Skip to main content

Advertisement

Log in

Patient Safety and Surgical Intervention for Urinary Incontinence and Pelvic Organ Prolapse

  • Stress Incontinence and Pelvic Prolapse (RR Dmochowski, Section Editor)
  • Published:
Current Bladder Dysfunction Reports Aims and scope Submit manuscript

Abstract

While surgical options for stress urinary incontinence and pelvic organ prolapse continue to become less-invasive, complications can still occur. Measures to standardize the preoperative diagnosis and treatment options are currently being developed. Likewise, the American Urological Association has developed best practice statements regarding the administration of perioperative antibiotics and prevention of deep vein thrombosis in patients undergoing pelvic surgery. Furthermore, other perioperative steps, such as the type of bowel preparation and proper patient positioning, play a significant role in perioperative morbidity. A discussion of available evidence regarding these perioperative issues is presented in this paper.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Wein AJ. Voiding function and dysfunction, bladder physiology and pharmacology, and female urology. J Urol. 2011;186:2328–30.

    Article  Google Scholar 

  2. Latthe PM, Foon R, Tooz Hobson P. Transobturator and retropubic tape procedure in stress urinary incontinence: a systematic review and meta analysis of effectiveness and complications. BJOG. 2007;114:522–31.

    Article  PubMed  CAS  Google Scholar 

  3. Sung VW, Schleinitz MD, Radin CR, et al. Comparison of retropubic vs transobturator approach to midurethral slings: a systematic review and meta analysis. Am J Obstet Gynecol. 2007;197:3–11.

    Article  PubMed  Google Scholar 

  4. Gomelsky A, Dmochowski RR. Biocompatibility assessment of synthetic sling materials for female stress urinary incontinence. J Urol. 2007;178:1171–81.

    Article  PubMed  Google Scholar 

  5. Kuuva N, Nilsson CG. A nationwide analysis of complications associated with the tension-free vaginal tape (TVT) procedure. Acta Obstet Gynecol Scand. 2002;81:72–7.

    Article  PubMed  Google Scholar 

  6. Tamussino KF, Hanzal E, Kolle D, et al. Tension-free vaginal tape operation: results of the Austrian registry. Obstet Gynecol. 2001;98:732–6.

    Article  PubMed  CAS  Google Scholar 

  7. Hammad FT, Kennedy-Smith A, Robinson RG. Erosions and urinary retention following polypropylene synthetic sling: Australasian survey. Eur Urol. 2005;47:641–6.

    Article  PubMed  CAS  Google Scholar 

  8. Wang AC, Lee LY, Lin CT, Chen JR. A histologic and immunohistochemical analysis of defective vaginal healing after continence taping procedures: a prospective case-controlled pilot study. Am J Obstet Gynecol. 2004;191:1868–74.

    Article  PubMed  Google Scholar 

  9. Sung VW, Rogers RG, Schaffer JI, et al. Society of Gynecologic Surgeons Systematic Review Group. Graft use in transvaginal pelvic organ prolapse repair: a systematic review. Obstet Gynecol. 2008;112:1131–42.

    Article  PubMed  Google Scholar 

  10. Abed H, Rahn DD, Lowenstein L, et al. Systematic Review Group of the Society of Gynecologic Surgeons: Incidence and management of graft erosion, wound granulation, and dyspareunia following vaginal prolapse repair with graft materials: a systematic review. Int Urogyecol J. 2011;22:789–98.

    Article  Google Scholar 

  11. Cohen SL, Einarsson JI. The role of mechanical bowel preparation in gynecologic laparoscopy. Rev Obstet Gynecol. 2011;4:28–31.

    Article  PubMed  Google Scholar 

  12. Botha MH. Mechanical bowel preparation in gynaecological surgery—are we doing more harm than good? S Afr Med J. 2007;97(1040):1042–3.

    Google Scholar 

  13. Guenaga KK, Matos D, Wille-Jørgensen P. Mechanical bowel preparation for elective colorectal surgery. Cochrane Database Syst Rev. 2009;1:CD001544.

    PubMed  Google Scholar 

  14. van der Voort M, Heijnsdijk EA, Gouma DJ. Bowel injury as a complication of laparoscopy. Br J Surg. 2004;91:1253–8.

    Article  PubMed  Google Scholar 

  15. Muzii L, Bellati F, Zullo MA, et al. Mechanical bowel preparation before gynecologic laparoscopy: a randomized, single-blind, controlled trial. Fertil Steril. 2006;85:689–93.

    Article  PubMed  Google Scholar 

  16. American College of Obstetricians and Gynecologists (ACOG). Antibiotic prophylaxis for gynecologic procedures. Washington (DC): American College of Obstetricians and Gynecologists (ACOG); 2009 May. 10 p. (ACOG practice bulletin; no. 104). http://www.guideline.gov/about/inclusion-criteria.aspx.

  17. AUA Best Practice Statement on Antimicrobial Prophylaxis for Urologic Surgery. AUA Education and Research Inc., 2008.

  18. Schaeffer AJ, Schaeffer EM. Infections of the urinary tract. In: Wein AJ, Kavoussi LR, Novick AC, Partin AW, Peters CA, editors. Campbell-Walsh urology, vol. 1. 9th ed. Philadelphia: Saunders-Elsevier; 2007. p. 223–303.

    Google Scholar 

  19. White RH, Zhou H, Romano PS. Incidence of symptomatic venous thromboembolism after different elective or urgent surgical procedures. Thromb Haemost. 2003;90:446–55.

