Download anterior repair - Fort Sanders Women`s Specialists

50119thStreet,TrusteeTowers Suite401,KnoxvilleTn37916 FORTSANDERSWOMEN’SSPECIALISTS
P#865-331-1122F#865-331-1976
1924PinnaclePointWay
Suite200,KnoxvilleTn37922
Dr.CurtisElam,M.D.,FACOG,AIMIS,Dr.DavidOwen,M.D.,FACOG,Dr.StevenPierceM.D.
Dr.DeanTurnerM.D.,FACOG,ASCCP,Dr.F.RobertMcKeownIII,M.D.,FACOG,AIMIS
Dr.BrookeFoulk,M.D.,FACOG,Dr.G.WaltonSmith,M.D.,FACOG,Dr.SusanRobertsonM.D.,FACOG
ANTERIORREPAIR
Pleasereadandsignthefollowingconsentformwhenyoufeelthatyoucompletelyunderstandthesurgicalprocedurethatis
tobeperformedandafteryouhaveaskedallofyourquestions.Ifyouhaveanyfurtherquestionsorconcerns,pleasecontact
ourofficepriortoyourproceduresothatwemayclarifyanypertinentissues.
Definition: Anterior Repair is a surgical procedure to correct a cystocele and/or urethrocele. A cystocele is the sinking or
bulging of the bladder into the vagina and a urethrocele is the sinking of the urethra (tube that empties urine from the
bladder) into the vagina. A cystocele/urethrocele occurs when the thin wall of tissue that separates the bladder from the
vaginaweakensorisinjured,allowingthebladdertobulgedownwardintothevagina.Ananteriorrepairreturnsthebladder
andurethratoitsnormalpositionandstrengthensthewallbetweenthebladderandthevagina.
Procedure:Aftersedationfromgeneralanesthesiaisachieved;thesurgeonwillbeginbyplacingacatheterinthebladderto
keepitemptyduringtheprocedure.Anincisionismadealongthecenterofthefrontwallofthevagina,startingnearthe
vaginalentranceandfinishingnearthetopofthevagina.Ameasuredportionoftheweakenedandstretchedvaginalskinis
thenseparatedfromtheunderlyingsupportive,connectivetissuelayer.Next,thebladderisplacedbackintoitsnormal
position.Thestrongsupportivetissuesoneachsideofthepelvisarethensuturedtogetherunderneaththebaseofthe
bladder;thisrecreatesastrongconnectivetissuewallbetweenthebladderandthevagina.Thesurgeonoccasionallymay
thenperformacystoscopy.Duringcystoscopy,asmalltelescopeisplacedintothebladdertoconfirmthatnoinjurytothe
bladder,ureters,orurethrahasoccurredduringsurgery.Thesurgeryisthencompletedbyremovingasmallstripof
redundantvaginalskinandthenclosingthevaginalincisionwithdissolvablestitches.Sometimespackingisplacedinthe
vaginaovernighttoreducevaginalbleedingorbruising.
Diagnosis:Thereasontohaveananteriorrepairisacystoceleand/orurethrocele.Acystoceleisthesinkingorbulgingofthe
bladderintothevaginaandanurethroceleisthesinkingoftheurethraintothevagina.Acystocele/urethroceleoccurswhen
thethinwalloftissuethatseparatesthebladderfromthevaginaweakens,allowingthebladdertobulgedownwardintothe
the vagina. Factors that contribute to the loss of normal support between the bladder and the vagina are: pregnancy and
childbirth, menopause, chronic coughing, obesity, chronic constipation, years of strenuous activity or heavy lifting, and/or
othergynecologicalorbladdersurgeries.Themostcommonsymptomsassociatedwithacystocele/urethroceleare:difficulty
emptying the bladder completely, difficulty starting and maintaining steady urine stream, urinary urgency and frequency,
leaking of urine with coughing/sneezing/exercising, bulging or pressure feeling in the vagina, frequent bladder infections,
and/orpainfulsexualintercourse.
ExpectationsofOutcome:Ananteriorrepairtypicallytakes1hourtocomplete.Whenyouawakefromsurgeryyouwillhave
anIV,andpossiblyabladdercatheterandvaginalpackinginplace.Mostpatientswillgohomethesamedayassurgerywhile
othersmayhaveadditionalsurgerieswiththeiranteriorrepairandwillstayonenightinthehospital.Recoveryfroman
anteriorrepairtypicallytakes4-6weeks;itisveryimportanttoabstainfromsexualintercourseandheavyliftinguntilreleased
byyourdoctor.Followingtherecoveryfromananteriorrepair,itisexpectedforpatientstohaveimprovementofbladder
functionandpossiblydecreasedepisodesofincontinenceandurinaryfrequency.Itisalsoexpectedforpatientstohaverelief
fromthevaginalpressure/fullnesssensationandintercourseshouldbemorecomfortable.
