Key Factors of Urogynecology is dependent on 2 factors.

By Dr. Vitasna Ketglang

The First factor–The Physician

1.) The physician has to be educated about the surgical techniques and the surgical materials used

shutterstock_2416489421.1) The surgical techniques.
  •   bullet_tickFor example– For A-P Repair Surgery, foreign women who have to return to their countries within 5 days after the operation may need a special suture technique(s) to avoid postoperative wound disruption.
1.2) The surgical materials used.
  • bullet_tickTo avoid wound disruption–you need a special absorbable suture material–the suture materials must be absorbable to become decayed after complete healing to avoid wound disruption. This can lead to serious complications such as excessive bleeding from the surgical wound.

2) The physician has to be educated about the appropriate pre-operative antibiotics and post-operative antibiotics.

  • bullet_tick You are more likely to get infection from urogynecological wounds than the surgical wounds in other body areas. This is due to these procedures being near the urinary tract and alimentary (fecal) tract. This leaves it at risk of complications such as bacterial infection.
  • bullet_tickTo prevent the wounds infection, from all kinds of urogynecological surgeries, a proper regiment of antibiotics for preoperative prophylaxis of infection should be followed. For prophylaxis in surgery, only antibiotics with good tolerability should be used. Cephalosporins remain the preferred drugs for preoperative prophylaxis due to their low toxicity.

 3) The physician has to educate the patient with pre & post operative care instructions, risk & complications, and a consent form.

3.1) Accurate, clear, and proper post-operative instructions.

Accurate, clear, and proper post-operative instructions will be given in order to avoid post-operative complications.

  • bullet_tickWithin 5-7 days after the surgery, take a rest (refrain from work) be still, and avoid constipation. This will enable the wound to heal faster.
  • bullet_tickHave little movement as possible to avoid wound disruption for 1-2 weeks after the surgery.
  • bullet_tickThe patient should refrain from swimming in the pool, some types of exercise affecting pelvic muscle movement, and sexual intercourse for 6 weeks after the surgery.
3.2) Most common risks & complications for Urogynecology Surgery.
  • bullet_tick1)Abnormal bleeding
  • bullet_tick2) Infection of the wound
  • bullet_tick3) Pain with sexual intercourse
  • bullet_tick4) Mesh Extrusion or exposure vaginally
  • bullet_tick5) Urinary frequency or difficulty in urination
  • bullet_tick6) Mesh Erosion into the bladder or rectum and fistula formation
3.3) Preoperative agreement (patient consent). 
  • bullet_tickInformed consent is very important to protect the patient and the surgeon also. It must be signed before any surgical procedure is performed.
  • bullet_tickIt is important for patients to fully understand the procedure.

4) The physician must be open-minded, honest, and responsible with the surgical procedures.

  • bullet_tickThe physician should deal honestly and openly with patients and inform them of all the necessary facts to ensure that they understand all the processes of the procedure.
  • bullet_tickIn case of unexpected surgical results or complications, corrective surgery is an option and will be discussed between the physician and the patient.
  • bullet_tickThe surgeon has to be open minded to others’ opinions, embracing new techniques and the constant changes to modern technologies, weighing the best options to the good of the patients.

The Second factor–The Patient

1) Patient selection.

Here are some points in selecting a potential patient.
1.1) The primary diagnosis and severity of pelvic organ prolapse or stress incontinence.
1.2) Any existing disease.
  • bullet_tickAny existing disease such as DM, Heart disease, Anemia, Renal disease etc, affecting the healing process, beyond the control by the physician.
1.3) Aging of the patient should not be too old.
  • bullet_tickAging of the patient should not be too old as to not affect the rate and success of the healing process.

2) Post operative manners of the patient.

One of the most important things associated with the patient, beyond the control of the physician, is ‘POST – OPERATIVE MANNERS’. As the Urogynecology surgical wound is inside the vagina and around the vulvar area, it may get contaminated with vaginal secretion or vaginal fluid. This consequently leads to a longer healing process than  surgical wounds in other body areas.

2.1) Surgical wounds of the Urogynecology Surgery.
  • bullet_tickIt is the contaminated surgical wound which is more likely to get infection, than surgical wounds in other body areas. At home, you have to completely take antibiotic (s) to avoid postoperative infection.
2.2) For the Urogynecology Surgery.
  • bullet_tickRecovery varies, but within the third day after the surgery the patient will be able to have movement and walk around. The patient may return to work within 5-7 days after the surgery. Moreover, the patient should follow Dr. Vitasna’s appointment for follow up examination or treatment.
  • bullet_tickAt home after the Urogynecologic procedure, the patient is allowed to take a shower. The patient should clean the surgical wound at the perineum area with soap daily when she is taking a shower in the morning and before bedtime. The patient is not allowed to use anything to clean the inside of the vagina.
  • bullet_tickWithin 2 weeks after the Urogynecologic procedure, cleaning the surgical wound at the perineum area after urinary excretion may be done with sanitary wipes and after fecal excretion done using water and toweling gently. The patient should try to avoid moisture around the surgical wound to let it heal faster.
  • bullet_tickThe patient may experience a light reddish discharge from the vagina in around 1-2 weeks after the procedure. In cases of a lot of bleeding or reddish blood clot, swollen reddish wound, or high fever, please contact the Hospital for suggestions or come to see Dr. Vitasna for surgical wound examination.
  • bullet_tickThe patient may have abnormal vaginal discharge, a green-yellowish color, after the Urogynecologic procedure. This is due to the vagina being full of secretion fluid and various kinds of bacteria, causing a reaction to surgical wound and suture. The patient may also experience itching or curd like discharge as a result of vaginal fungi. Antibiotics should be taken to avoid post-operative infection and slim sanitary napkins should be used also.
  • bullet_tick In cases of smelly vaginal discharge or vaginal fungal infection, the patient will have to take additional medication.
  • bullet_tickAfter 4 weeks of the surgery, relaxing exercises, and lifting light weights, are permitted. However, the patient should refrain from energy-consuming activities such as running, soaking in the bathtub, swimming, heavy lifting, cycling, and other heavy activities, for 6 weeks after the surgery.

Therefore, please be informed that despite an excellent surgery by the best physician, it is of no use in case of the complications resulting from infection. The patient should cooperate and adhere strictly to the post operative instructions.

3) The Patient’s realistic expectations should be discussed before undergoing surgery.

  • bullet_tickAn optimal Urogynecology Surgery candidate will understand not only what Urogynecologic Surgery can accomplish, but also the limitations of the procedure. After all these have been assessed and considered, then a decision for surgery may be made.

The key factors affecting the success of Urogynecology Surgery include both the physician and the patient. They are equally important in the success of Urogynecology practice and helped me get through the surgeries, avoiding complications.