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Dr Odile Bagot (Gynecologist-obstetrician)
Medical validation:
April 23, 2023
Faced with the potential complications caused by the surgical implantation of strips or pelvic reinforcement implants, the Haute Autorité de Santé has issued new recommendations. The point with Dr. Bagot, gynecologist and member of the committee of experts of Doctissimo.
Urinary incontinence and genital prolapse are two common pathologies in women. To treat them, the surgical implantation of strips or pelvic reinforcement implants is sometimes considered. But these techniques carry significant risks. In this context, the High Authority for Health (HAS) has just published recommendations aimed at better managing these complications.
Sometimes irreversible complications
After one or more deliveries or approaching menopause, it is not uncommon for a woman to suffer from urinary incontinence or genital prolapse (descent of organs).
Sub-urethral strips, placed around the urethra to treat incontinence or reinforcement prostheses intended to lift the organs, are sometimes offered to these patients as a treatment.
“If suburethral prostheses or strips are completely indicated in the context of the surgical treatment of prolapse and urinary incontinence, they must nevertheless be properly placed.“, specifies Odile Bagot, gynecologist and member of the committee of experts of Doctissimo. “This is why, faced with the choice of the implant, it is necessary to have favorable medical opinions.“.
And for good reason: the surgical implantation of strips or pelvic reinforcement implants can cause irreversible complications, as we pointed out in a previous article.
“These possible complications, although rare, must be explained to the patient before surgery.“, emphasizes Dr. Bagot.
Once present, they also remain difficult to manage.
Any symptom suggestive of a complication requires a consultation
In this context, HAS has decided to distribute “recommendations” on the management of complications of surgery with prosthesis of urinary incontinence and prolapse.
“These recommendations list the main complications that may occur during or after the operation, their rate of occurrence, as well as the means of avoiding and managing them.“, explains the HAS in a press release.
The public authority recalls in this respect that transparency is essential: the surgical option in the treatment of stress urinary incontinence or prolapse “should always be made as part of a shared medical decision with the patient“.
“This therefore requires transmitting to the patient information relating to the risks of complications linked to the fitting of a prosthesis, to the stages of post-operative follow-up and to the benefits/risks in the event of the need for a reoperation.“, specifies the organization.
For the same purpose, the patient’s post-operative follow-up should not be rushed. It must include at least two mandatory consultations, “the first in the month following the operation, the second 1 year after.”
Finally, any undesirable effect felt by the patient (fever, red scar, pain during sexual intercourse, incontinence, bleeding at the anal level, etc.) must be reported and be the subject of a consultation.
“At the slightest doubt, at the slightest abnormal symptom after the surgery, you must contact the surgeon who performed the operation”recommends Dr. Bagot.