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Liang S, Chen Z, Tang W, Andarini E, Kou L, Li Y, Cai W. Prevalence and predictors of help-seeking behavior among post-partum women with urinary incontinence in China and Indonesia: A cross-sectional survey based on Andersen Help-Seeking Model. Midwifery 2024; 128:103885. [PMID: 37984080 DOI: 10.1016/j.midw.2023.103885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 09/26/2023] [Accepted: 11/13/2023] [Indexed: 11/22/2023]
Abstract
INTRODUCTION Urinary incontinence (UI) is a prevalent condition among post-partum women, and it can significantly affect their physical and psychosocial well-being. Therefore, it's crucial for post-partum women to discuss any UI symptoms they may be experiencing with their healthcare provider and seek appropriate treatment. PURPOSE To investigate what leads post-partum women with UI to seek help in China and Indonesia based on the Andersen Help-Seeking Model. METHODS A cross-sectional digital survey among post-partum women (6 weeks to 1 year) was conducted from May to November 2021 in China and Indonesia. The survey contents included: (1) demographic characteristics, (2) social support, (3) health care needs, (4) capacity and resources. For analysis, descriptive statistics, independent sample t-tests and chi-square tests were used to determine the differences between help-seeking and non-help-seeking women with UI, and logistic regression analysis and the receiver operating characteristic curve (ROC) was used to determine the predictors of heal-seeking behavior in post-partum women with UI. RESULTS The prevalence of UI was 25 % (215/868) and 31 % (187/605) among post-partum women in China and Indonesia. Among post-partum women with UI, the help-seeking rate was 46 % (98/215) and 52 % (98/187) in China and Indonesia. Incontinence quality of Life, support from women of the family (Yes), knowing the available department for UI (Yes), current knowledge of UI and the current status of UI were independent risk factors for China (P<0.05). Support from husband (Yes), being asked about UI by a doctor (Yes) and the current status of UI were independent risk factors for Indonesia. The obtained area under ROC curve (AUC) for the model were 0.884 and 0.935 in China and Indonesia. CONCLUSIONS The prevalence of UI and the rate of seeking help for UI in Indonesia were higher than those in China. Social support, needs and the availability of resources and organizational support to assist patients in their help-seeking efforts, were the main predictors affecting help-seeking behavior among post-partum women with UI.
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Affiliation(s)
- Surui Liang
- Department of Nursing, Shenzhen Hospital, Southern Medical University, Shenzhen, Guangdong, China
| | - Zhaoying Chen
- Department of Nursing, Shenzhen Hospital, Southern Medical University, Shenzhen, Guangdong, China; School of Nursing, Southern Medical University, Guangzhou, Guangdong, China
| | - Wenjun Tang
- Department of Nursing, Shenzhen Hospital, Southern Medical University, Shenzhen, Guangdong, China; School of Nursing, Southern Medical University, Guangzhou, Guangdong, China
| | - Esti Andarini
- Department of Nursing, Shenzhen Hospital, Southern Medical University, Shenzhen, Guangdong, China; School of Nursing, Southern Medical University, Guangzhou, Guangdong, China
| | - Lin Kou
- Department of Nursing, Shenzhen Hospital, Southern Medical University, Shenzhen, Guangdong, China; School of Nursing, Southern Medical University, Guangzhou, Guangdong, China
| | - Yan Li
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, SAR, China
| | - Wenzhi Cai
- Department of Nursing, Shenzhen Hospital, Southern Medical University, Shenzhen, Guangdong, China.
