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Complications of Incontinence Management

Complications of Incontinence Management. Judith Goh FRANZCOG CU PhD Professor Griffith University Urogynaecologist Greenslopes Private Hospital Brisbane, Australia. Pharmacological management of overactive bladder. Anticholinergics. Common side-effects

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Complications of Incontinence Management

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  1. Complications of Incontinence Management Judith Goh FRANZCOG CU PhD Professor Griffith University Urogynaecologist Greenslopes Private Hospital Brisbane, Australia

  2. Pharmacological management of overactive bladder

  3. Anticholinergics • Common side-effects • Dry mouth, constipation, blur vision • Try smaller dose, then dose-up • Oxybutynin • Most side-effects due to metabolite (N-desethyloxyloxybutynin) produced through first-pass metabolism in gut • Transdermal – less systemic effects but local skin irritation

  4. Anticholinergics • Cochrane • Overall efficacy similar • If one not helpful, try another • Chapple et al. Eur Urol 2008 • Precautions • Glaucoma - ask woman’s ophthalmologist • Voiding difficulty • Elderly – medications for Parkinson’s and dementia also have anticholnergic effects • Elderly – cognitive side-effects esp oral oxybutynin

  5. Complications of Continent Surgery

  6. Potential complications • Immediate • Haemorrhage, injury to urinary tract, viscera • Short-term • Infection, voiding difficulty, fistula, osteitis pubis, nerve injury • Long-term • Detrusor overactivity, prolapse, pain, mesh complications, voiding difficulty

  7. Urinary tract injury • Routine cystoscopy • Avoid and recognise injury • Fill bladder • Dye test • Cystoscopy • Manage injury

  8. Voiding difficulty • Difficult to assess rate in literature due to variable definitions • Risks factors • Short-term factors • Pain, oedema, drugs, over hydration (IV) • Over elevating bladder neck • Excess tensioning of sling • Pre-existing abnormal voiding pattern

  9. Management Voiding Difficulty • Manage / treat • Pain, infection, over hydration, anxiety • Catheterisation • Intermittent or continuous • Remove suture/sling • Urethral dilatation • Controversial

  10. Management Voiding Difficulty • Urethrolysis • No standardised guidelines • Risk of recurrence USI • Divide sling • Retropubic urethrolysis

  11. Detrusor overactivity • Persistent DO risk factors • Age • Nocturia ≥ 2 • Low UCP • Bladder neck slings

  12. Management detrusor overactivity • Pre-operation • Counselling, management of OAB • Exclude • infection, voiding difficulty, foreign body • Management • Pelvic floor rehabilitation • Anticholinergics

  13. Mesh Complications • Rate varies depending on type of mesh used • Vaginal or urinary tract

  14. Conclusion • Pre-operative • Counselling • Conservative management • Optimise conditions prior to surgery • Avoidable complications • Recognise and treat • Cystoscope • Do not over tension • Surgical technique

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