pelvic reconstructive surgery

Indications

• pelvic organ prolapse*

* not recommended

Complications

• vesicovaginal fistula results in urinary incontinence, vaginal bleeding with coitus, dyspareunia, vaginal discharge
• recurrence of pelvic organ prolapse
• mesh erosion (10%)
  • may cause bleeding, discomfort or discharge or may be asymptomatic
  • mesh may erode into the bladder or bowel (1%) causing dysuria, urinary urgency, urinary frequency, hematuria, dyschezia, pelvic pain
  • obstructive uropathy
  • bowel onstruction
• mesh contracture may cause pain & dysparunia
• vaginal mesh exposure is the most common complication
  • characterized by vaginal discharge, dyspareunia, vulvar irritation
  • exposed vaginal mesh may be seen on speculum exam or palpated on bimanual pelvic exam as bristly plastic*

* topical vaginal estrogen may suffice to treat symptoms of exposed vaginal mesh without surgical removal

Management

• self-removal of indwelling urinary catheter with similar postoperative outcome & greater satisfaction vs-office removal

More general terms

• pelvic surgery

More specific terms

• sacrocolpopexy
• urethral sling procedure

Additional terms

• vaginal mesh