Cystocele Repair and Sacrospinous Ligament Fixation Pelvic organ prolapse refers to pelvic organs “falling” into the vaginal vault.  When the bladder does this it is referred to as a cystocele.  One of the main associated areas of prolapse is the anterior vaginal vault where the uterus or small bowel (if the uterus is not present) may also bulge into the vagina.  If the posterior vault or rectum are involved, a gynecologist may be needed to assist in the repair of these defects. Urologists repair the bladder and the anterior apex of the vagina at the same time to prevent recurrence.  We also typically use mesh to perform the repairs despite some of the well-known mesh-associated risks because there is good evidence that these repairs last longer.  For the FDA opinion on the risks of using mesh in vaginal prolapse, see the following link: https://www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/Implants… The procedure is performed under general or spinal anesthesia in a hospital setting. You are placed in lithotomy position (position used to do pelvic exams in office), and prepped using antiseptic solution on the inside of the vagina, the labia, and surrounding areas. A catheter is placed and the vaginal wall underlying the bladder is injected with local anesthetic. This tissue is then incised and the bladder is carefully mobilized off of the vagina until the ligaments of the pelvis are palpated. A mesh kit is then used to anchor the mesh to the sacrospinous ligaments (along the back of the pelvis) and to the lateral muscle or tendon of the pelvis. This gives support to the sides and back of the vagina. Antibiotic solution is then used to cleanse the area. A scope of the bladder is performed so the bladder can be evaluated for any injury. The vaginal incision is then closed and a packing is inserted vaginally to prevent bleeding. You are then kept overnight in the hospital. The next morning, the packing and catheter are removed and the bladder is checked with an ultrasound to make sure that you are emptying normally. This is particularly important if a procedure was done for urinary leakage during the same operation. What to expect afterwards: Vaginal bleeding similar to a light period or spotting is normal for several weeks after surgery. Some pelvic pressure or discomfort is common.  If severe, let your doctor know. You will be instructed to do no heavy lifting, intercourse, bathing or swimming in a pool for 6 weeks. You may shower the next day, drive when you are no longer on pain medicine and moving your legs normally, and resume normal daily activities as tolerated. No baths until seen by your urologist for follow-up in the office. If you would like more specific information on the type of repair “kit” that will be used for your repair, please ask your doctor who can direct you to the website for that company or provide you with materials to review.