2026 Urogynecology for the Advanced Practice Provider-Urogyn Complications: an APP Survival Guide

Video Transcription

Video Summary

The presentation reviewed common urogynecologic postoperative complications through three cases. First, a 50-year-old developed fever, pelvic pain, and tenderness 10 days after vaginal hysterectomy with uterosacral suspension; CT showed a 5 cm pelvic abscess. The speakers emphasized early evaluation, CT imaging, broad-spectrum IV antibiotics, and IR drainage for larger abscesses. They also outlined expected recovery symptoms and warning signs after surgery, plus prevention strategies such as good diabetes control and ERAS protocols.  <br /><br />Second, a patient with extensive prior pelvic surgery developed a rare infected retropubic midurethral sling and later suffered major complications after mesh excision, including rectus sheath hematoma, arterial bleeding requiring embolization, and an incidental pulmonary embolism. This led into a discussion of VTE risk, diagnosis, treatment, and prevention with SCDs, early mobilization, and selective chemoprophylaxis.  <br /><br />Finally, they reviewed mesh exposure and infection, noting vaginal estrogen and excision options, and discussed how mesh properties, smoking, obesity, and glycemic control influence complication risk.

Asset Subtitle

This session provides APPs with a practical, case-based overview of the most important post-operative complications encountered in urogynecologic surgery. We will review early recognition of red flags, evidence-based diagnostic approaches, and initial management strategies within the APP scope of practice. Emphasis is placed on differentiating normal post-operative recovery from concerning findings, communicating effectively with the surgical team, and optimizing patient outcomes through prevention, early intervention, and patient education. Attendees will leave with actionable tools to confidently navigate pelvic floor–related complications.

Learning Objectives

By the end of this session, participants will be able to:

Identify common early and late post-operative complications and their typical time course.
Recognize red-flag symptoms and physical exam findings that require urgent intervention or escalation to the surgical team.
Formulate initial management plans for common complications, including fluid resuscitation, pain control adjustments, infection management, and early mobilization strategies.
Implement strategies to reduce postoperative complications: VTE prophylaxis, wound care protocols, multimodal analgesia, glycemic control, and ERAS (Enhanced Recovery After Surgery) principles.
Counsel patients on post-operative expectations, warning signs, and self-monitoring to reduce unplanned ED visits and readmissions.

Speakers: Amanda Artsen, MD & Beth Klump, MPAS, PA-C

Keywords

urogynecologic postoperative complications

pelvic abscess

midurethral sling infection

venous thromboembolism

mesh exposure

mesh excision