    PubMed  CAS  Google Scholar 

  20. Davis JD. Prevention, diagnosis, and treatment of venous thromboembolic complications of gynecologic surgery. Am J Obstet Gynecol. 2001;184:759–75.

    Article  PubMed  CAS  Google Scholar 

  21. Geerts WH, Pineo GF, Heit JA, et al. Prevention of venous thromboembolism. Chest. 2004;126:338S–400S.

    Article  PubMed  CAS  Google Scholar 

  22. Nicolaides AN, Breddin HK, Fareed J, et al. Prevention of venous thromboembolism. International consensus statement. J Vasc Biol. 2002;1:133–70.

    Google Scholar 

  23. Quek ML, Stein JP, Daneshmand S, et al. A critical analysis of perioperative mortality from radical cystectomy. J Urol. 2006;175:886–90.

    Article  PubMed  Google Scholar 

  24. AUA Best Practice Statement for the Prevention of Deep Vein Thrombosis in Patients Undergoing Urologic Surgery. AUA Education and Research Inc., 2008.

  25. Turner GM, Cole SE, Brooks JH. The efficacy of graduated compression stocking in the prevention of deep vein thrombosis after major gynecologic surgery. Br J Obstet Gynecol. 1984;91:588–91.

    Article  CAS  Google Scholar 

  26. Clarke-Pearson D, Synan IS, Dodge R, et al. A randomized trial of low-dose heparin and intermittent pneumatic calf compression for the prevention of deep vein thrombosis after gynecologic oncology surgery. Am J Obstet Gynecol. 1993;168:1146–53.

    PubMed  CAS  Google Scholar 

  27. Maxwell GL, Synan I, Dodge R, et al. Pneumatic compression versus low molecular weight heparin in gynecologic oncology surgery: a randomized trial. Ob Gyn. 2001;98:989–95.

    Article  CAS  Google Scholar 

  28. Martin JT, Warner MA. Patient positioning. In: Barash PG et al., editors. Clinical anesthesia. 3rd ed. Philadelphia: Lippincott-Raven Publishers; 1996. p. 595–620.

    Google Scholar 

  29. Martin JT. Compartment syndromes: concepts and perspectives for the anesthesiologist. Anesth Analg. 1992;75:275–83.

    PubMed  CAS  Google Scholar 

  30. Raza A, Byrne D, Townell N. Lower limb (well leg) compartment syndrome after urological pelvic surgery. J Urol. 2004;171:5–11.

    Article  PubMed  Google Scholar 

  31. • Bode LG, Kluytmans JA, Wertheim HF, et al. Preventing surgical-site infections in nasal carriers of Staphylococcus aureus. N Engl J Med. 2010;362:9–17. While the implications and usefulness of screening for S. aureus in women undergoing pelvic surgery is unknown, this RCT demonstrates the ease and effectiveness of screening and treatment.

    Article  PubMed  CAS  Google Scholar 

  32. Ingber MS, Vasavada SP, Firoozi F, Goldman HB. Incidence of perioperative urinary tract infections after single-dose antibiotic therapy for midurethral slings. Urology. 2010;76:830–4.

    Article  PubMed  Google Scholar 

  33. Swartz M, Ching C, Gill B, et al. Risk of infection after midurethral sling surgery: are postoperative antibiotics necessary? Urology. 2010;75:1305–8.

    Article  PubMed  Google Scholar 

  34. • Swartz M, Vasavada S, Goldman H. Perioperative management of patients undergoing sling surgery: a survey of US urologists. Urology. 2010;76:314–7. Although the response rate to this American Urological Association survey was only 13 %, the data showed a significant variation in perioperative antibiotic regimens and postoperative admission and voiding trial protocols in women undergoing sling surgery. The data suggest that consensus guidelines for perioperative management may be beneficial.

    Article  PubMed  Google Scholar 

  35. Chang PL, Wang TM, Huang ST, et al. The implementation of clinical paths for six common urological procedures, and an analysis of variances. BJU Int. 1999;84:604–9.

    Article  PubMed  CAS  Google Scholar 

  36. Chang SS, Baumgartner RG, Well N, et al. Causes of increased hospital stay after radical cystectomy in a clinical pathway setting. J Urol. 2002;168:208–11.

    Google Scholar 

  37. Chughtai B, Abraham C, Finn D, et al.: Fast track open partial nephrectomy: reduced postoperative length of stay with a goal-directed pathway does not compromise outcomes. Adv Urol 2008: 507543.

  38. Arumainayagam N, McGrath J, Jefferson KP, Gillatt DA. Introduction of an enhanced recovery protocol for radical cystectomy. BJU Int. 2008;101:698–701.

    Article  PubMed  Google Scholar 

  39. •• Khan A, Kiyosaki K, Scott V, et al.: Evaluating the quality of urinary incontinence and prolapse treatment (EQUIPT) study: quality indicator development for urinary incontinence. Presented at the AUA Annual Meeting. Washington, DC; May 14, 2011. This study introduced quality indicators for diagnosis and treatment of SUI and urge urinary incontinence.

Download references

Disclosure

Dr. Gomelsky has served as a consultant for the Coloplast Group.

Dr. Dmochowski has served as a consultant for Allergan, Merck & Co., and Johnson & Johnson.

Mr. McCourt reported no potential conflicts of interest relevant to this article.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Roger R. Dmochowski.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Gomelsky, A., McCourt, J. & Dmochowski, R.R. Patient Safety and Surgical Intervention for Urinary Incontinence and Pelvic Organ Prolapse. Curr Bladder Dysfunct Rep 7, 187–193 (2012). https://doi.org/10.1007/s11884-012-0135-x

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11884-012-0135-x

Keywords

Navigation