PossibleComplicationsoftheProcedure:Allsurgicalprocedures,regardlessofcomplexityortime,canbeassociatedwith
unforeseenproblems.Theymaybeimmediateorevenquitedelayedinpresentation.Whilewehavediscussedtheseand
possiblyothersinyourconsultation,wewouldlikeyoutohavealistofsomespecificcomplicationssothatyoumayask
questionsifyouarestillconcerned.Asidefromanesthesiacomplications,alistofpossiblecomplications,wouldinclude,but
arenotlimitedto:
•OrganInjury:Duringanypartoftheprocedure,anyorganinthepelvis(intestine,bladder,uterus,ureter,rectum,
etc)canbeinadvertentlyinjured.Damagetothebladder,urethra,ureter,orvaginaisthemostcommontypeofsurgicalinjury
duringananteriorrepair.Oftentheinjuryisminorandcanbetreatedwithrelativeease;howeveriftheinjuryismajororthe
repairiscomplicated,moreextensivesurgerymaybenecessary.Thismayprolongthehospitalstayandrecoveryandmight
alsonecessitateadditionalsurgicalproceduresinthefuture.Ifinjurytothebladderoccurs,itmaybenecessarytoweara
Foleycatheterfor2-4weekswhilethebladderheals.
•Infections:AlthoughprophylacticantibioticsaregiventhroughyourIVpriortosurgery,postoperativeinfectionscan
stilloccur.Themostcommontypeofinfectionisabladderinfection(UTI).AUTIcancauseburningwithurination,increased
urinaryfrequency,bloodintheurine,pelvicorbackpain,feverandorchills.Aninfectioncanalsooccurintheincisionsinthe
vagina.Ifaninfectionispresentthepatientmayhaveafevermorethan100degrees,increasingpaininthevaginaorpelvic
region,severeconstipation,andfoulodorousvaginaldischarge.Theentrancetothevaginamayalsoappearirritatedand
warmtotouchifaninfectionispresent.Pneumoniaisaninfectioninvolvingthelungs.Pneumoniamayoccurfromlackof
deepbreathingaftersurgeryduetopainfromtheincisionsites.Earlyambulationanddeepbreathinghelpstoreducetherisk
ofpneumonia.Whilerare,sepsisisanotherinfectionthatcanoccur.Sepsisiswhentheinfectionentersthebloodstreamand
canmakeyouveryill.Sepsissymptomsusuallyinclude:fever,chills,weakness,nausea,vomitingandorconfusion.Ifanyof
theabovesymptomsofinfectionoccur,callouroffice.
•VascularInjury:Anyofthevesselsinsidethepelvisareatpotentialriskforinjuryduringananteriorrepair.
Inadvertentinjurytoabloodvesselcanoccurasinstrumentsareintroducedintothepelvis,duringtherepairofthevaginal
andpelvictissues,orfromelectricalinjurytothevesselwall.Anothertypeofvascularinjuryoccurswhenthesealedor
suturedvesselcomeslooseaftertheprocedurehasbeenfinished.Mostoftheseinjuriesarerecognizedandresolvedatthe
timeofsurgery.Majorvesselinjuryordelayedbleedingmayrequireadditionalsurgery,prolongedhospitalstayandrecovery,
readmissiontothehospital,andbloodtransfusion.
•UrinaryRetention/BladderInstability:Ifthecystocelewaspresentforalongtime,youmayhavebecome
accustomedtotheabnormalchangesinyouranatomy.Therefore,afterananteriorrepairitmaytakesometimeforyour
bladdertoadjusttoitsrestoredposition.Itisnotuncommontodevelopurinaryfrequency/urgencyduringthisadjustment
period.Whilerare,somepatientswilldevelopurgeincontinenceandneedmedicationstorelaxthebladder.Itisalsopossible
tohaveurinaryretention(inabilitytoemptybladdercompletely)followingsurgery.Patientswhodevelopurinaryretention
mayneedtohaveaFoleycatheterplacedoruseselfcatheterizationfor1-2weekswhilethebladderadjustsfromsurgery.
•BloodLoss/Transfusion:Thevaginalregionisvascular.Usuallythebloodlossinthisprocedureisminimal.Insome
casesbloodlosscanbesignificantenoughtonecessitateabloodtransfusion.Ifatransfusionisnecessary,thereisasmallrisk
ofbloodrelatedinfectionssuchasHepatitisorHIV.
•PainfulIntercourseandVaginalShortening:Afterananteriorrepair,thedepthofthevaginamaybelessenedand
theanglechanged,causingsomewomentocomplainofpainordifficultywithintercourseaftersurgery.Thispainisusually
temporarybutmaybepermanent.Itisextremelyimportanttonotresumeintercourse(vaginalpenetration)untilreleasedto
dosobyyoursurgeon.Thisistypically6-8weeksaftersurgery.Ifyouhavesuddenonsetofwateryorbloodydischargebeyond
whatalightsanitarypadwouldtakecareof,thencallouroffice.
