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Kim P, Cantrell AB, Wallach SJ, Rothschild J, Durbin-Johnson B, Kurzrock EA. Reoperation rates for stress urinary incontinence and pelvic organ prolapse in women after undergoing Mid-Urethral sling with or without concomitant colporrhaphy in academic centers within the United States. J OBSTET GYNAECOL 2022; 42:2381-2386. [PMID: 35712775 DOI: 10.1080/01443615.2022.2056827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
In this study, the rates of reoperation for stress urinary incontinence (SUI) and pelvic organ prolapse (POP) in women who underwent a mid-urethral sling (MUS) with or without concurrent colporrhaphy were evaluated. An academic faculty practice consortium database was used to identify a cohort of patients treated surgically for SUI with or without concurrent POP repair (apical, anterior, posterior, or a combination of the three) with or without hysterectomy between 2009 and 2011. A total of 20,484 patients matched the criteria. Of patients who underwent a MUS, 7.2% underwent secondary surgery, with a higher rate of 8.6% associated with those who underwent concurrent prolapse repair (Apical repair HR 1.84, p < .01; Anterior compartment repair HR 1.47, p < .01). Concurrent hysterectomy was associated with a lower hazard of secondary prolapse surgery (HR 0.48; p < .01) if the initial surgery involved a complete POP repair. Prolapse mesh repair resulted in a higher hazard of additional surgery (HR 1.43, p < .01). Medicaid insurance was also associated with an increased hazard ratio compared to commercial insurance for secondary surgery (HR 1.32, p < .01). For women undergoing MUS with complete prolapse repair, concurrent hysterectomy is associated with lower secondary surgery rates. Concurrent prolapse repair with mesh is associated with higher secondary surgery rates.Synopsis: For women undergoing MUS (mid-urethral sling) with complete prolapse repair, concurrent hysterectomy is associated with lower secondary surgery rates. Concurrent prolapse repair with mesh is associated with higher secondary surgery rates.Impact StatementWhat is already known on this subject? Stress urinary incontinence (SUI) and pelvic organ prolapse (POP) can present at the same time and negatively impact patients' quality of life. There is little data regarding reoperation rates for patients who undergo both MUS and colporrhaphy in one setting.What do the results of this study add? This study found that patients who undergo concurrent MUS (mid-urethral sling) and complete POP repair with the addition of hysterectomy had a lower risk of secondary surgery.What are the implications of these findings for clinical practice and/or further research? Our data can be used by surgeons to counsel patients on the risks of re-operation for SUI for those who would like to undergo concurrent POP repair with or without hysterectomy.
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Affiliation(s)
- Phillip Kim
- Department of Urologic Surgery, University of California Davis, Sacramento, CA, USA
| | - Alexander B Cantrell
- Department of Urology, Veterans Administration Medical Center, Sacramento, CA, USA
| | - Stacey J Wallach
- Department of Obstetrics and Gynecology, University of California Davis, Sacramento, CA, USA
| | - Jennifer Rothschild
- Department of Urologic Surgery, University of California Davis, Sacramento, CA, USA
| | | | - Eric A Kurzrock
- Department of Urologic Surgery, University of California Davis, Sacramento, CA, USA
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McVey A, Qu LG, Chan G, Perera M, Brennan J, Chung E, Gani J. What a mesh! An Australian experience using national female continence surgery trends over 20 years. World J Urol 2021; 39:3931-3938. [PMID: 33837448 DOI: 10.1007/s00345-021-03691-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 03/30/2021] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To review the evolution of female continence surgical practice in Australia over the last 20 years and observe whether vaginal mesh controversies impacted these trends. MATERIALS AND METHODS From January 2000 to December 2019, medicare benefit schedule codes for female continence procedures were identified