Incidence a prevalence komplikací po protetických urogynekologických a rekonstrukčních operacích pánevního dna a jejich řešení u žen

The Incidence and Prevalence of Complications after Urogynaecological and Reconstructive Pelvic Floor Prosthetic Surgery and Management of these Complications in Women

Objective:
The aim of this article is to review the incidence and prevalence of complications after prosthetic surgery for POP (pelvic organ prolaps) and USI (urodynamic stress incontinence) and to introduce diagnostic and therapeutic advice into clinical practice.

Design:
Review article.

Settings:
Gynecological and Obstetric Clinic, 1^st LF UK and VFN, Prague.

Methods:
Summary of complications, recent findings, opinions and specific diagnostic and therapeutic recommendations with special focus to vaginal erosion, post-operative voiding difficulties, persisting leakage of urine and de novo urgency.

Results:
In the last decade the surgical treatment of female USI by prosthetic slings procedures has been shown to be effective with high cure rate and low morbidity. Similary, prosthetic reconstruction of pelvic organ prolapse through the different compartments has been introduced into clinical practice with good anatomical and promising functional results. The article is structured to the different sections, describing the epidemiology and management of complications after prosthetic slings procedures and after vaginal prosthetic treatment of pelvic organ prolapse. The effect of various operations of pelvic floor and USI using synthetic implants may differ, depending on the material of the implant used. Current recommendation for the implants material: a light-weight, flexible polypropylene; Amid’s classification: type 1, i.e macro-porous, monofilament material. The advantage of surgical treatment of pelvic floor defect using implants comprises a low percentage of recurrence of the descensus.

Key words:
pelvic organ prolapse, urodynamic stress incontinence, surgical repair, synthetic implant