Functional disorders of the lower urinary tract following urogynecologic and abdominal surgery

Bladder dysfunction is divided into storage and emptying disorders, which can also be the result of surgical interventions in the small pelvis, either individually or in combination. Neuroirritants from alloplastic implants are often associated with urge complaints and pelvic pain. Removal of the irritant agent carries the risk of incalculable collateral damage and recurrence of the symptoms that initially led to surgery. Conservative measures, on the other hand, are often lengthy, multimodal, and yet frustrating. Iatrogenic denervation of the lower urinary tract-mainly due to damage to the pelvic plexus-can be asymptomatic for years and remain undetected, because detrusor hypo- or acontractility can be compensated for by using alternative emptying mechanisms (Valsalva maneuver, pressureless micturition via pelvic floor relaxation). Neuromodulative therapeutic approaches require residual contractility of the detrusor, in the case of complete acontractility, only intermittent self-catheterization and suprapubic urinary diversion remain as therapeutic options. Iatrogenic urogenital fistulas occur most frequently after hysterectomies in benign indications, and the risk of a fistula following vaginal hysterectomy is tenfold with laparoscopic approaches. Due to the heterogeneity of fistulas, a correspondingly broad range of therapies must also be provided and, in addition to conservative permanent catheterization, also include vaginal or transabdominal fistula closure strategies.