A & P repair with a sling vs having a hysterectomy with it

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OK-so I have cystocele and rectocele. I have a choice of having the A and P repair with or without a hysterectomy. I am torn. ANY advice is appreciated on the options and why/why not you chose the op you did.

thank you!!

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  • Posted

    Why do you need a hysterectomy? You mention you have an anterior and posterior prolapse but not why a hysterectomy may be necessary.
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    • Posted

      There is no reason as far as I know. It would be for ease of visualization for surgeon and "in case" my uterus prolapes in the future-or he mentioned if organs are gone no risk of cancer in the future to those organs. He seemed to be pushing the A and P and hysterectomy...is the visualization that important to remove my uterus and ovaries and tubes?? It sounds preventative to me. Just in case. I know I want A and P repair but am VERY hesitant to have a hysterectomy and am trying to justify to myself why it is ok to keep my organs. I am 54 years old just to let you know my age in life-peri-menopausal-no period after an ablation about 3 years ago.

      thank you-I just want to feel good in my decision.

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    • Posted

      You are sensible to research all options mar, I think it's important so you can go to your appointment with some idea of what you want or don't want. Urogynaecologists and Gynaecologists tend to look at preventative surgery once we get to a certain age or past childbearing years. Ovarian cancer in particular is very difficult to diagnose or should I say there are very few symptoms to warrant a woman to seek medical advice so total hysterectomy and  oopherectomy is often discussed. It is rare nowadays for a partial hysterectomy to be performed unless a woman requests this. Some women only reach orgasm through the cervix so that is something to be aware of. If you have an oopherectomy you will very quickly start to have menopausal symptoms. I had a hysterectomy and oopherectomy some years before my repair so I was in a different situation to you but I'm sure other ladies on the forum can help.  

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    • Posted

      Thank you Matron...it is a difficult decision for sure. When you had your hysterectomy were you already in or through menopause or did it throw you into it? What would be my main concerns with that? Of course another concern. I tell ya-out of many surgeries-this one seems to not be clear cut-do you agree? It seems there are so many variances.
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    • Posted

      I was only 39 when I had my hysterectomy and oopherectomy. I was only having a hysterectomy initially but when I was in theatre they had to remove my ovaries because I had adhesions. One was stuck to my bowel and the other was covered in cysts. I became menopausal very quickly and went onto HRT because it made me very depressed as well. I have been on HRT ever since and I'm almost 64! I agree the hysterectomy isn't clear cut and if you don't want the sudden menopause then keep your ovaries particularly if there's no family history of ovarian cancer or any gynaecological cancers. It really is up to you but you could have a surgeon who doesn't want to remove healthy organs. You need a sit down discussion with him.

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  • Posted

    Hi mar1964. I'm in California. I'm scheduled for rectocele repair in April. My Gyn will be doing the surgery. He, to initially stated I should have a hysterectomy as I also have a small cystocele. This was 3 yrs ago. However, when I finally decided it was time to correct the now very large rectocele, we had a long conversation about the need for hysterectomy. I'm not having any problems going through menopause right now, and although I urinate frequently, I do not "spill" urine. My biggest concern with a hysterectomy was keeping my cervix as I am how Matron described. I was also worried about adverse effects of the hysterectomy causing extra pressure that would cause problems later with repeat cystocele or developing an enterocoele. After much thought, he said I was doing well, and no hysterectomy. He said he preferred to have me pee more frequently than possibly cause more problems down the road. He also took into consideration my age (55 this year), and said I was too young to change my sexual pleasure. Yay! Talk to your surgeon about what your options are and what your needs are. And gather as much info that you can. Matron and others have greatly helped me, and I follow a lot of post surgery discussions. Best of luck! 

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    • Posted

      Susan

      Hello and thank you for responding. Can you tell me about the extra pressure a hysterectomy can cause? And how it can cause the need for a repeat cystocele/rectocele repair. I was under the impression that getting the hysterectomy would make these things occur less.

      I appreciate all responses.

      Mary

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    • Posted

      Hi mar. Just reading through these threads and saw this one from you. I had a hysterectomy and bladder/anterior repair when I was 40. Since then had a posterior repair for rectocele. I'm now told I have a vaginal vault prolapse plus rectocele again. The v v prolapse is apparently caused in later years as the cervix was removed at hysterectomy and now there's nothing to anchor the vagina to the top so everything has slid downwards. I have to have a sacrospinous fixation, (ssf) plus the posterior repair done again. I'm now 74 so it's 34 years since first op. I've done some heavy jobs with lifting, standing, bending etc so I don't think I've done too badly. I need the v v op as I'm having bowel problems now plus loads of back and pelvic pain. I'm hoping all can be fixed so I can get on with the rest of my life with a bit more comfort and mobility than I have at the moment. x rolleyes

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  • Posted

    Hi ladies,

    I just signed up as reading posts from saints like Matron today have somewhat assuaged my blues.  I am 5 weeks post op. I was originally scheduled to have a posterior, anterior, bladder sling, perineum repair and uterus removal, leaving overies. This was recommendation of 3 separate surgeons.  At last minute, I backed out of removing uterus.  I didn't want my abdomen cut, in addition to my vagina, nor did I want mesh.  And, although my uterus is prolapsed, it is otherwise ok.  My surgeon said he could suture the back of my uterus to lift and hold in place and perform rest of repairs vaginally.  He didn't disagree with my decision but said I may have to deal with uterus in the future.

    I am struggling with anxiety, fatigue and depression as I recover and couldn't imagine adding abdominal incisions to contend with as well right now.  I do not even know yet if this surgery was a good idea in the first place.  And, yes, I struggle with whether or not I should have just had uterus taken while they were in there.

    I understand your struggle to decide and by no means am offering a recommendation, just a recent case from someone who has in a similiar situation.

    For reference, I am 49 years old today and had 2 vaginal births 13 and 17 years ago.

    My sincere and best wishes to you

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