Perioperative patient care issues in female pelvic reconstructive surgery
- Quinn Lippmann, MD, MPH
Quinn Lippmann, MD, MPH
- Attending Physician
- Virginia Urology
- Richmond, Virginia
- Emily S Lukacz, MD, MAS
Emily S Lukacz, MD, MAS
- Professor of Clinical Reproductive Medicine
- UC San Diego Heath System
Urogynecologic surgery is frequently performed to treat symptoms of incontinence and pelvic organ prolapse in women. As an example, in the United States, 20 percent of women are estimated to undergo some type of urogynecologic procedure in their lifetime . While certain elements of urogynecologic surgery are common to all operations, these procedures have unique components that must be addressed by the surgical team.
This topic will review pre-, intra-, and postoperative care issues specific to women undergoing urogynecologic procedures. Information on general planning for benign gynecologic surgery is reviewed separately. (See "Overview of preoperative evaluation and preparation for gynecologic surgery".)
Preparation for urogynecologic surgery includes counseling regarding the unique procedure-related risks, evaluation and testing as directed by the patient's history and symptoms, understanding patient preferences, and recognition of clinical scenarios that require additional action.
Counseling — Preoperatively, the surgeon has a detailed discussion of the risks, benefits, and alternatives to surgery with the patient and her support team, and clearly documents the conversation in the medical record. This conversation addresses potential complications common to all pelvic surgeries and identifies issues unique to each patient's surgical plan.
Universal issues in female reconstructive pelvic surgery — Common potential complications related to female reconstructive pelvic surgery that are discussed and written in the surgical consent include:
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- - Universal issues in female reconstructive pelvic surgery
- - Procedure-specific issues
- - Timing with regards to childbearing
- - General
- - Procedure-specific
- - Testing
- - Urodynamic studies
- Management of specific patient groups
- - Abnormal uterine bleeding
- - Bladder symptoms
- - Obliterative procedures
- - Pessary removal
- - Prolapse
- - Vaginal atrophy
- - Smokers
- Surgical preparation of skin and vagina
- Bladder catheter
- Retractor use in surgery
- Intraoperative cystourethroscopy
- Vaginal packing
- Pain management
- Catheter removal and voiding trial
- Postoperative antibiotics
- Bowel function
- Resumption of estrogen therapy
- Activity restrictions
- FOLLOW-UP CARE
- SPECIAL POPULATIONS
- SUMMARY AND RECOMMENDATIONS