the complications incontinence management john short
TRANSCRIPT
![Page 1: The complications incontinence management John Short](https://reader035.vdocument.in/reader035/viewer/2022062519/5697bfd21a28abf838cab7e6/html5/thumbnails/1.jpg)
The complications incontinence management
John Short
![Page 2: The complications incontinence management John Short](https://reader035.vdocument.in/reader035/viewer/2022062519/5697bfd21a28abf838cab7e6/html5/thumbnails/2.jpg)
• Intraoperative
• Postoperative
• Long term
![Page 3: The complications incontinence management John Short](https://reader035.vdocument.in/reader035/viewer/2022062519/5697bfd21a28abf838cab7e6/html5/thumbnails/3.jpg)
Intraoperative
• Haemorrhage
• Visceral injury
![Page 4: The complications incontinence management John Short](https://reader035.vdocument.in/reader035/viewer/2022062519/5697bfd21a28abf838cab7e6/html5/thumbnails/4.jpg)
postoperative
• Infection
• Voiding problems
• Nerve injury
• Fistula
• Erosion
![Page 5: The complications incontinence management John Short](https://reader035.vdocument.in/reader035/viewer/2022062519/5697bfd21a28abf838cab7e6/html5/thumbnails/5.jpg)
Long term
• Detrusor Overactivty
• Sexual dysfunction
• Prolapse
![Page 6: The complications incontinence management John Short](https://reader035.vdocument.in/reader035/viewer/2022062519/5697bfd21a28abf838cab7e6/html5/thumbnails/6.jpg)
Haemorrhage
Vessel Distance from trochar
Superficial epigastric 3.9 (0.9-6.7)
Inferior epigastric 3.9 (1.9-6.6)
External Iliac 4.9 (2.9-6.2)
Obturator 3.2 (1.6-4.3)
![Page 7: The complications incontinence management John Short](https://reader035.vdocument.in/reader035/viewer/2022062519/5697bfd21a28abf838cab7e6/html5/thumbnails/7.jpg)
Visceral injury
• Bowel
• Bladder
• Ureter
• Urethra
![Page 8: The complications incontinence management John Short](https://reader035.vdocument.in/reader035/viewer/2022062519/5697bfd21a28abf838cab7e6/html5/thumbnails/8.jpg)
![Page 9: The complications incontinence management John Short](https://reader035.vdocument.in/reader035/viewer/2022062519/5697bfd21a28abf838cab7e6/html5/thumbnails/9.jpg)
Bladder
• Lap colpo 2.8%
• Open colpo 0.7%
• TVT 5-9%
• TOT 0-12.9%(*)
• Sling 3.5%
![Page 10: The complications incontinence management John Short](https://reader035.vdocument.in/reader035/viewer/2022062519/5697bfd21a28abf838cab7e6/html5/thumbnails/10.jpg)
Urethra
• TVT 0.5% (0-2%)
• TOT 1.09% (0-2.5%)
![Page 11: The complications incontinence management John Short](https://reader035.vdocument.in/reader035/viewer/2022062519/5697bfd21a28abf838cab7e6/html5/thumbnails/11.jpg)
Infection
• UTI
• wound
![Page 12: The complications incontinence management John Short](https://reader035.vdocument.in/reader035/viewer/2022062519/5697bfd21a28abf838cab7e6/html5/thumbnails/12.jpg)
UTI
• TVT 5.9-22%
• Colpo 2.1-61%
• TOT 2.3-17.8%
• Sling91% (?)
