Female pelvic floor dysfunction (FPFD) is a disorder caused by defects, injuries and dysfunctions of the pelvic floor support structures, the incidence of which is about 40% and increases with age, seriously affecting the quality of life and physical and mental health of patients. It mainly includes stress urinary incontinence (SUI), pelvic organ prolapse (POP), female sexual dysfunction (FSD) and fecal incontinence (FI). incontinence (FI). The diagnosis and treatment of female pelvic floor dysfunction has formed the subdisciplines of urogynecology and reconstruction of pelvic surgery (RPS). With the development of new pelvic floor reconstructive surgery in China in the past 10 years, the occurrence of complications related to it has been on the rise, which has attracted the high attention of fellow gynecologists and urologists. I. Commonly used surgical procedures for female pelvic floor dysfunctional diseases Commonly used surgical procedures include two main categories: anti-incontinence surgery and pelvic floor reconstruction surgery for pelvic organ prolapse. Since Kelley’s anterior vaginal wall urethral folding in 1913, anti-incontinence surgery has covered more than 150 types of procedures, with a wide variety. With the development of modern biotechnology, material science and minimally invasive surgical methods, anti-incontinence surgery has been revolutionized, and various minimally invasive procedures have emerged one after another. Currently, the commonly used anti-incontinence procedures can be broadly divided into six categories: (1) anterior vaginal wall repair (urethral folding); (2) retropubic bladder neck suspension (Marshall-Marchetti-Krantz, MMK; Burch procedure); (3) broad fascial bladder neck urethral suspension band (Sling Lata); (4) tension-free urethral suspension (4) tension-free urethral suspension banding (TVT, IVS, SPARC, etc.); (5) transseptal tension-free urethral suspension (TVT-O, TOT); (6) periurethral injection. Pelvic floor reconstructive surgery is divided into anterior, middle and posterior pelvic defect repair according to different pelvic defect sites; transabdominal, trans-laparoscopic or transvaginal pelvic floor reconstructive surgery according to different surgical routes; and self-tissue repair surgery and graft replacement surgery according to the type of repair materials. The following three categories of POP reconstructive surgery are commonly used in clinical practice: (1) anterior pelvic defect repair surgery includes: (1) various types of anti-incontinence surgery; (2) self-tissue repair of central vaginal wall defects or paracentesis of paracentesis (transvaginal or transabdominal); (3) anterior vaginal wall patch repair (e.g. Prolift anterior pelvic repair surgery). The latter is indicated for patients with giant bladder bulge, old age, weak self-tissue, or postoperative recurrence. (2) The repair of mid-pelvic defects is based on suspension surgery, including suspension and fixation of own ligaments and fascial tissues such as Sacrospinous Ligament Fixation (SSLF), Iliococaudal Myofascial Fixation, High Utero-sacral ligament (HUS) (2) The posterior pelvic defect can be treated by the following methods: (1) transabdominal or laparoscopic vaginal-sacral fixation (Laparoscopic Sacral Colpopexy, LSC). (3) The repair of posterior pelvic defects mainly includes: tissue repair of the defective area and perineal body reconstruction surgery. The repair of the defective site is also in the form of both self-tissue repair and patch repair, and patch repair surgery (such as Prolift posterior pelvic repair surgery) can be chosen for those with severe rectal bulge, old age with weak tissues or recurrent posterior vaginal wall prolapse. However, the anterior, middle and posterior pelvic repair surgeries are not absolutely independent and often require combined surgery. Common surgical complications Due to the variety of pelvic floor reconstructive surgeries, the application of various new surgical procedures and auxiliary materials, the difference in the surgeon’s understanding and mastery of new surgical methods, the mastery of surgical indications and other factors, surgical complications increase. Therefore, to fully understand the prevention and treatment of complications in pelvic floor reconstructive surgery and to continuously explore new measures to improve its therapeutic effect and prevent complications is the direction for pelvic floor reconstructive surgeons to work together. 