the complications incontinence management john short
TRANSCRIPT
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