and extracted for: mesh sling, fascial sling, bulking agent, female urethral prosthesis, colposuspension, and removal of sling. Population-adjusted incidences per 100,000 persons were calculated using publicly available demographic data. Three discrete phases were defined over the study time frame for analysis: 2000-2006; 2006-2017, and 2017-2019. Interrupted time-series analyses were conducted to assess for impact on incidence at 2006 and 2017. RESULTS There were 119,832 continence procedures performed in Australia from 2000 to 2019, with the mid-urethral sling (MUS) the most common (72%). The majority of mesh (n = 63,668, 73%) and fascial sling (n = 1864, 70%) procedures were in women aged < 65 years. Rates of mesh-related procedures steeply declined after 2017 (initial change: -21 cases per 100,000; subsequent rate change: -12 per 100,000, p < 0.001). Non-mesh related/bulking agents increased from + 0.34 during 2006-2017 to + 2.1 per 100,000 after 2017 (p < 0.001). No significant change in mesh extraction was observed over 2006-2017 (+ 0.06 per 100,000, p = 0.192). There was a significant increase in mesh extraction procedures after 2017 (0.83 per 100,000, p < 0.001). CONCLUSION Worldwide, controversy surrounding vaginal mesh had a significant impact on Australian continence surgery trends. The most standout trends were observed after the 2017 Australian class-action lawsuit and Senate Inquiry.
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Affiliation(s)
- Aoife McVey
- Department of Urology, Austin Health, Melbourne, VIC, Australia
| | - Liang G Qu
- Department of Urology, Austin Health, Melbourne, VIC, Australia
| | - Garson Chan
- Department of Urology, Austin Health, Melbourne, VIC, Australia
- Division of Urology, Department of Surgery, University of Saskatchewan, Saskatoon, SK, Canada
| | - Marlon Perera
- Department of Urology, Austin Health, Melbourne, VIC, Australia.
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia.
| | - Janelle Brennan
- Department of Urology, Bendigo Health, Bendigo, VIC, Australia
| | - Eric Chung
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Johan Gani
- Department of Urology, Austin Health, Melbourne, VIC, Australia
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Carter E, Cartwright R. Surgical interventions for stress urinary incontinence. BMJ 2019; 365:l2350. [PMID: 31167751 DOI: 10.1136/bmj.l2350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Ng SC, Chen CC, Cheng SH, Chen GD. Escalating utilization of inpatient surgery for pelvic floor dysfunction in the elderly in Taiwan. Neurourol Urodyn 2019; 38:1707-1712. [PMID: 31141199 DOI: 10.1002/nau.24046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 04/07/2019] [Accepted: 04/24/2019] [Indexed: 11/05/2022]
Abstract
AIMS The direct cost of operations and health care expenditure for treating pelvic floor dysfunction are substantial. In this study, we evaluate the number of inpatient surgical procedures and direct expenditures for treating pelvic organ prolapse and urinary incontinence under the coverage of National Health Insurance (NHI) in Taiwan. METHODS Thirteen years of population-based NHI inpatient claims were used in this study. The number of surgical procedures and the average direct cost of inpatient fees for treating pelvic floor dysfunction for each patient from 1999 to 2011 were calculated. The patients were stratified based on age into a younger than 65 years group and 65 years or older group for comparisons. RESULTS The number of patients per year increased by 27%, increasing from 5278 patients in 1999 to 6706 patients in 2011. The total direct cost of inpatient (surgical and admission) fees for pelvic floor dysfunction increased by 57.2%, increasing from $6 674 968 USD in 1999 to $10 494 894 USD in 2011. However, while the expenditures for women 65 years or older increased by 102.2% from 1999 to 2011, there was only a 38.3% increase for those younger than 65 years when we stratified the patients by age. CONCLUSION The increasing expenditures for inpatient surgery for pelvic floor dysfunction are mainly due to the escalating utilization of inpatient surgical procedures, especially those for pelvic organ prolapse in women aged 65 or older.
