complications of incontinence management judith goh franzcog cu phd professor griffith university...
TRANSCRIPT
Complications of Incontinence Management
Judith Goh FRANZCOG CU PhD
Professor Griffith UniversityUrogynaecologistGreenslopes Private HospitalBrisbane, Australia
Pharmacological management of overactive bladder
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
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
Complications of Continent Surgery
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
Urinary tract injury
Routine cystoscopyAvoid and recognise
injuryFill bladderDye testCystoscopy
Manage injury
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
Management Voiding Difficulty
Manage / treatPain, infection, over
hydration, anxiety
Catheterisation Intermittent or continuous
Remove suture/slingUrethral dilatation
Controversial
Management Voiding Difficulty
Urethrolysis No standardised guidelines Risk of recurrence USI
Divide slingRetropubic urethrolysis
Detrusor overactivity
Persistent DO risk factorsAgeNocturia ≥ 2Low UCPBladder neck slings
Management detrusor overactivity
Pre-operationCounselling, management of OAB
Exclude infection, voiding difficulty, foreign body
ManagementPelvic floor rehabilitationAnticholinergics
Mesh Complications
Rate varies depending on type of mesh usedVaginal or urinary tract
ConclusionPre-operative
CounsellingConservative managementOptimise conditions prior to surgery
Avoidable complicationsRecognise and treatCystoscopeDo not over tensionSurgical technique