1. Common complications of anti-incontinence surgery: postoperative voiding disorder; sling exposure or erosion; vesicourethral injury; pelvic vascular injury. The literature reports: complications of anti-incontinence surgery in which the incidence of bladder injury for TVT and IVS surgery is 3.8% to 10.0%, urethral injury is 0.07%, retropubic hematoma is 1.9% to 3.0%, large vessel injury is 0.01% to 0.07%, and bowel injury is 0.007%. (1) Postoperative voiding disorder is the most common complication of stress urinary incontinence surgery, and the incidence of urinary retention is about 10%. Causes: ① preoperative weakening of the detrusor muscle already exists, when postoperative urethral resistance increases, then voiding difficulties occur; ② short term postoperative bladder urethra edema, spasm or urinary tract infection; ③ sling or suture suspension is too tight. Preventive measures: ① pay attention to the special history of preoperative dyspareunia, such as incomplete urination, interrupted urination, delayed urination and dribbling; ② preoperative assessment of bladder function urodynamic examination is very necessary, such as reduced urinary flow rate (<25ml/s), instability and elevated pressure of the forceps during the filling phase, decreased pressure of the forceps during the voiding phase, residual urine volume >50ml, and maximum bladder volume <200ml. then postoperative voiding disorders are likely to occur. (iii) Preoperative evaluation is important for those with internal urethral sphincter dysfunction (ISD). Type III stress urinary incontinence (ISD) is not suitable for the Burch procedure. In addition, the tension of the sling should be individualized. Especially for patients with ISD, the mechanism of the sling procedure is compression and the tension of the sling should be increased relatively. ④ For patients with type III stress urinary incontinence or preoperative mild voiding disorder already present, adequate preoperative conversation and informed consent signing are very important, and the information should include: type III stress urinary incontinence can be selected for mid-urethral suspension belt surgery, but the failure rate is relatively high, and the surgical approach is mostly recommended for TVT, because the success rate of TVT is 70%, while TVT-O is only about 40%. In addition, patients with voiding disorders should be fully informed about bladder function and the presence of combined urinary tract obstruction factors before surgery, and there is a possibility of postoperative voiding difficulties or the need for autonomic catheterization. Management of postoperative voiding disorders: For those with mild voiding disorders, most of them are caused by bladder urethral edema, inflammation or spasm, and can be treated with extended indwelling urinary catheter, anti-inflammatory and physical therapy, such as electrical stimulation and bladder training. For patients with hypocapnia of the detrusor muscle, drugs that enhance detrusor contraction and cholinergic receptor agonists such as carbachol and bronstimine can be used. If the above treatment is not effective, severe cases require sling release, which can be done by partially cutting the sling extension or completely cutting the sling or performing scar release. Completely cutting the sling does not necessarily result in recurrence of postoperative incontinence, because the postoperative scar has formed around the urethra has a certain role in fixing the urethra. (2) Exposure or erosion of the sling: The literature reports that the rate of erosion and exposure of the urethral sling is about 3%. Causes: thin vaginal wall; suture leakage; sling exposure during puncture; premature postoperative sex; postoperative co-infection; rejection reaction, etc. Preventive measures: ①Vaginal wall separation should not be too thin; ②during puncture via the closed-hole path, pay attention to pulling the ipsilateral labia minora outward so that the sling is not exposed in the inner part of the labia minora at the upper corner of the closed-hole area; ③avoid heavy physical labor for 1 month after surgery and avoid sexual intercourse for 3 months after surgery. Treatment: When the exposed area of the sling is small, estrogen ointment and local anti-inflammatory treatment can be given; if the treatment is ineffective, the exposed sling will be removed. (3) Bladder or urethral injury mostly occurs during TVT surgery, and the chance of bladder injury during TVT-O is rare. causes of bladder injury during TVT surgery: the hip joint cannot be sufficiently abducted; the incision above the pubic symphysis is too high; the puncture direction is not grasped; the bladder is not emptied during puncture, etc. In case of injury, remove the puncture needle and puncture again, extend the duration of indwelling urinary catheter (at least 7 days after surgery) and apply antibiotics to prevent infection. cystoscopy is routinely performed after TVT. Because pelvic floor reconstructive surgery is mainly negative surgery, the operating field is narrow, and the new surgical method often relies on special