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Zhong C, Hu P, Ran S. Authors' Reply to "Comments on 'Association Between Urinary Stress Incontinence and Levator Avulsion Detected by 3D Transperineal Ultrasound'". ULTRASCHALL IN DER MEDIZIN (STUTTGART, GERMANY : 1980) 2023; 44:554-555. [PMID: 36257332 DOI: 10.1055/a-1866-7729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Affiliation(s)
- Chunyan Zhong
- Ultrasound, Women and Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Pan Hu
- Obstetrics and Gynecology, Women and Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Suzhen Ran
- Ultrasound, Women and Children's Hospital of Chongqing Medical University, Chongqing, China
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Melnyk AI, Meckes N, Artsen A, Clark SG, Grosse PJ, Bonidie M. Surgical treatment of stress urinary incontinence: comparison of robotic-assisted Burch urethropexy with retropubic midurethral sling. J Robot Surg 2023; 17:1645-1652. [PMID: 36947294 PMCID: PMC10031710 DOI: 10.1007/s11701-023-01573-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 03/11/2023] [Indexed: 03/23/2023]
Abstract
Synthetic retropubic midurethral slings (RMUS) and robotic-assisted Burch urethropexies (RA-Burch) are common surgical treatment options for stress urinary incontinence (SUI). Few data exist comparing the success of these two retropubic surgeries. This retrospective cohort study of RA-Burch and RMUS procedures compared the proportion of patients with subjective cure after RA-Burch compared to RMUS at our institution between 2016 and 2020. Subjective cure was defined as reporting no symptoms of SUI at longest follow-up. Chi-square, Fisher's exact, Mann-Whitney U tests, logistic regression, and Kaplan-Meier log-rank tests were used in analyses. The overall cohort of 235 subjects included 47 RA-Burch cases matched 1:4 with 188 RMUS cases. Patients who underwent RA-Burch were younger (p < .01), had lower BMIs (p = .04), and were more likely to have concomitant procedures, including hysterectomy (p < .01). There was no difference in subjective cure at longest follow-up (p = .76). Median follow-up was longer in the RA-Burch group (p < .01). There was no difference in early postoperative complications, EBL, treatment for persistent SUI, or new urge urinary incontinence at longest follow-up. Both groups experienced postoperative urinary retention at a similar rate, although 4 RMUS patients required sling lysis and one patient experienced a mesh exposure. Patients undergoing RA-Burch had significantly longer OR times when no concomitant procedure was performed (p < .01). There were no significant predictors of SUI recurrence when controlling for baseline variables. This study suggests that RA-Burch and RMUS may be equally efficacious for patients with symptoms of SUI desiring surgical management.
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Affiliation(s)
- Alexandra I Melnyk
- Department of Obstetrics, Gynecology and Reproductive Sciences, Division of Urogynecology and Reconstructive Pelvic Surgery, Magee-Womens Hospital of UPMC, University of Pittsburgh, Pittsburgh, PA, USA.
| | - Nicole Meckes
- Department of Obstetrics, Gynecology and Reproductive Sciences, Magee-Womens Hospital of UPMC, University of Pittsburgh, Pittsburgh, PA, USA
| | - Amanda Artsen
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Division of Urogynecology and Pelvic Reconstructive Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Magee Womens Research Institute, Pittsburgh, PA, USA
| | - Stephanie Glass Clark
- Department of Obstetrics, Gynecology and Reproductive Sciences, Division of Urogynecology and Reconstructive Pelvic Surgery, Magee-Womens Hospital of UPMC, University of Pittsburgh, Pittsburgh, PA, USA
| | - Philip J Grosse
- Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, PA, USA
| | - Michael Bonidie
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Division of Urogynecology and Pelvic Reconstructive Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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Clark E, Wermuth DE, Oliver J, Sheridan A. Translabial Ultrasound: An Effective Modality for Evaluation of Midurethral Sling Revision. Ultrasound Q 2022; 38:316-321. [PMID: 36103414 DOI: 10.1097/ruq.0000000000000623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
ABSTRACT Midurethral sling (MUS) surgical procedures, in which a polypropylene synthetic mesh graft is transvaginally placed to support the urethra and manage stress urinary incontinence (SUI), is commonly performed ( Urology. 2013;82(1):38-41; Radiology. 2018;289(3):728-729). Within 10 years of sling placement, about 1 in 20 women undergo subsequent surgery to revise their mesh, in which the mesh is cut or partially excised ( Obstet Gynecol . 2019;133:1099-1108). Translabial ultrasound (TLUS) has been described as a sensitive technique for viewing MUS, although few studies have evaluated its ability to view surgically revised MUS ( Radiology . 2018;289(3):721-727). Understanding the anatomy of the MUS is critical to urologists and urogynecologists striving to optimize management of patients presenting with lower urinary tract symptoms and history of MUS. To assess the clinical utility and reliability of TLUS as a diagnostic tool in its detection of MUS discontinuity, we conducted a retrospective analysis on patients who underwent TLUS at a tertiary care center between September 2017 and May 2020 for indication of lower urinary tract symptoms and history of MUS placement. Performance of TLUS was evaluated by comparing findings with operative or clinical records. Among the 81 women included, detection of MUS revision, which was defined as a discontinuity in sling material, had a sensitivity of 84.6% and specificity of 97.1%. Translabial ultrasound is an inexpensive, nonirradiating, and noninvasive modality that is effective at visualizing MUSs. It is a reliable identifier of previous MUS revision, in which it detects a midline discontinuity of the hyperechoic mesh with an average 10 mm gap.
