the complications incontinence management john short

The complications incontinence management

John Short

• Intraoperative

• Postoperative

• Long term

Intraoperative

• Haemorrhage

• Visceral injury

postoperative

• Infection

• Voiding problems

• Nerve injury

• Fistula

• Erosion

Long term

• Detrusor Overactivty

• Sexual dysfunction

• Prolapse

Haemorrhage

Vessel Distance from trochar

Superficial epigastric 3.9 (0.9-6.7)

Inferior epigastric 3.9 (1.9-6.6)

External Iliac 4.9 (2.9-6.2)

Obturator 3.2 (1.6-4.3)

Visceral injury

• Bowel

• Bladder

• Ureter

• Urethra

Bladder

• Lap colpo 2.8%

• Open colpo 0.7%

• TVT 5-9%

• TOT 0-12.9%(*)

• Sling 3.5%

Urethra

• TVT 0.5% (0-2%)

• TOT 1.09% (0-2.5%)

Infection

• UTI

• wound

UTI

• TVT 5.9-22%

• Colpo 2.1-61%

• TOT 2.3-17.8%

• Sling91% (?)

Wounds

• Colpo 4-19%

• Sling 3-21%

• TVT 2%

• (7% colpo)

Others

• DVT

• Incisional hernia

Voiding

• TVT 1.5-21%

• Sling 7.1-8.3%

• Colpo 3-14.7%

• TOT 2.1-22.6%

TVT vs Colpo

• Catheter beyond 7 days

• TVT 5%

• Colpo 33%

TVT vs Colpo

• Catheter beyond 6 months

• TVT 3%

• Colpo 8%

Sling vs Colpo

• Voiding dysfunction leading to surgical revision

• Colpo 0%

• Sling 6%

TVT vs TOT

• TVT 3.4%

• TOT 1.3%

Voiding

• Sling > Burch > TVT > TOT

Prediction

• Bladder capacity

• Flow rate

• Voiding pressure

• (Liverpool Nomogram)

treatment

• Catheter

• Revision

Nerve Injury

• TVT VS TOT

• 2 vs 2.3% (numbness)

• 2.3 vs 7% (weakness)

• 2.3 vs 2% (pain)

• (groin pain/‘post colpo- syndrome’)

Fistula

Mesh problems

• Vagina

• Bladder

• Urethra

• Vaginal mesh erosion/exposure 0.4-5.9%

• Bladder erosion 0-3.3%

• Urethral erosion ?

Can develop over several years

Suture problems

De novo Detrusor overactivity

• TVT 8%

• Sling 16.%

• Colpo 17%

prolapse

• Significant increase in enterocoele/apical prolapse 5 years following colposuspension

Sexual dysfunction

• Limited data

THE END