HYSTERECTOMY (VAGINAL) WITH BLADDER/RECTAL REPAIR

General Information

DEFINITION--Removal of the uterus, including cervix, through an incision made in the deepest recesses of the vagina. This surgery is frequently accompanied by plastic surgery (colporrhaphy) to repair bladder muscles and rectal muscles.

BODY PARTS INVOLVED--Uterus; cervix; bladder muscles; rectal muscles; vagina.

REASONS FOR SURGERY--Strengthening of the bladder muscles, rectal muscles and pelvic ligaments.

SURGICAL RISK INCREASES WITH

• Obesity.
• Smoking.
• Iron deficiency anemia, heart or lung disease, or diabetes mellitus.
• Use of drugs such as: antihypertensives; muscle relaxants; tranquilizers; sleep inducers; insulin; sedatives; beta-adrenergic blockers; or cortisone.
• Use of mind-altering drugs, including: narcotics; psychedelics; hallucinogens; marijuana; sedatives; hypnotics; or cocaine.

What To Expect

WHO OPERATES--General surgeon or obstetrician-gynecologist.

WHERE PERFORMED--Hospital.

DIAGNOSTIC TESTS

• Before surgery: Blood and urine studies; x-rays of abdomen and kidneys; dilatation and curettage (See Glossary) of the uterus (D & C).
• After surgery: Blood studies.

ANESTHESIA

• General anesthesia by injection and inhalation with an airway tube placed in the windpipe.
• Spinal anesthesia by injection.

DESCRIPTION OF OPERATION

• The vaginal walls are carefully separated from the bladder and rectal muscles.
• The deepest recesses of the vagina are opened. The uterus and cervix are cut free and removed. The rear part of the vagina is closed with sutures.
• The bladder muscles and rectal muscles are sewn into their proper position.
• A small catheter is left in the bladder. The catheter will remain in for 7 to 10 days.

POSSIBLE COMPLICATIONS

• Excessive bleeding.
• Surgical-wound infection.
• Rectal, ureter or bladder damage.
• Muscles supporting bladder and rectum may require a second repair.
• Urinary retention.

AVERAGE HOSPITAL STAY--8 to 9 days.

PROBABLE OUTCOME--The vagina will be shortened somewhat after surgery. This should cause no lasting problem. Expect permanent sterility. Allow about 6 weeks for recovery from surgery.

Postoperative Care

† Don't use tampons for bleeding---they may cause infection. Use sanitary pads instead.

MEDICATION---

Your doctor may prescribe:

• Pain relievers. Don't take prescription pain medication longer than 4 to 7 days. Use only as much as you need. > Vaginal creams or medicated douches, if vaginal discharge develops a bad odor.

† To help recovery and aid your well--

being, resume daily activities, including work, as soon as you are able.

• Resume driving 15 days after returning home. > Resume sexual relations when your doctor determines that healing is complete.

DIET--Clear liquid diet until the gastrointestinal tract functions again. Then eat a well--balanced diet to promote healing.

Call Your Doctor If

Any of the following occurs:

• Increased vaginal swelling, bleeding or pain (soaking more than 1 pad an hour).
• Signs of infection: headache, muscle aches, dizziness or a general ill feeling and fever.
• Frequent urination that persists longer than 1 month.
• Excessive vaginal discharge that persists longer than 1 month.
• Abdominal swelling or pain.