Intraoperative complications are of low risk and include vaginal or pelvic hematoma, bleeding, rectal injury and bladder injury. In contrast, postoperative complications are most frequent among patients and are mainly related to the<unk> . The high incidence of postoperative complications of<unk>  has led to its ban by the FDA in 2019.<unk>  erosion<unk>  erosion describes the exposure, extrusion or protrusion of the<unk>  exteriorly at the surgery scar. Generally, it is the most common postoperative complication and 10.3% of the patients experience<unk>  erosion within 12 months for pelvic organ prolapse (POP) repair.<unk>  erosion can be classified into 2 main types according to the location of erosion: Vaginal extrusion Postoperative vaginal extrusion is defined as a<unk>  extrusion through the vaginal mucosa and is the most common form of<unk>  erosion. Patients with this complication usually present with discomfort in the vagina as a result of mucosal irritation, abnormal vaginal discharge, or pelvic pain. For sexually active patients, their partners may even feel pain during intercourse, causing notice of the presentation. The most common site for vaginal extrusion is usually in the midline of the surgical incision site since major causes of vaginal extrusion include suture disruption, subclinical infection and damage at the surrounding tissue. As vaginal extrusion worsen due to delayed healing, conservative treatment with oestrogen or antibiotics and recommendation for sexual abstinence is usually suggested to alleviate the symptoms. If conservative treatment fails due to large<unk>  exposure (i.e. > 0.5mm), partial<unk>  excision is suggested with symptoms expected to resolved in 71-95% of the patients. If partial<unk>  excision fails, a more invasive complete<unk>  excision will be considered to avoid further complications, especially for those with severe complications. Erosion into the urethra or bladder Postoperative erosion into the urethra or bladder is less common and presents within 18 month after<unk>  surgery. Patients with this complication typically show urge incontinence, stress urinary incontinence, urinary retention, hematuria or dysuria. Complete inspection of urethra by cystoscopy can help diagnose this complication and the<unk>  must be excised. Pain Postoperative pain is usually experienced at pelvic, groin, thigh region or during sexual intercourse. Furthermore, it can be caused by<unk>  erosion or subclinical infection. One hypothesised aetiology for<unk> -related pain is that inflammatory response induces the shrinkage of<unk> , leading to vaginal tightening. To treat postoperative pain, an examination in the pelvic region is performed to determine the cause of pain. If there are no significant examination findings, pain relief drugs, such as nonsteroidal anti-inflammatory medicine, will be first prescribed to patients. If the pain persists for months, local anesthetics with corticosteroids can be injected at the site of pain. For more severe cases,<unk>  excision with targeted physical therapy can be considered as a last resort. Pelvic infection Although postoperative infection seldom occur among patients who have undergone<unk>  surgery, it is still an inherent risk for any surgical implantations and results in severe implications. In cases of severe infection, complete<unk>  excision is highly commended. Others Other common complications include urinary problems, abnormal bleeding, organ perforation while some rare complications, such as recurrent pelvic organ prolapse, neuro-muscular problems, vaginal scarring and emotional problems are also observed. From 2008 to 2010, three deaths were associated with<unk>  surgery for POP repair due to bowel perforation and abnormal bleeding. Risk factors for complications Concomitant surgery The number and extent of concomitant surgeries increase with the complication risks. However, for patients who require concurrent<unk>  slings, concomitant hysterectomy is often necessary. Certain incision methods for hysterectomy, such as an inverted T incision, will also increase the risk of complications significantly. Inappropriate surgical techniques The size of the incision and extent of sling tension should be minimized to reduce risk of complications. This is often determined by the surgical skills of surgeons. Protective factors for complications Uterine preservation and minimal incision size should be performed as they prevent damage to the urogenital system.
Transvaginal mesh
Cervical pessary
Macy catheter
Vaginoplasty
Perineal dilator
Vaginal dilator
Hymenorrhaphy
Progesterone vaginal ring