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 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

4. 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

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