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