![Page 13: The complications incontinence management John Short](https://reader035.vdocument.in/reader035/viewer/2022062519/5697bfd21a28abf838cab7e6/html5/thumbnails/13.jpg)
Wounds
• Colpo 4-19%
• Sling 3-21%
• TVT 2%
• (7% colpo)
![Page 14: The complications incontinence management John Short](https://reader035.vdocument.in/reader035/viewer/2022062519/5697bfd21a28abf838cab7e6/html5/thumbnails/14.jpg)
Others
• DVT
• Incisional hernia
![Page 15: The complications incontinence management John Short](https://reader035.vdocument.in/reader035/viewer/2022062519/5697bfd21a28abf838cab7e6/html5/thumbnails/15.jpg)
Voiding
• TVT 1.5-21%
• Sling 7.1-8.3%
• Colpo 3-14.7%
• TOT 2.1-22.6%
![Page 16: The complications incontinence management John Short](https://reader035.vdocument.in/reader035/viewer/2022062519/5697bfd21a28abf838cab7e6/html5/thumbnails/16.jpg)
TVT vs Colpo
• Catheter beyond 7 days
• TVT 5%
• Colpo 33%
![Page 17: The complications incontinence management John Short](https://reader035.vdocument.in/reader035/viewer/2022062519/5697bfd21a28abf838cab7e6/html5/thumbnails/17.jpg)
TVT vs Colpo
• Catheter beyond 6 months
• TVT 3%
• Colpo 8%
![Page 18: The complications incontinence management John Short](https://reader035.vdocument.in/reader035/viewer/2022062519/5697bfd21a28abf838cab7e6/html5/thumbnails/18.jpg)
Sling vs Colpo
• Voiding dysfunction leading to surgical revision
• Colpo 0%
• Sling 6%
![Page 19: The complications incontinence management John Short](https://reader035.vdocument.in/reader035/viewer/2022062519/5697bfd21a28abf838cab7e6/html5/thumbnails/19.jpg)
TVT vs TOT
• TVT 3.4%
• TOT 1.3%
![Page 20: The complications incontinence management John Short](https://reader035.vdocument.in/reader035/viewer/2022062519/5697bfd21a28abf838cab7e6/html5/thumbnails/20.jpg)
Voiding
• Sling > Burch > TVT > TOT
![Page 21: The complications incontinence management John Short](https://reader035.vdocument.in/reader035/viewer/2022062519/5697bfd21a28abf838cab7e6/html5/thumbnails/21.jpg)
Prediction
• Bladder capacity
• Flow rate
• Voiding pressure
• (Liverpool Nomogram)
![Page 22: The complications incontinence management John Short](https://reader035.vdocument.in/reader035/viewer/2022062519/5697bfd21a28abf838cab7e6/html5/thumbnails/22.jpg)
treatment
• Catheter
• Revision
![Page 23: The complications incontinence management John Short](https://reader035.vdocument.in/reader035/viewer/2022062519/5697bfd21a28abf838cab7e6/html5/thumbnails/23.jpg)
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’)
![Page 24: The complications incontinence management John Short](https://reader035.vdocument.in/reader035/viewer/2022062519/5697bfd21a28abf838cab7e6/html5/thumbnails/24.jpg)
Fistula
![Page 25: The complications incontinence management John Short](https://reader035.vdocument.in/reader035/viewer/2022062519/5697bfd21a28abf838cab7e6/html5/thumbnails/25.jpg)
![Page 26: The complications incontinence management John Short](https://reader035.vdocument.in/reader035/viewer/2022062519/5697bfd21a28abf838cab7e6/html5/thumbnails/26.jpg)
![Page 27: The complications incontinence management John Short](https://reader035.vdocument.in/reader035/viewer/2022062519/5697bfd21a28abf838cab7e6/html5/thumbnails/27.jpg)
![Page 28: The complications incontinence management John Short](https://reader035.vdocument.in/reader035/viewer/2022062519/5697bfd21a28abf838cab7e6/html5/thumbnails/28.jpg)
Mesh problems
• Vagina
• Bladder
• Urethra
![Page 29: The complications incontinence management John Short](https://reader035.vdocument.in/reader035/viewer/2022062519/5697bfd21a28abf838cab7e6/html5/thumbnails/29.jpg)
• Vaginal mesh erosion/exposure 0.4-5.9%
• Bladder erosion 0-3.3%
• Urethral erosion ?
Can develop over several years
![Page 30: The complications incontinence management John Short](https://reader035.vdocument.in/reader035/viewer/2022062519/5697bfd21a28abf838cab7e6/html5/thumbnails/30.jpg)
Suture problems
![Page 31: The complications incontinence management John Short](https://reader035.vdocument.in/reader035/viewer/2022062519/5697bfd21a28abf838cab7e6/html5/thumbnails/31.jpg)
De novo Detrusor overactivity
• TVT 8%
• Sling 16.%
• Colpo 17%
![Page 32: The complications incontinence management John Short](https://reader035.vdocument.in/reader035/viewer/2022062519/5697bfd21a28abf838cab7e6/html5/thumbnails/32.jpg)
prolapse
• Significant increase in enterocoele/apical prolapse 5 years following colposuspension
![Page 33: The complications incontinence management John Short](https://reader035.vdocument.in/reader035/viewer/2022062519/5697bfd21a28abf838cab7e6/html5/thumbnails/33.jpg)
Sexual dysfunction
• Limited data
![Page 34: The complications incontinence management John Short](https://reader035.vdocument.in/reader035/viewer/2022062519/5697bfd21a28abf838cab7e6/html5/thumbnails/34.jpg)
THE END