Current Bladder Dysfunction Reports

, Volume 7, Issue 3, pp 187–193

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

  • Alex Gomelsky
  • Jason McCourt
  • Roger R. Dmochowski
Stress Incontinence and Pelvic Prolapse (RR Dmochowski, Section Editor)


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.


Stress urinary incontinence Pelvic organ prolapse Surgery Complications Patient safety Surgical intervention Quality indicators Perioperative Bowel preparation Positioning Antibiotics Deep vein thrombosis 


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

  1. 1.
    Wein AJ. Voiding function and dysfunction, bladder physiology and pharmacology, and female urology. J Urol. 2011;186:2328–30.CrossRefGoogle Scholar
  2. 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.PubMedCrossRefGoogle Scholar
  3. 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.PubMedCrossRefGoogle Scholar
  4. 4.
    Gomelsky A, Dmochowski RR. Biocompatibility assessment of synthetic sling materials for female stress urinary incontinence. J Urol. 2007;178:1171–81.PubMedCrossRefGoogle Scholar
  5. 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.PubMedCrossRefGoogle Scholar
  6. 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.PubMedCrossRefGoogle Scholar
  7. 7.
    Hammad FT, Kennedy-Smith A, Robinson RG. Erosions and urinary retention following polypropylene synthetic sling: Australasian survey. Eur Urol. 2005;47:641–6.PubMedCrossRefGoogle Scholar
  8. 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.PubMedCrossRefGoogle Scholar
  9. 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.PubMedCrossRefGoogle Scholar
  10. 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.CrossRefGoogle Scholar
  11. 11.
    Cohen SL, Einarsson JI. The role of mechanical bowel preparation in gynecologic laparoscopy. Rev Obstet Gynecol. 2011;4:28–31.PubMedCrossRefGoogle Scholar
  12. 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. 13.
    Guenaga KK, Matos D, Wille-Jørgensen P. Mechanical bowel preparation for elective colorectal surgery. Cochrane Database Syst Rev. 2009;1:CD001544.PubMedGoogle Scholar
  14. 14.
    van der Voort M, Heijnsdijk EA, Gouma DJ. Bowel injury as a complication of laparoscopy. Br J Surg. 2004;91:1253–8.PubMedCrossRefGoogle Scholar
  15. 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.PubMedCrossRefGoogle Scholar
  16. 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).
  17. 17.
    AUA Best Practice Statement on Antimicrobial Prophylaxis for Urologic Surgery. AUA Education and Research Inc., 2008.Google Scholar
  18. 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. 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.PubMedGoogle Scholar
  20. 20.
    Davis JD. Prevention, diagnosis, and treatment of venous thromboembolic complications of gynecologic surgery. Am J Obstet Gynecol. 2001;184:759–75.PubMedCrossRefGoogle Scholar
  21. 21.
    Geerts WH, Pineo GF, Heit JA, et al. Prevention of venous thromboembolism. Chest. 2004;126:338S–400S.PubMedCrossRefGoogle Scholar
  22. 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. 23.
    Quek ML, Stein JP, Daneshmand S, et al. A critical analysis of perioperative mortality from radical cystectomy. J Urol. 2006;175:886–90.PubMedCrossRefGoogle Scholar
  24. 24.
    AUA Best Practice Statement for the Prevention of Deep Vein Thrombosis in Patients Undergoing Urologic Surgery. AUA Education and Research Inc., 2008.Google Scholar
  25. 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.CrossRefGoogle Scholar
  26. 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.PubMedGoogle Scholar
  27. 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.CrossRefGoogle Scholar
  28. 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. 29.
    Martin JT. Compartment syndromes: concepts and perspectives for the anesthesiologist. Anesth Analg. 1992;75:275–83.PubMedGoogle Scholar
  30. 30.
    Raza A, Byrne D, Townell N. Lower limb (well leg) compartment syndrome after urological pelvic surgery. J Urol. 2004;171:5–11.PubMedCrossRefGoogle Scholar
  31. 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.PubMedCrossRefGoogle Scholar
  32. 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.PubMedCrossRefGoogle Scholar
  33. 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.PubMedCrossRefGoogle Scholar
  34. 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.PubMedCrossRefGoogle Scholar
  35. 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.PubMedCrossRefGoogle Scholar
  36. 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. 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.Google Scholar
  38. 38.
    Arumainayagam N, McGrath J, Jefferson KP, Gillatt DA. Introduction of an enhanced recovery protocol for radical cystectomy. BJU Int. 2008;101:698–701.PubMedCrossRefGoogle Scholar
  39. 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. Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Alex Gomelsky
    • 1
  • Jason McCourt
    • 2
  • Roger R. Dmochowski
    • 3
  1. 1.Department of UrologyLouisiana State University Health Sciences Center–ShreveportShreveportUSA
  2. 2.MS III, Louisiana State University Health Sciences Center–Shreveport School of MedicineShreveportUSA
  3. 3.Department of Urologic SurgeryVanderbilt University Medical CenterNashvilleUSA

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