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Complications of Incontinence Management
Judith Goh FRANZCOG CU PhD
Professor Griffith UniversityUrogynaecologistGreenslopes Private HospitalBrisbane, Australia
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Pharmacological management of overactive bladder
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AnticholinergicsCommon side-effects
Dry mouth, constipation, blur vision
Try smaller dose, then dose-upOxybutynin
Most side-effects due to metabolite (N-desethyloxyloxybutynin) produced through first-pass metabolism in gut
Transdermal – less systemic effects but local skin irritation
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AnticholinergicsCochrane
Overall efficacy similar
If one not helpful, try another Chapple et al. Eur Urol 2008
PrecautionsGlaucoma - ask woman’s ophthalmologistVoiding difficultyElderly – medications for Parkinson’s and
dementia also have anticholnergic effectsElderly – cognitive side-effects esp oral oxybutynin
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Complications of Continent Surgery
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Potential complications
ImmediateHaemorrhage, injury to urinary tract, viscera
Short-termInfection, voiding difficulty, fistula, osteitis pubis,
nerve injuryLong-term
Detrusor overactivity, prolapse, pain, mesh complications, voiding difficulty
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Urinary tract injury
Routine cystoscopyAvoid and recognise
injuryFill bladderDye testCystoscopy
Manage injury
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Voiding difficulty
Difficult to assess rate in literature due to variable definitions
Risks factorsShort-term factors
Pain, oedema, drugs, over hydration (IV)
Over elevating bladder neck Excess tensioning of slingPre-existing abnormal voiding pattern
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Management Voiding Difficulty
Manage / treatPain, infection, over
hydration, anxiety
Catheterisation Intermittent or continuous
Remove suture/slingUrethral dilatation
Controversial
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Management Voiding Difficulty
Urethrolysis No standardised guidelines Risk of recurrence USI
Divide slingRetropubic urethrolysis
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Detrusor overactivity
Persistent DO risk factorsAgeNocturia ≥ 2Low UCPBladder neck slings
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Management detrusor overactivity
Pre-operationCounselling, management of OAB
Exclude infection, voiding difficulty, foreign body
ManagementPelvic floor rehabilitationAnticholinergics
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Mesh Complications
Rate varies depending on type of mesh usedVaginal or urinary tract
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ConclusionPre-operative
CounsellingConservative managementOptimise conditions prior to surgery
Avoidable complicationsRecognise and treatCystoscopeDo not over tensionSurgical technique