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ABOG Urogynecology and Reconstructive Pelvic Surgery study materials
ABOG Urogynecology and Reconstructive Pelvic Surgery study resources

ABOG Urogynecology and Reconstructive Pelvic Surgery: Reconstructive Pelvic Surgery Complications and Reoperation

ABOG Urogynecology and Reconstructive Pelvic Surgery · Work through your exam, one topic at a time.

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Reconstructive Pelvic Surgery Complications and Reoperation

Common complications

Bleeding, infection, urinary retention, voiding dysfunction, mesh erosion/extrusion, dyspareunia, de novo urgency, recurrent prolapse, and fistula. Vaginal mesh erosion presents with discharge, bleeding, pain, or partner discomfort; management ranges from estrogen and observation to partial or complete excision. Ureteral injury may present with flank pain, fever, or leak.

Reoperation

Recurrence after native tissue repair is common; reoperation rates vary. Consider the index procedure, compartment involved, patient goals, and mesh status. Reoperation for mesh complications may require specialized expertise. Document preoperative counseling about recurrence and mesh risks.

Traps

  • Missing ureteral injury after prolapse or incontinence surgery (high index of suspicion, imaging).
  • Assuming mesh erosion always requires full excision; partial excision or conservative management may suffice.
  • Overlooking voiding dysfunction after sling; check PVR and consider sling loosening or takedown.
  • Failing to counsel about de novo dyspareunia and urgency.

Rule of thumb

After any pelvic surgery, new fever, flank pain, or leakage should prompt evaluation for ureteral injury or fistula. For mesh erosion, start with estrogen and conservative measures; escalate to excision for persistent symptoms.