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Affiliation(s)
- Ellen Clark
- School of Medicine, University of Colorado, Aurora, CO
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Khalifa AO, Isali I, Celik H, Mastran M, McClellan P, Gillespie C, Shankar S, MacLennan GT, Anderson JM, Schumacher FR, Akkus O, Hijaz AK. A preliminary evaluation of in vivo response to a filament-wound macroporous collagen midurethral sling in an ovine model. J Biomed Mater Res B Appl Biomater 2022; 110:2676-2685. [PMID: 35779040 PMCID: PMC10148708 DOI: 10.1002/jbm.b.35120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 04/23/2022] [Accepted: 06/17/2022] [Indexed: 12/15/2022]
Abstract
Stress urinary incontinence (SUI) impacts ~1/3 of women over age 50. Negative publicity around PP meshes used in pelvic prolapse repair drives the need for identifying alternative biomaterials for SUI repair. Our study evaluated in vivo response to collagen sling implanted in an ovine model. Electrocompacted collagen threads were filament wound as slings and crosslinked in genipin. Collagen slings were implanted suburethrally mimicking the transvaginal tape technique. Main study groups were: Collagen sling (n = 3, 6 months) and PP sling (n = 3, 6 months). Collagen sling was also tested at 3-weeks (n = 1) to observe early-stage tissue response and 1-year (n = 2) to assess biomaterial longevity in a preliminary capacity. Collagen slings healed to a fibrous ligament texture at 6 months and maintained such texture to 1 year. Histological scoring indicated biocompatible responses to collagen slings with no adverse events. All study groups exhibited complete tissue ingrowth and interstitial de novo collagen deposition at all time points. Collagen threads induced orderly de novo collagen deposition that was aligned along long axes of threads. Tissue infiltrated collagen slings that were explanted at 6 and 12 months presented similar structural strength with native tissues such as vagina and fascia, and PP (Lynx) slings (p > .05). With the limitation of low number of animals per time point in hindsight, this preliminary study justifies evaluation of collagen slings in a larger sample size of animals, particularly to assess persistence of ligamentous tissue response over longer durations than 1-year.
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Affiliation(s)
- Ahmad O. Khalifa
- Department of Urology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio, USA
- Department of Urology, Menoufia University, Shebeen El-Kom, Egypt
| | - Ilaha Isali
- Department of Urology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio, USA
- Department of Mechanical and Aerospace Engineering, Case Western Reserve University, Cleveland, Ohio, USA
| | - Hakan Celik
- Department of Mechanical and Aerospace Engineering, Case Western Reserve University, Cleveland, Ohio, USA
| | | | - Phillip McClellan
- Department of Mechanical and Aerospace Engineering, Case Western Reserve University, Cleveland, Ohio, USA
| | | | | | - Gregory T. MacLennan
- Department of Pathology, Case Western Reserve University & University Hospitals Case Medical Center, Cleveland, Ohio, USA
| | - James M. Anderson
- Department of Pathology, Case Western Reserve University & University Hospitals Case Medical Center, Cleveland, Ohio, USA
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio, USA
| | - Fredrick R. Schumacher
- Department of Population and Quantitative Health Sciences, School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Ozan Akkus
- Department of Mechanical and Aerospace Engineering, Case Western Reserve University, Cleveland, Ohio, USA
- CollaMedix Inc., Cleveland, Ohio, USA
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio, USA
- Department of Orthopedics, Case Western Reserve University, Cleveland, Ohio, USA
| | - Adonis K. Hijaz
- Department of Urology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio, USA
- CollaMedix Inc., Cleveland, Ohio, USA
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Bicudo MC, Rodrigues AF, Dalle YO, Luiz Farinhas Tomé A, Placco Araujo Glina F, Glina S. Prevalence and cost of surgical treatment for female stress urinary incontinence in Brazil: A comparison between abdominal and vaginal approaches. Int J Clin Pract 2021; 75:e14527. [PMID: 34125984 DOI: 10.1111/ijcp.14527] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 06/09/2021] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE Report the progress of the treatment of female stress urinary incontinence (SUI) in Brazil through vaginal and abdominal approaches and the direct costs by hospitalisation, using DATASUS-a public entity of the Strategic and Participative Management Secretary of Health Ministry, with the responsibility of collecting, processing, and disseminating public health information. DESIGN Epidemiological study using the Brazilian Public Health Data Center System (DATASUS). PARTICIPANTS/MATERIALS, SETTING, AND METHODS Data were collected on all hospital admissions associated with treatment from 2008 to 2019 from the DATASUS. We analysed the records of hospitalisations associated with an abdominal or vaginal surgical SUI treatment. RESULTS The total number of procedures for the treatment of female SUI performed from 2008 to 2019 was 84.378, of which 70 238 were vaginal and 14 140 abdominal. There was an overall decrease in the number of SUI procedures in Brazil over the years analysed (F = 52.72; P < .0001); only exception was the South region (F = 1.38; P = .267). A declining trend was identified for the abdominal approach, with an increased trend of the vaginal approach (F = 170.11; P < .0001). A declining number of hospitalisation days was noted in the vaginal procedures (P = .002). Despite the fact that no differences were noted between abdominal and vaginal expenses (P = .054), hospital expenditure increased over the years for both vaginal and abdominal approaches, with no significant differences between either approaches. However, a statistically significant professional expenditure was observed in the abdominal approach (P < .001). Analysing hospitalisation and professional expenses, the total mean in the period was statistically higher for the abdominal approach (P < .0001). CONCLUSIONS The number of procedures to treat female SUI in Brazil has decreased from 2008 to 2019. Total financial expenditure per procedure and length of hospital stay were both higher for the abdominal approach (Burch colposuspension). A preference for a vaginal approach (pubovaginal sling or midurethral sling) has increased significantly since 2008, and our study favours this approach.