•Hematoma:Whenasmallbloodvesselcontinuestobleedaftertheprocedureisover,theareaofcollectedbloodis
referredtoasahematoma.Thebodynormallyre-absorbsthiscollectionoverashortperiodoftimebutsurgicaldrainage
maybenecessary,however,thisisrare.
•ChronicPain:Withanyprocedure,apatientcandevelopchronicpaininanareathathasundergonesurgery.
Typically,thepaindisappearsovertime,althoughsomefeelingofnumbnessmaypersist.
•TreatmentFailure:Whileananteriorrepairhasahighsuccessrate,thereisachancethattheprocedurecanfailin
themonthsoryearstofollow.Prolapsecouldoccuragaininthefuture,inthesameordifferentpartofthevagina.
•Incontinence:Afteralargeanteriorrepair,somewomenmaydevelopstressurinaryincontinence(leakageofurine
withcough/sneeze)duetotheun-kinkingoftheurethra.Yourdoctormayperformtests(urodynamics)andexamspriorto
surgerytoseeifitisnecessarytoplaceasupportiveslingundertheurethraduringsurgerytohelppreventincontinencefrom
occurring.However,additionalsurgeriesmaybeneededtofurthercorrecttheincontinence.
•DeepVeinThrombosis(DVT)/PulmonaryEmbolus(PE):Inanyoperation(especiallylongeroperations),youcan
developaclotinaveinofyourleg(DVT).Typically,thispresentstwotosevendayspostopaspain,swellingandtendernessto
touchinthelowerlegarea.Althoughlesslikely,thisbloodclotcanmovethroughtheveinsandblockoffpartofthelung(PE).
Thispresentsasshortnessofbreathandchestpain.Ifyounoticeanyofthesesigns,callouroffice.
•LowerExtremityWeakness/Numbness:Whilethisisrare,itispossiblethatduetothepositioningofyourlegsinthe
lithotomyposition(legsintheair/stirrup)foralongperiodoftimeordirectinjurytonervesbysurgicalinstruments,youmay
developweaknessornumbnessinyourlegs.Itisusuallyself-limited,withareturntobaseline.
•PermanentInjury/Death:Permanentinjuriesfromsurgeryarerarebutdooccur.Permanentinjuriesmayinvolve
removaloforgansnotplannedduringtheoriginalsurgery,painthatdoesnotresolvewithtime,ordiminishedabilitytoenjoy
life.DeathisextremelyrarefromGynecologicsurgerybutdoesoccur.Themostcommonreasonsaremassivebloodloss,
overwhelmingsepsis,heartattack,DVT/Pulmonaryembolus,stroke,andanesthesiacomplications.
AdditionalProcedures/Consultations:Ifthereareunanticipatedfindings,difficultyduringthesurgery,orasituationwhere
yourdoctordoesnotbelievethathehastheexpertisetoaccomplishallofyourcasethenanintra-operativeconsultationmay
benecessary.Intra-operativeconsultationiswhenanotherphysicianorsurgeonisaskedtogiverecommendations,assistor
takeoverasurgicalcase.Thisoccursatyourdoctor’sdiscretionforyoursafetyandwithoutregardtowhethertheother
physicianisonyourinsurancepanel.Bysigningbelowyougiveconsenttointra-operativeconsultationsifnecessary.
Photographs/Recordings:Stillphotographsanddigitalrecordingsofyoursurgerymayoccurfordocumentationofintraoperativefindingsorforeducationalpurposes.
Consent:I,Dr._________________________,havecounseled___________________________________________regarding
herplannedsurgery.InmyprofessionalopinionIbelievethatthesurgeryisreasonableandmostlikelywillresultina
beneficialoutcome.Itismybeliefthatthepatienthasconsideredheroptionsandfullyweighedtherisksofsurgery.
Signed__________________________________________________Date____________________Time______________
I,____________________________________________________,believethatthesurgicalprocedurelistedaboveisthebest
optionforme.MysituationisnotanemergencyandIunderstandthatIhaveotheroptions,includingnothavingsurgery.I
understandthatcomplications,badoutcomes,andunanticipatedeventswilloccuroccasionallyduringsurgeryandrecovery.I
understandthatmydoctorandhissurgicalteamarenotperfectandatnopointhaveIbeenguaranteedanyoutcomesor
results.IhavebeengiventheopportunitytoaskallmyquestionsandIbelievethatIhavealltheinformationnecessaryto
makeareasonabledecision.Therefore,Ielecttogivemyconsentandproceedwiththeabovesurgery,aswitnessedbymy
signaturebelow.
PatientSignature___________________________________________________________Date_________________
WitnessSignature___________________________________________________________Date_________________