surgical equipment, often through the closed-hole path or through the pararectal path, improper operation of the surgical puncture path can often cause damage to adjacent organs, such as bladder, urethra, rectum, blood vessels and nerves. In pelvic floor reconstruction surgery, the key to avoid injury complications lies in: (1) familiarity with the local anatomy of the pelvic floor, especially the local anatomy of the surgical puncture path; (2) adequate separation of the lateral bladder space and the lateral rectal space is the key to avoid bladder and rectal injury; (3) the patient's surgical position is one of the important links to ensure successful surgery and avoid nerve and joint injury, and the patient should be allowed to (3) The patient's surgical position is one of the important links to ensure successful surgery and avoid nerve and joint injuries. IV. Complications associated with patches New pelvic floor reconstruction surgery mostly uses surgical adjunct materials, including synthetic materials (such as polypropylene materials) and biological mesh. The former has a certain chance of erosion, exposure and infection; while the latter has good histocompatible properties and is not prone to mesh exposure, but has a certain rate of postoperative degradation. Feiner B (2009) summarized a meta-data of 8 centers for Prolift surgery with 1295 Prolift procedures with a mean success rate of 87% ( 75C94%) and a mean complication rate of 16% ( 2C61%) at 30 weeks of follow-up (12C52 weeks). Complications occurred: mesh erosion 7%, dyspareunia 2%, vaginal/buttock pain 2%, mesh constriction 1.5%, bladder injury 1% , rectal injury 1, need for blood transfusion 10, necrotizing fasciitis 1. Piet Hinoul, MD (2008) performed Prolift surgery in 48 patients with prolapse II or greater. Objective cure rate 46/48 (95.8%), subjective cure rate 40/42 (95.2%), mesh erosion: 5/48 (10.4%), 2 (4.3%) required surgical treatment, persistence of urgency 3/21 (14%), postoperative stress urinary incontinence 4/30 (13%), preoperative dyspareunia due to prolapse disappeared after surgery, postoperative dyspareunia 3 /20 (15%). Preventive measures for mesh erosion and prolapse: (1) the vaginal mucosal tissue should not be separated too thinly before placing the mesh, and the placement of the mesh should be emphasized below the vaginal fascia layer; (2) excessive tension on the vaginal suture surface should be avoided, and excessive trimming of the vaginal mucosa is inappropriate; patients with vaginal stenosis should not choose mesh repair surgery. ③The patch area is not suitable to be too large, while the mesh placement should be flat and not folded; ④Stop bleeding sufficiently before suturing the vaginal mucosa; ⑤Avoid hematoma formation Avoid sexual intercourse for 3 months after surgery. The possible causes of painful intercourse are: the mesh is too close to the anal raphe complex leading to spasm of the anal raphe and subsequent difficulty in intercourse. 17% of patients have difficulty in intercourse after surgery, 85% of patients are satisfied with the results and are willing to undergo surgery (75% have difficulty in intercourse, 83% have difficulty in intercourse after surgery) V. Infection-related complications Due to the poor compatibility of the implant with the tissue, the implant is not compatible with the tissue Infection can occur when the implant is incompatible with the tissue and forms a pus cavity along the perimeter of the mesh, which repeatedly migrates and forms a sinus tract, which can cause chronic bleeding, or fever when drainage is poor. In addition, for transvaginal pelvic floor reconstruction surgery, care should be taken to prevent infection due to anal fecal contamination during the procedure. Patients with unstable blood glucose in diabetes are also prone to combined postoperative infections; therefore, mesh repair surgery is not recommended for patients with severe diabetes. VI. Other comorbidities: Because of the older age of pelvic floor reconstruction surgery patients, most of them are middle-aged and elderly women, they may be accompanied by serious medical and surgical diseases, such as hypertension, heart disease, liver and kidney diseases, diabetes and thrombotic diseases. The postoperative period is prone to medical and surgical comorbidities, and it is especially important to strengthen the perioperative management. In conclusion, pelvic floor reconstructive surgery has made breakthroughs in recent years, and the therapeutic effect has been improving. However, there are still many confusions in the surgery of pelvic organ prolapse, and multidisciplinary participation and assistance are needed to continuously improve its therapeutic effect, increase the success rate and reduce the incidence of surgical complications.