prolapsed uterus affect bladder surgery?

  I have been diagnosed with fibroids and a prolapsed uterus. Being 47, it wasn't much of a shock. But I had the Vessiker procedure two years ago and my incontinence has improved but not 100% which was expected. My question is that if I someday decide to have a hysterectomy, will it affect or possibly worsen my bladder function to the point of further surgery? I also have a very mild cystocele. Thanks for your time
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Dear Ann S.:
Sorry about the confusion, this is definitly an incontinence question.
There are several types of incontinence.  Stress urinary incontinence occurs with increased abdominal pressure such as with coughing, sneezing, etc.  Urge incontinence occurs due to an overactive bladder that contracts frequently and strongly resulting in an urge to urinate which may be severe enough to cause incontinence.  Most individuals have some component of both types of incontinence (mixed picture).  The vesica bladder neck suspension procedure is aimed at treating pure stress urinary incontinence.  If there is persistent (but improved) incontinence, it may be due to the urge incontinence component that is still present, inadequate bladder neck suspension, or due to redevelopment of the original problem due to further laxity that develops in the tissues several years after the original operation.  The uterine prolapse and cystocele can also make the problem worse with time, and most likely will require surgical repair.  However, there is a risk that your incontinence problem can become worse with the hysterectomy alone requiring another surgical procedure at the same operating room setting or on a separate occasion.  It is important that you consult a urologist or urogynecologist who is familiar and comfortable  with cystocele (and possible enterocele and rectocele) repair and vaginal vault suspension in addition to the hysterectomy so that some of these procedures may be performed at the time of hysterectomy as needed or at a later date as needed.  Of course, it would be impossible for me to evaluate your situation over this limited internet exchange, and it is also possible that no further operation will become necessary.  Wish you the best.
This information is provided for general medical education purposes only.  Please consult your physician for diagnostic and treatment options pertaining to your specific medical condition. More individualized care is available at the Henry Ford Hospital and its satellites (1 800 653 6568).
Sincerely,
HFHS M.D.-JJ
*Keyword: bladder neck suspension, incontinence, uterine prolapse, hysterectomy