Post-operative incontinence and fistulae

The proximity of the urinary tract to the reproductive organs puts it at risk of injury and incontinence as a consequence of gynaecological surgery. Incontinence of urine after gynaecological surgery is not only distressing and disappointing to the patient but also causes considerable stress to the surgeon. It also leads to medico-legal implications. Post-operative incontinence can occur in those who had it prior to surgery, whilst others develop it after surgery. Surgery may fail in those who came for surgery for incontinence if there is inadequate evaluation and counselling before surgery, if an inappropriate operation is performed or when there is poor surgical technique. In those who were continent, incontinence may develop as an undesired outcome of surgery. This may be due to de novo detrusor instability, retention with overflow in the immediate post-operative period, or to inadequate evaluation before vaginal surgery unmasking occult incontinence. Rarely, it may be due to unrecognised injury to the lower urinary tract. This article will deal with the prevention, evaluation, diagnosis and management of urinary tract injury and other causes of post-operative incontinence.