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The complications incontinence management John Short.

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Presentation on theme: "The complications incontinence management John Short."— Presentation transcript:

1 The complications incontinence management John Short

2 Intraoperative Postoperative Long term

3 Intraoperative Haemorrhage Visceral injury

4 postoperative Infection Voiding problems Nerve injury Fistula Erosion

5 Long term Detrusor Overactivty Sexual dysfunction Prolapse

6 Haemorrhage VesselDistance from trochar Superficial epigastric3.9 (0.9-6.7) Inferior epigastric3.9 (1.9-6.6) External Iliac4.9 (2.9-6.2) Obturator3.2 (1.6-4.3)

7 Visceral injury Bowel Bladder Ureter Urethra

8

9 Bladder Lap colpo2.8% Open colpo0.7% TVT5-9% TOT0-12.9%(*) Sling3.5%

10 Urethra TVT 0.5% (0-2%) TOT 1.09% (0-2.5%)

11 Infection UTI wound

12 UTI TVT 5.9-22% Colpo2.1-61% TOT2.3-17.8% Sling91% (?)

13 Wounds Colpo4-19% Sling3-21% TVT2% (7% colpo)

14 Others DVT Incisional hernia

15 Voiding TVT1.5-21% Sling7.1-8.3% Colpo3-14.7% TOT2.1-22.6%

16 TVT vs Colpo Catheter beyond 7 days TVT 5% Colpo33%

17 TVT vs Colpo Catheter beyond 6 months TVT 3% Colpo8%

18 Sling vs Colpo Voiding dysfunction leading to surgical revision Colpo0% Sling6%

19 TVT vs TOT TVT 3.4% TOT1.3%

20 Voiding Sling > Burch > TVT > TOT

21 Prediction Bladder capacity Flow rate Voiding pressure (Liverpool Nomogram)

22 treatment Catheter Revision

23 Nerve Injury TVT VS TOT 2 vs 2.3% (numbness) 2.3 vs 7% (weakness) 2.3 vs 2% (pain) (groin pain/‘post colpo- syndrome’)

24 Fistula

25

26

27

28 Mesh problems Vagina Bladder Urethra

29 Vaginal mesh erosion/exposure0.4-5.9% Bladder erosion0-3.3% Urethral erosion? Can develop over several years

30 Suture problems

31 De novo Detrusor overactivity TVT8% Sling16.% Colpo17%

32 prolapse Significant increase in enterocoele/apical prolapse 5 years following colposuspension

33 Sexual dysfunction Limited data

34 THE END


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