Complications of Vaginal Surgery

  • Shlomo Raz


Vaginal surgery complications can at times be difficult to manage. Clearly the best management scheme entails steps to prevent complications. These steps require judicious preoperative planning with detailed knowledge of the patient’s case, operative anatomy, surgical indications, and expectations, as well as prudent use of preoperative diagnostic testing. This kind of preparation facilitates better recognition of intraoperative complications and consequent expeditious treatment.


Bleeding Infection Obstruction Bladder or urethral erosion Pelvic pain Fistula Prolapse Incontinence 

Supplementary material

Video 9.1

Removal of obturator mesh. Two oblique incisions are made in the distal vaginal area. The mesh entering the obturator fascia is isolated over silk sutures. A transverse incision is made on the anterior vaginal and two flaps are created. The mesh is dissected free from the urethral wall and divided in two. The mesh is followed toward the obturator fascia. The fascia is opened, dissecting the mesh from the posterior medial periosteum of the pubic bone, obturator internus, and obturator membrane. A separate incision is made lateral to the labia. The skin and subcutaneous tissues are dissected to expose the adductor fascia (gracilis and adductor longus). Under finger control in the vagina, the fascia is incised to expose the lateral margin of the lateral descending rami of the pubic bone. The mesh is isolated from the surrounding musculature and the periosteum. The mesh is transferred from the vaginal incision to the lateral labial incision and removed entirely. The same maneuver will be performed in the contralateral side. The vaginal wall and lateral labial incisions are closed (MP4 691239 kb)

Video 9.2

Removal of retropubic mesh. Two vaginal incisions are made in the distal vagina. The mesh is isolated over silk sutures. A transverse incision is made over the vaginal wall and two flaps are created. The mesh is freed from the urethral wall and divided in two segments. The retropubic space is entered and the mesh freed from the periurethral fascia, the posterior inferior aspect of the pubic bone, and the obturator fascia. The dissection is carried out up to the superior margin of the pubic bone. Under finger control in the vagina, a transverse incision is made in the suprapubic area. The retropubic space is entered and the mesh dissected free from the surrounding musculature and periosteum of the pubic bone. The mesh is removed bilaterally. The vaginal wall and abdominal incisions are closed (MP4 440580 kb)

Suggested Reading

  1. Abbott S, Unger CA, Evans JM, Jallad K, Mishra K, Karram MM, et al. Evaluation and management of complications from synthetic mesh after pelvic reconstructive surgery: a multicenter study. Am J Obstet Gynecol. 2014;210(2):163.e1–8.CrossRefGoogle Scholar
  2. Abouassaly R, Steinberg JR, Lemieux M, Marois C, Gilchrist LI, Bourque JL, et al. Complications of tension-free vaginal tape surgery: a multi-institutional review. BJU Int. 2004;94:110–3.CrossRefPubMedGoogle Scholar
  3. Ashok K, Petri E. Failures and complications in pelvic floor surgery. World J Urol. 2012;30(4):487–94.CrossRefPubMedGoogle Scholar
  4. Blaivas JG, Sandhu J. Urethral reconstruction after erosion of slings in women. Curr Opin Urol. 2004;14:335–8.CrossRefPubMedGoogle Scholar
  5. Bontje HF, van de Pol G, van der Zaag-Loonen HJ, Spaans WA. Follow-up of mesh complications using the IUGA/ICS category-time-site coding classification. Int Urogynecol J. 2014;25(6):817–22.PubMedGoogle Scholar
  6. Crosby EC, Abernethy M, Berger MB, DeLancey JO, Fenner DE, Morgan DM. Symptom resolution after operative management of complications from transvaginal mesh. Obstet Gynecol. 2014;123(1):134–9.CrossRefPubMedPubMedCentralGoogle Scholar
  7. de Tayrac R, Sentilhes L. Complications of pelvic organ prolapse surgery and methods of prevention. Int Urogynecol J. 2013;24(11):1859–72.CrossRefPubMedGoogle Scholar
  8. Ellington DR, Richter HE. The role of vaginal mesh procedures in pelvic organ prolapse surgery in view of complication risk. Obstet Gynecol Int. 2013;2013:356960.Google Scholar
  9. Khan ZA, Thomas L, Emery SJ. Outcomes and complications of trans-vaginal mesh repair using the Prolift™ kit for pelvic organ prolapse at 4 years median follow-up in a tertiary referral centre. Arch Gynecol Obstet. 2014;290(6):1151–7.CrossRefPubMedGoogle Scholar
  10. Klutke C, Siegel S, Carlin B, Paszkiewicz E, Kirkemo A, Klutke J. Urinary retention after tension-free vaginal tape procedure: incidence and treatment. Urology. 2001;58:697–701.CrossRefPubMedGoogle Scholar
  11. Kuuva N, Nilsson C. A nationwide analysis of complications associated with the tension-free vaginal tape (TVT) procedure. Acta Obstet Gynecol Scand. 2002;81:72–7.CrossRefPubMedGoogle Scholar
  12. Laurikainen E, Killholma P. A nationwide analysis of transvaginal tape release for urinary retention after tension-free vaginal tape procedure. Int Urogynecol J. 2006;17:111–9.CrossRefGoogle Scholar
  13. Marks BK, Goldman HB. Controversies in the management of mesh-based complications: a urology perspective. Urol Clin North Am. 2012;39(3):419–28.CrossRefPubMedGoogle Scholar
  14. Mothes AR, Mothes HK, Radosa MP, Runnebaum IB. Systematic assessment of surgical complications in 438 cases of vaginal native tissue repair for pelvic organ prolapse adopting Clavien-Dindo classification. Arch Gynecol Obstet. 2015;291:1297–301.CrossRefPubMedGoogle Scholar
  15. Muffly T, Barber MD. Insertion and removal of vaginal mesh for pelvic organ prolapse. Clin Obstet Gynecol. 2010;53(1):99–114.CrossRefGoogle Scholar
  16. Rice NT, Hu Y, Slaughter JC, Ward RM. Pelvic mesh complications in women before and after the 2011 FDA public health notification. Female Pelvic Med Reconstr Surg. 2013;19(6):333–8.CrossRefPubMedGoogle Scholar
  17. Sokol AI, Jelovsek JE, Walters MD, Paraiso MF, Barber MD. Incidence and predictors of prolonged urinary retention after TVT with and without concurrent prolapse surgery. Am J Obstet Gynecol. 2005;192:1537–43.CrossRefPubMedGoogle Scholar
  18. Unger CA, Walters MD, Ridgeway B, Jelovsek JE, Barber MD, Paraiso MF. Incidence of adverse events after uterosacral colpopexy for uterovaginal and posthysterectomy vault prolapse. Am J Obstet Gynecol. 2015;212(5):603.e1–7.CrossRefGoogle Scholar
  19. Wong KS, Nguyen JN, White T, Menefee SA, Walter AJ, Krulewitch CJ, et al. Adverse events associated with pelvic organ prolapse surgeries that use implants. Obstet Gynecol. 2013;122(6):1239–45.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Shlomo Raz
    • 1
  1. 1.Division of Pelvic Medicine and Reconstructive SurgeryUCLA School of MedicineLos AngelesUSA

Personalised recommendations