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Affiliation(s)
- Soo-Cheen Ng
- Department of Obstetrics and Gynecology, Chung Shan Medical University Hospital, Taichung City, Taiwan.,Institute of Medicine, Chung Shan Medical University, Taichung City, Taiwan.,School of Medicine, Chun Shan Medical University, Taichung City, Taiwan
| | - Chi-Chen Chen
- Department of Public Health, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Shou-Hsia Cheng
- College of Public Health, Institute of Health Policy and Management, National Taiwan University, Taipei, Taiwan
| | - Gin-Den Chen
- Department of Obstetrics and Gynecology, Chung Shan Medical University Hospital, Taichung City, Taiwan.,Institute of Medicine, Chung Shan Medical University, Taichung City, Taiwan
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Zacche MM, Mukhopadhyay S, Giarenis I. Changing surgical trends for female stress urinary incontinence in England. Int Urogynecol J 2018; 30:203-209. [DOI: 10.1007/s00192-018-3839-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 11/21/2018] [Indexed: 10/27/2022]
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James MB, Theofanides MC, Sui W, Onyeji I, Badalato GM, Chung DE. Sling Procedures for the Treatment of Stress Urinary Incontinence: Comparison of National Practice Patterns between Urologists and Gynecologists. J Urol 2017; 198:1386-1391. [DOI: 10.1016/j.juro.2017.06.093] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/27/2017] [Indexed: 11/25/2022]
Affiliation(s)
- Maxwell B. James
- Department of Urology, Columbia University Medical Center, New York, New York
| | | | - Wilson Sui
- Department of Urology, Columbia University Medical Center, New York, New York
| | - Ifeanyi Onyeji
- Department of Urology, Columbia University Medical Center, New York, New York
| | - Gina M. Badalato
- Department of Urology, Columbia University Medical Center, New York, New York
| | - Doreen E. Chung
- Department of Urology, Columbia University Medical Center, New York, New York
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Cohen AJ, Packiam VT, Nottingham CU, Alberts BD, Faris SF, Bales GT. 30-Day Morbidity and Reoperation Following Midurethral Sling: Analysis of 8772 Cases Using a National Prospective Database. Urology 2016; 95:72-9. [DOI: 10.1016/j.urology.2016.04.043] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 03/31/2016] [Accepted: 04/04/2016] [Indexed: 12/21/2022]
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Abstract
PURPOSE OF REVIEW We sought to provide a review of the recent literature regarding the prevalence and epidemiological trends in pelvic floor disorders (PFDs) including pelvic organ prolapse (POP), urinary incontinence and fecal incontinence. We also examined the current trends in surgical treatment for these disorders and discuss future care needs. RECENT FINDINGS Approximately, one quarter of all women suffer from at least one or more PFDs. Urinary incontinence represents the most common PFD with an estimated prevalence of 15-17%, whereas fecal incontinence affects, approximately, 9% of adult women. POP is more difficult to assess with prevalence estimates ranging from 3 to 8%. Surgery for PFDs is common as 20% of women undergo stress urinary incontinence or POP surgery over their lifetime. As the aging population grows, the number of women with PFDs will increase substantially and the demand for care for these disorders will continue to grow through the year 2050. SUMMARY PFDs are a significant public health issue and they negatively impact the lives of millions of adult women. The projected increase in the number of women affected by PFDs over the next 40 years will create increased demand for providers properly trained in Female Pelvic Medicine and Reconstructive Surgery.
