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 Try smaller dose, then dose-up 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

Anticholinergics Cochrane If one not helpful, try another Precautions 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

Complications of Continent Surgery

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

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

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

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

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

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

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

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

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