Complications Following Incontinence Surgery


Surgical and postsurgical complications are an
unfortunate reality in incontinence surgery. Even for
patients treated by the most experienced and skilled
physicians, a certain small number of complications
occurs. Recovery can be difficult, and long-term or
permanent disability can occur. These potential
problems must be taken into account when counseling
patients and weighed against the disability caused by
the incontinence itself. The patients should be prepared
for the possibility of complications, procedure failure,
and prolonged catheterization or ISC.

The following measures can be taken by the surgeon to
minimize the number and severity of these
complications: Appropriate patient selection;
Management of medical comorbidities, appropriate
consultation with specialists, and consultation with
anesthesiologists; Thorough knowledge of the relevant
surgical anatomy; Meticulous hemostasis; Attention to
surgical technique; Prophylactic antibiotics; Routine use
of intraoperative cystoscopy to ensure bladder and
ureteral integrity; Attention to patient positioning on the
operating room table; Resisting the urge to overcorrect
defects; Appropriate use of bladder drainage;
Knowledge of personal surgical limitations and
willingness to seek help if needed.

Complications such as intraoperative hemorrhage or
visceral injury can be immediate. Other complications,
including erosion of sling material or wound infection,
can be delayed. Minor and transient injury or severe,
permanent, and debilitating problems may exist. Patient
prognosis for hemorrhage, urinary tract, and visceral
injuries is better if diagnosed and repaired
intraoperatively rather than in the postoperative period.

Injuries Should Be Detected Early

Routine intraoperative cystoscopy detects most of these
injuries. Ureteral patency can be demonstrated by
observation of the free flow of blue-stained urine from
each ureteral orifice following IV administration of
indigo carmine dye. One recent review found that 90%
of unsuspected bladder injuries and 85% of unsuspected
ureteral injuries were detected with routine
intraoperative cystoscopy and were managed
successfully under the same anesthesia. Sling
procedures traditionally have resulted in the highest
rates of long-term voiding problems.


Success Rates of Incontinence Procedures

Past studies have demonstrated that approximately 8%
of patients require long-term or permanent ISC
(intermittent self catheterization). The incidence of
voiding dysfunction after various procedures varies
widely and depends partly on the type of procedure but
also on technique-most importantly, how tightly the
suspension sutures or slings are tied or placed.
Increasingly, many recognize that both slings
and colposuspension sutures do not need to be tight to
be effective. Voiding complications may be on the
decline due to this realization. In addition to ISC,
postsurgical voiding problems have been managed with
varying results with cholinergic agents, alpha-blockers,
and intravesical prostaglandin therapy.