Possible complications of prolapse surgery

There are general risks involved with having any surgery. These include adverse reactions to the anaesthetic, excessive bleeding, infection and the potential for blood clots. Antibiotic are given during surgery and continued after your operation to reduce the risk of infection. Medication (e.g. Fragmin or Clexane) to thin your blood is given during surgery and while you are in hospital to reduce your risk of developing blood clots. It is very uncommon to experience serious bleeding or need a blood transfusion.

Generally, there is improved sexual function after prolapse surgery, however about 2% of women experience painful intercourse after surgery and this may require minor corrective surgery or the use of vaginal dilators.

Occasionally, bladder problems can occur after surgery (e.g. difficulty with bladder emptying, cystitis or urinary leakage) but these problems usually settle soon after surgery. However, if urinary incontinence remains a problem then further surgery or medication may be required.

Pain may occur immediately after surgery, but this generally settles after a few days or weeks. It is uncommon for women to experience long-term pain following prolapse surgery.

Uncommon complications from prolapse surgery may include injury to a nearby structure (e.g. bowel, bladder, ureter, nerve). Dr Carey may inspect the bladder with a cystoscope (a telescope-like camera) at the completion of surgery to exclude any bladder or ureter injury. Uncommon long-term complications after laparoscopy, robot-assisted or abdominal prolapse surgery include bowel obstruction from adhesions and abdominal hernia. Further surgery may be necessary if a complication occurs.

If your own fascia lata is used there is a small risk of muscle herniation or a fluid collection (seroma) occurring at the donor site in your thigh. Whenever a synthetic (mesh) graft is used during laparoscopic or robot-assisted surgery, there are risks of the synthetic (mesh) graft becoming exposed in the vagina, bladder or bowel, infection and persistent pain. This is usually treated either by vaginal oestrogen pessaries, analgesic medication, or surgery to remove the exposed synthetic graft (usually the entire graft will not need to be removed) or removal of the entire graft if infection or persistent pain is the complication. Surgery to treat prolapse can be successfully performed without using mesh. Dr Carey’s strong preference is to perform prolapse surgery WITHOUT using synthetic mesh.

Recovery time and instructions following surgery

Most women stay in hospital for one, two or three nights.

It is MOST important to rest after the operation and allow the area to heal.

You will be seen by Dr Carey 4 weeks following surgery to check for any problems and remove the S-POP device. You will also have a final review with Dr Carey 12 months following surgery.

Generally it is recommended to…..

Completely restrict your level of physical activity for two weeks.
From two to four weeks do light activity only.
Avoid heavy lifting (nothing heavier than 5 kg) for four weeks, including small children.
Abstain from sexual intercourse for six weeks.
Avoid playing sport and impact exercises such as jogging or jumping for four weeks.

Pain relief

If you experience pain after discharge we suggest that you take pain control medication (e.g. Panadol) every four hours as required until pain resolves.
Make sure you take some time each day to rest.

Maintain good bowel habits

Try do drink approximately 1.5 litres of fluids each day.
Maintain a healthy diet.
Use Movicol or similar preparations (available at the chemist or supermarket) if required to maintain regular bowel function and to keep your bowel motions soft.

Some vaginal loss may occur after you leave hospital, but this should be minimal and light pink, and may last for three weeks. Occasionally, some women experience a sudden moderate dark blood loss from a blood collection under the vaginal wall one to two weeks after surgery that should stop within a few hours. You must seek urgent medical attention if you experience ongoing, heavy vaginal bleeding at any time after surgery.

Any stitches that you still have in when you go home will dissolve in about 10 days (but possibly up to three weeks). These do not need to be removed.

Addition information about vaginal surgery when a synthetic or biologic graft (mesh) is used

In Australia, in January 2018 the TGA withdrew approval for the used of synthetic and biologic mesh for trans-vaginal prolapse repair. The TGA continues to approve synthetic and biological mesh for prolapse when placed using laparoscopy, robot assisted and through an abdominal incision.

In the USA, the Food and Drug Administration (FDA) has issued the following safety communication regarding the use of mesh.

The FDA wants to inform you about the complications that can occur when surgical mesh is used to treat Pelvic Organ Prolapse (POP) and Stress Urinary Incontinence (SUI), and provide you with questions to ask your surgeon before having these procedures. This is part of our commitment to keep healthcare professionals and the public informed about the medical products we regulate.

FDA has received reports of complications associated with the placement of mesh through an incision made in the wall of the vagina. Although rare, these complications can have serious consequences. The reports have not been linked to a single brand or model of mesh.

The most frequent complications included erosion through the vagina, infection, pain, urinary problems and recurrence of the prolapse and/or incontinence.

In some cases, erosion of the mesh and scarring of the vagina led to discomfort and pain, including pain during sexual intercourse. Some patients needed additional surgery to remove the mesh that had eroded into the vagina. Other complications included injuries to nearby organs such as the bowel and bladder, or blood vessels.

Background

A pelvic organ prolapse, (POP) occurs when a pelvic organ, such as your bladder, drops (“prolapses”) from its normal position and pushes against the walls of your vagina. This can happen if the muscles that hold your pelvic organs in place become weak or stretched from childbirth or surgery. More than one pelvic organ can drop at the same time. Organs that can be involved in a pelvic organ prolapse include the bladder, the uterus, the bowel and the rectum.

Pelvic organ prolapse can cause pain or problems with bowel and bladder functions or interfere with sexual activity.

Stress urinary incontinence (SUI) is a type of incontinence caused by leakage of urine during moments of physical stress.

Talking to your doctor

Before having an operation for POP or SUI, be sure to let your surgeon know if you’ve had a past reaction to mesh materials such as polypropylene.

Questions you should ask the surgeon before you agree to surgery in which mesh will be used:

What are the pros and cons of using surgical mesh in my particular case? Can my repair be successfully performed without using mesh?
If a mesh is to be used, what has been your experience with implanting this particular product? What experience have your other patients had with this product?
What has been your experience in dealing with the complications that might occur?
What can I expect to feel after surgery and for how long?
Are there any specific side effects I should let you know about after the surgery?
What if the mesh doesn’t correct my problem?
If I have a complication related to the mesh, can the mesh be removed and what could the consequences be?
If a mesh is to be used, is there patient information that comes with the product, and can I have a copy?

Dr Carey will be happy to answer any questions you may have and can give more specific advice. Before deciding to have surgery, you should read carefully all the information about your operation and consider obtaining a second opinion.

If you experience complications after you leave hospital, contact Dr Carey or the nursing staff on 1 West at the Epworth Freemasons Hospital for advice. In an emergency you may attend the Royal Women’s Hospital, Parkville or Epworth Hospital, Richmond emergency department or attend your closest hospital emergency department.