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Brown J, King J. Age-stratified trends in 20 years of stress incontinence surgery in Australia. Aust N Z J Obstet Gynaecol 2016; 56:192-8. [PMID: 26869461 DOI: 10.1111/ajo.12445] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Accepted: 01/09/2016] [Indexed: 12/01/2022]
Abstract
BACKGROUND Stress urinary incontinence (SUI) is a common, debilitating condition in Australian women. Since its introduction in 1998-1999, the less invasive mid-urethral sling (MUS) procedure has become the new standard for surgical correction of SUI and overall numbers of continence procedures increased. Trends since 2009 have not been analysed. AIMS To identify patterns in the surgical treatment of women with SUI in Australia from January 1994 to December 2014 stratified by age. MATERIALS AND METHODS Gender- and age-specific data from Medicare Australia between January 1994 and December 2014 were extracted and the patterns of SUI surgery analysed for the 20-year period. Data on gynaecologists and urologists performing MUS and colposuspension were collected from Department of Human Services. RESULTS Following the introduction of MUS, total SUI operations increased with the peak in 2002, a plateau between 2006 and 2011, and a new decline from 2012 onwards. There has been a sustained 51.7% increase in total SUI operations in 75- to 84-year-old women, and a 105.2% increase in women aged over 84. However, SUI operations in 45- to 64-year-olds decreased below pre-MUS baseline in 2014. CONCLUSIONS Mid-urethral sling has become the standard SUI procedure being performed in Australia since its introduction in 1999. SUI operations have increased each year for patients aged over 65, with the greatest increase seen in patients aged over 84 - indicating expanded eligibility for SUI surgery in older women. However, since 2010, there has been a fall in SUI operations to below the pre-MUS baseline.
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Affiliation(s)
- James Brown
- Obstetrics and Gynaecology, Westmead Hospital, Westmead, New South Wales, Australia
| | - Jennifer King
- Obstetrics and Gynaecology, Westmead Hospital, Westmead, New South Wales, Australia
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Davé BA, Jaber C, Leader-Cramer A, Higgins N, Mueller M, Lewicky-Gaupp C, Kenton K. Effect of anesthesia type on perioperative outcomes with a midurethral sling. Int Urogynecol J 2016; 27:1327-32. [DOI: 10.1007/s00192-016-2950-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Accepted: 01/04/2016] [Indexed: 10/22/2022]
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Chang CP, Chang WH, Hsu YM, Chen YJ, Wen KC, Chao KC, Yen MS, Horng HC, Wang PH, Chuang CM, Chang YH, Wu HH, Lau HY, Tseng JY, Tsai HW, Twu NF, Chao HT. Comparison of single-incision mini-slings (Ajust) and standard transobturator midurethral slings (Align) in the management of female stress urinary incontinence: A 1-year follow-up. Taiwan J Obstet Gynecol 2015; 54:726-30. [DOI: 10.1016/j.tjog.2015.10.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/08/2015] [Indexed: 01/15/2023] Open
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Hakim L, De Ridder D, Van der Aa F. Slings for urinary incontinence and the application of cell-based therapy. Adv Drug Deliv Rev 2015; 82-83:22-30. [PMID: 25463774 DOI: 10.1016/j.addr.2014.11.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Revised: 10/15/2014] [Accepted: 11/08/2014] [Indexed: 02/08/2023]
Abstract
The most commonly used technique for the treatment of stress urinary incontinence (SUI) in women is the suburethral polypropylene sling, using either a retropubic or transobturator tape approach This treatment results in a cure rate of over 80%, based on both subjective and objective evaluations. Biological slings have been largely abandoned due to lack of efficacy. Despite the high success rates, 10-20% of women remain incontinent. Cell-based therapy might offer solutions for the future both for the primary setting as for the treatment of failures. Preclinical studies suggest that stem cells (SC) can enhance the recovery of damaged tissue either by direct integration and replacement of damaged tissue (differentiation) or by secreting factors that influence host response mechanisms (paracrine effect). The clinical data to date do not allow strong efficacy conclusions, except that SC therapy seems to be safe in the short term. Most published studies use autologous cells. Allogeneic cell sources need to be investigated as well to allow ready-to-use solutions in the future. Most importantly, we need better insight into the mechanisms of action. We need more basic stem cell research, better acute and chronic animal models, better investigational tools and more efforts using tissue engineering approach.
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