Consent for prolapse surgery involving mesh or Surgisis and/or to do any other procedures that in the doctors’ judgment may be advisable to my well-being, including such procedures that are considered medically advisable to treat other conditions initially undetected that are discovered during the above procedure.
Complications associated with anaesthesia:
At the time of operation
Immediate post operation complication:
24 hours after the operation
Late complications include:
- infection (operation site, bladder, chest and pelvis )
- bleeding requiring transfusion
- damage to the surrounding organs (bowel, urinary, womb, nerve, muscle or bone)
- forming clots in the legs (DVT) & lungs (embolism)
- complications of anaesthesia
- and death
The chance of a minor complication is 1/100, major complication 1/1000, and death 1/100,000.
You should be satisfied with your understanding of the specific risks of this operation which include:
Infection of mesh, graft, suture or anchor. This is uncommon & most will settle with antibiotics. Rarely is removal necessary.
May cause bruising or a clot (haematoma). Seldom is a blood transfusion or further surgery required.
Is uncommon & may develop at the same site or nearby. Most require no further treatment. Some are helped by physiotherapy or a pessary. A minority need more surgery.
- proud tissue (granulations) in 10%
- exposure in the vagina (10%)
- pelvic pain including pain with intercourse (10%)
- erosion or migration into an organ(<1%)
- distortion of anatomy (rare)
1/20 women require further surgery to treat mesh-related problems. Problems occur less commonly when mesh is placed via the abdomen than through the vagina.
New bladder problems:
Urgency, leakage & trouble emptying occur in a minority & most settle with time & simple treatments (physio, medicine or catheter). Occasionally a tape operation is needed to cure leakage.
Occurs commonly after prolapse surgery, especially when the back wall is repaired. Most cases respond well to laxatives & enemas. A minority require physiotherapy assistance or referral to a bowel surgeon.
Estimated 5 year success (no symptoms, bulge or need for further surgery):
You should be satisfied with the understanding of the possible consequences, outcomes or risks if no treatment is undertaken: prolapse is rarely life-threatening but tends to progress over time & affect one’s quality of life by causing discomfort &/or interfering with bowel, bladder & sexual function.
I am satisfied with my understanding of alternative procedures & treatments & their potential risks & benefits.
Traditional vaginal repair or keyhole repair.
Vaginal oestrogen, a pessary, physiotherapy and uses of magnetic chair.
You should be aware that conditions may arise which are unforeseen at this time and that it may be necessary and advisable to perform operations or procedures different from, or in addition to, that described. You need to authorise and consent to the performance of such additional or different operations and procedures that are considered necessary and advisable.
If agreeable please consent to the photographing, filming or videotaping of the operation for educational or diagnostic use. Photos/videos for educational purposes would be unidentifiable.
I understand there are risks involved in any procedure or treatment, and it is not possible to guarantee or give assurance of a successful result.
FBW and the team always endeavour to provide their best effort but cannot guarantee the outcome.
You should be satisfied with understanding of the nature of the procedure and treatment, and all of your additional questions about the treatment and procedure should have been answered to your satisfaction.
I have read and been given a copy of this form.
Please do not hesitate to ask FBW any further questions