The First factor–The Physician
The physician has to be educated about the surgical techniques and materials used.
1.1) The surgical techniques
For 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
To 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.
The physician has to be educated about the appropriate pre-operative antibiotics and post-operative antibiotics.
You are more likely to get an infection from urogynecological wounds than 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.
To prevent wound infection, from all kinds of urogynecological surgeries, a proper regimen 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.
The physician has to educate the patient with pre and post operative care instructions, risk and complications, and the consent form.
3.1) Accurate, clear, and proper pre & post-operative instructions
Accurate, clear, and proper pre & post-operative instructions will be given in order to avoid post-operative complications.
3.2) Most common risks & complications for Urogynecology Surgery
- 1)Abnormal bleeding
- 2) Infection of the wound
- 3) Pain with sexual intercourse
- 4) Mesh Extrusion or exposure vaginally
- 5) Urinary frequency or difficulty in urination
- 6) Mesh Erosion into the bladder or rectum and fistula formation
3.3) Preoperative agreement (patient consent)
Informed consent is very important to protect the patient and the surgeon also. It must be signed before any surgical procedure is performed.
It is important for patients to fully understand the procedure.
The physician must be open-minded, honest, and responsible with the surgical procedures.
The 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.
In case of unexpected surgical results or complications, corrective surgery is an option and will be discussed between the physician and the patient.
The surgeon has to be open-minded to others’ opinions, embracing new techniques and the constant changes to modern technologies, weighing the best options for the good of the patients.
The First factor–The Patient
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 Urinary incontinence
1.2) Any existing disease
Any 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
Aging 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.
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.
An 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.