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Vaginal Hysterectomy and Reconstruction for Pelvic Organ Prolapse

Vaginal Hysterectomy and Reconstruction for Pelvic Organ prolapse is a procedure which may be performed if you have a uterine prolapse with a cystocele or rectocele. When the uterus (womb) drops down into the vagina it can, in more advanced cases, extend beyond the entrance to the vagina. A Vaginal Hysterectomy and Reconstruction for Pelvic Organ Prolapse is the surgical removal of the uterus through the vagina and correct the prolapse.

These are becoming quite common surgeries but how often are the risks of Vaginal Hysterectomy and Reconstruction for Pelvic Organ Prolapse discussed fully? An important aspect of post-operative recovery is to check blood counts, signs of anaemia and complications of surgery. Objective signs of anaemia included tachycardia, hypotension, and low urine output. Subjective signs of anaemia included dizziness, weakness, pallor, and diaphoresis. Complications, such as blood transfusions, additional testing, and readmission are often recorded.

Anaesthetic risk

This risk depends on the extent of your specific medical conditions, such as with your heart, or breathing. Smoking and being overweight increases all risks. A vaginal hysterectomy can be performed with you asleep (a general anaesthetic) or awake but numb from the waist down (a spinal anaesthetic).

Bleeding

There is a risk of bleeding. Excessive bleeding may require abdominal surgery to stop the bleeding. It is important that your Doctor is aware if you take blood-thinning tablets such as Warfarin, Aspirin, Clopidogrel or rivaroxaban. You may be asked to stop them before your operation.

Infection

There is a risk of infection. This could be a wound infection, vaginal infection or a urinary infection. on most occasions it can be treated with antibiotics. Chest infections may also occur because of the anaesthetic or you may be exposed to hospital acquired pneumonia.

Deep Vein Thrombosis (DVT)

This is a clot in the deep veins of the leg which can travel to the lungs (pulmonary embolism) which can be very serious. In rare circumstances it can be fatal. The risk increases with obesity, severe varicose veins, infection, immobility and other medical problems. You should be advised to stop taking any hormones such as hormone replacement therapy (HRT) and some types of birth-control pills 4 weeks before surgery. Do not arrange surgery the day after a long car journey or flight.

Wound complications

The wound within the vagina can become infected or occasionally stitches can become loose allowing the wound to open up or tighten causing discomfort.

General risks of prolapse surgery

You may get another prolapse. This may be straight away or in a few years. Recurrence of the same prolapse probably occurs in about 1 in 10 cases but it is generally believed that about 3 in 10 women who have an operation for prolapse will eventually require treatment for another prolapse. This is because the vaginal tissue is weak.

Failure to cure symptoms

You may still suffer from an overactive bladder following your repair. Urinary urgency and frequency with or without incontinence can occasionally can start or worsen after the operation.

Stress incontinence

Having a prolapse sometimes causes some kinking of the tube through which you pass urine (urethra). This can be enough to stop urine leaks on coughing, laughing or sneezing. By correcting the prolapse this kink gets straightened out and the leaks are no longer stopped. It is difficult to define an exact risk but it is reported to be in the order of 10% (1 in 10).

Bladder emptying or voiding problems

These may not improve after surgery for prolapse. Your doctor may wish to do bladder tests (urodynamics) prior to surgery to predict post-operative voiding difficulties. There can be persistence of voiding problems in 1 in 10 women.

A change in the way your bowel works

Some patients experience worsening constipation following surgery. This may resolve with time. It is important to try to avoid being constipated following surgery to reduce prolapse recurrence.

Painful sexual intercourse

Some women find sex is uncomfortable and this does not go away and becomes permanent. Sometimes the sensation during intercourse may be less and occasionally orgasm may be less intense.

Specific risks of vaginal hysterectomy

A vaginal hysterectomy can cause damage to the bladder or bowel. They can occur because these organs are immediately next to the vagina. The risk is greater if you have had pelvic surgery or pelvic infection in the past or if there is inflammation of the tissues. Occasionally the damage is not recognised at the time of surgery and has to be repaired later. There is also a risk of making a hole in the bladder as well as a risk of a fistula between bladder and vagina. The risk of bowel injury and damage to the ureter can also occur.

If you have not been warned about the risks and complications of surgery you may have a claim if you are then injured. Vaginal Hysterectomy and Reconstruction for Symptomatic Pelvic Organ Prolapse is major surgery which is often routine but the complications can be significant.