leaking from an incision
    • New bruising after discharge from the hospital that is large or expanding. (Bruising around the incision is normal)
    • Nausea and vomiting
    • Severe vaginal discharge (spotting and light discharge are normal)
    • Skin rash
    • Unable to urinate at all
    • Pain or burning when urinating
    • Blood or turbidity in urine
    • Feeling Continuous urination
    • Feeling that something is wrong.

How to prevent nausea?

The best way to prevent nausea is to eat small, frequent meals. It is important to take something before taking painkillers.

What can you eat?

After going home, you can eat your normal diet. Frequent meals are easier to digest than a few large meals.

  • Eat high-protein foods
  • Beans and lentils
  • Nuts 
  • egg
  • Dairy (Greek yogurt is very high in protein)
  • Chicken
  • Meat 
  • Eat foods that are rich in vitamins that help improve healing
  • Bell pepper
  • Vegetables (kale, spinach and broccoli)
  • Sweet potatoes
  • Carrots
  • tomato
  • Citrus
  • Berries 
  • Kiwi
  • cantaloupe
  • Apricot
  • Mango

Tip !

 If you have diabetes: Controlling your blood sugar is very important. Take your medication on time and follow your diet. Check your blood sugar every day and call your doctor if you have high blood sugar to help you manage your diabetes.

How often should you take painkillers?

It is normal to have some pain after surgery. The goal of taking painkillers is to make you as comfortable as possible while keeping the risk of bad or annoying side effects as low as possible. We want you to be comfortable enough to wake up, wash, get dressed, and do simple things at home. Some discomfort is likely. We do not expect you to be completely free of pain.

The following are general guidelines for taking painkillers :

Unless your doctor tells you otherwise, ibuprofen is the main medicine you will use to control pain.

If ibuprofen alone does not control your pain, you may be told to add acetaminophen.

You may also be prescribed a drug such as hydrocodone or oxycodone. Drugs should be added to reduce pain that is not adequately relieved by ibuprofen and acetaminophen.

Norco contains hydrocodone and acetaminophen Percocet contains oxycodone and acetaminophen. Oxycodone is free of acetaminophen.

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