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Published byRolf Clarke Modified over 9 years ago
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The complications incontinence management John Short
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Intraoperative Postoperative Long term
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Intraoperative Haemorrhage Visceral injury
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postoperative Infection Voiding problems Nerve injury Fistula Erosion
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Long term Detrusor Overactivty Sexual dysfunction Prolapse
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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)
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Visceral injury Bowel Bladder Ureter Urethra
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Bladder Lap colpo2.8% Open colpo0.7% TVT5-9% TOT0-12.9%(*) Sling3.5%
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Urethra TVT 0.5% (0-2%) TOT 1.09% (0-2.5%)
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Infection UTI wound
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UTI TVT 5.9-22% Colpo2.1-61% TOT2.3-17.8% Sling91% (?)
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Wounds Colpo4-19% Sling3-21% TVT2% (7% colpo)
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Others DVT Incisional hernia
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Voiding TVT1.5-21% Sling7.1-8.3% Colpo3-14.7% TOT2.1-22.6%
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TVT vs Colpo Catheter beyond 7 days TVT 5% Colpo33%
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TVT vs Colpo Catheter beyond 6 months TVT 3% Colpo8%
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Sling vs Colpo Voiding dysfunction leading to surgical revision Colpo0% Sling6%
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TVT vs TOT TVT 3.4% TOT1.3%
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Voiding Sling > Burch > TVT > TOT
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Prediction Bladder capacity Flow rate Voiding pressure (Liverpool Nomogram)
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treatment Catheter Revision
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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’)
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Fistula
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Mesh problems Vagina Bladder Urethra
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Vaginal mesh erosion/exposure0.4-5.9% Bladder erosion0-3.3% Urethral erosion? Can develop over several years
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Suture problems
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De novo Detrusor overactivity TVT8% Sling16.% Colpo17%
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prolapse Significant increase in enterocoele/apical prolapse 5 years following colposuspension
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Sexual dysfunction Limited data
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THE END
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