Anterior vaginal wall repair

The anterior vaginal wall can sink (prolapse) or bulge. This occurs when the bladder or the urethra sink into the vagina.

The repair may be done while you are under:

• General anesthesia: You will be asleep and unable to feel pain.
• Spinal anesthesia: You will be awake, but you will be numb from the waist down and you will not feel pain. You will be given medicines to help you relax.

Your surgeon will:

• Make a surgical cut through the front wall of your vagina.
• Move your bladder back to its normal location.
• May fold your vagina, or cut away part of it.
• Put sutures (stitches) in the tissue between your vagina and bladder. These will hold the walls of your vagina in the correct position.
• Place a patch between your bladder and vagina. This patch can be made of commercially available biological material (cadaveric tissue). The FDA has banned use of synthetic material and animal tissue in the vagina to treat anterior vaginal wall prolapse.
• Attach sutures to the walls of the vagina to the tissue on the side of your pelvis.

This procedure is used to repair sinking or bulging of the anterior vaginal wall.

Symptoms of anterior vaginal wall prolapse include:

• You may not be able to empty your bladder completely.
• Your bladder may feel full all the time.
• You may feel pressure in your vagina.
• You may be able to feel or see a bulging at the opening of the vagina.
• You may have pain when you have sex.
• You may leak urine when you cough, sneeze, or lift something.
• You may get bladder infections.

This surgery by itself does not treat stress incontinence. Stress incontinence is the leaking of urine when you cough, sneeze, or lift. Surgery to correct stress urinary incontinence may be performed along with other surgeries.

Before doing this surgery, your health care provider may have you:

• Learn pelvic floor muscle exercises (Kegel exercises)
• Use estrogen cream in your vagina
• Try a device called a pessary in your vagina to strengthen the muscle around the vagina

Risks for anesthesia and surgery in general are:

• Reactions to medicines
• Breathing problems
• Bleeding, blood clots
• Infection

Risks for this procedure include:

• Damage to the urethra, bladder, or vagina
• Irritable bladder
• Changes in the vagina (prolapsed vagina)
• Urine leakage from the vagina or to the skin (fistula)
• Worsening urinary incontinence
• Lasting pain
• Complications from the material used during surgery (mesh/grafts)

Tell your surgeon or nurse if:

• You are or could be pregnant
• You are taking any medicines, including medicines, drugs, supplements, or herbs you bought without a prescription
• You have been drinking a lot of alcohol, more than 1 or 2 drinks a day

Planning for your surgery:

• If you have diabetes, heart disease, or other medical conditions, your surgeon may ask you to see the provider who treats you for these conditions. 
• If you smoke, it's important to cut back or quit. Smoking can slow healing and increase the risk for blood clots. Ask your provider for help quitting smoking.
• If needed, prepare your home to make it easier to recover after surgery.
• Ask your surgeon if you need to arrange to have someone drive you home after your surgery.

During the week before your surgery:

• You may be asked to temporarily stop taking medicines that keep your blood from clotting. These medicines are called blood thinners. This includes over-the-counter medicines and supplements such as aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve, Naprosyn), and vitamin E. Many prescription medicines are also blood thinners.
• Ask your surgeon which medicines you should still take on the day of surgery.
• Let your surgeon know about any illness you may have before your surgery. This includes COVID-19, a cold, flu, fever, herpes outbreak, or other illness. If you do get sick, your surgery may need to be postponed.

On the day of surgery:

• Follow instructions about when to stop eating and drinking.
• Take the medicines your surgeon told you to take with a small sip of water.
• Follow instructions on when to arrive at the hospital. Be sure to arrive on time.

You may have a catheter to drain urine for 1 or 2 days after surgery. You can start eating normal food soon after the surgery.

When your normal bowel function returns, you can return to your regular diet.

You should not insert anything in the vagina, lift heavy items, or have sex until your surgeon says it is OK.

This surgery will very often repair the prolapse and the symptoms will go away. This improvement will often last for years.

Vaginal wall repair; Colporrhaphy - repair of vaginal wall; Cystocele repair - vaginal wall repair

Kirby AC, Lentz GM. Pelvic organ prolapse, abdominal hernias, and inguinal hernias: diagnosis and management. In: Gershenson DM, Lentz GM, Valea FA, Lobo RA, eds. Comprehensive Gynecology. 8th ed. Philadelphia, PA: Elsevier; 2022:chap 20.

Krlin R, Hallner B, Rourke E, Winters JC. Vaginal and abdominal reconstructive surgery for pelvic organ prolapse. In: Dmochowski RR, Kavoussi LR, Peters CA, et al, eds. Campbell-Walsh-Wein Urology. 13th ed. Philadelphia, PA: Elsevier; 2026:chap 117.

Tarsi EJ, Winters JC, Rourke E, Krlin RM. Anterior pelvic organ prolapse repair. In: Smith JA, Dmochowski RR, Thomas JC, Preminger GM, eds. Hinman's Atlas of Urologic Surgery. 5th ed. Philadelphia, PA: Elsevier; 2026:chap 84.

Updated by: Kelly L. Stratton, MD, FACS, Associate Professor, Department of Urology, University of Oklahoma Health Sciences Center, Oklahoma City, OK. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.