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Affiliation(s)
- Maria Claudia Bicudo
- Urology Division, Faculdade de Medicina do ABC do Centro Universitário de Saúde ABC, Sao Paulo, Brazil
| | - Antônio Flávio Rodrigues
- Urology Division, Faculdade de Medicina do ABC do Centro Universitário de Saúde ABC, Sao Paulo, Brazil
| | - Yasser Omar Dalle
- Urology Division, Faculdade de Medicina do ABC do Centro Universitário de Saúde ABC, Sao Paulo, Brazil
| | - André Luiz Farinhas Tomé
- Urology Division, Faculdade de Medicina do ABC do Centro Universitário de Saúde ABC, Sao Paulo, Brazil
| | | | - Sidney Glina
- Urology Division, Faculdade de Medicina do ABC do Centro Universitário de Saúde ABC, Sao Paulo, Brazil
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Long-Term Outcomes After Midurethral Mesh Sling Surgery for Stress Urinary Incontinence. Female Pelvic Med Reconstr Surg 2021; 28:188-193. [PMID: 34608036 DOI: 10.1097/spv.0000000000001094] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Although midurethral mesh slings are the criterion standard surgical treatment for stress urinary incontinence (SUI), limited data exist regarding long-term outcomes. Thus, our objectives were to evaluate the long-term risk of sling revision and the risk of repeat SUI surgery up to 15 years after the initial sling procedure and to identify predictors of these outcomes. METHODS Using a population-based cohort of commercially insured individuals in the United States, we identified women aged 18 years or older who underwent a sling procedure between 2001 and 2018. For sling revision, we evaluated indications (mesh exposure or urinary retention). We estimated the cumulative risks of sling revision and repeat SUI surgery annually using Kaplan-Meier survival curves and evaluated predictors using Cox proportional hazards models. RESULTS We identified 334,601 mesh sling surgical procedures. For sling revision, the 10-year and 15-year risks were 6.9% (95% confidence interval [CI], 6.7-7.0) and 7.9% (95% CI, 7.5-8.3), with 48.7% of sling revisions associated with mesh exposure. The 10-year and 15-year risks of repeat SUI surgery were 14.5% (95% CI, 14.2-14.8) and 17.9% (95% CI, 17.3-18.6). Women aged 18-29 years had an elevated risk for both sling revision (hazard ratio, 1.20; 95% CI, 1.15-1.25) and repeat SUI surgery (hazard ratio, 1.30; 95% CI, 1.25-1.37) compared with women 70 years and older. CONCLUSIONS In our study population, the 15-year risk of sling revision was 7.9%, with nearly half of revisions due to mesh exposure. These findings provide critical long-term data to support informed decisions for women and health care providers considering midurethral mesh slings.
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Wermuth DE, Sheridan A, Oliver J, Glanc P, Khatri G, Bagley A, Patel N. Translabial Ultrasound for Assessment of Synthetic Midurethral Sling Complications. Ultrasound Q 2021; 37:237-243. [PMID: 34478421 DOI: 10.1097/ruq.0000000000000545] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Translabial ultrasound (TLUS) is an inexpensive, noninvasive imaging modality traditionally used for assessment of pelvic organ prolapse. The utility of TLUS has recently been expanded to the evaluation of synthetic midurethral slings (MUS) surgically implanted for management of stress urinary incontinence. The purpose of this article is to familiarize radiologists with translabial ultrasound technique and provide a technical protocol for TLUS execution because it can be optimized for imaging and assessment of MUS, including identification of MUS configuration and recognition of common complications. This article provides example images of transobturator and retropubic slings and their associated complications, as visualized on TLUS. Accurate imaging and assessment of MUS is helpful in the evaluation of the patient presenting with symptoms suspicious for sling-related complications and in the planning of surgical revision.
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Affiliation(s)
| | - Alison Sheridan
- Department of Radiology, University of Colorado School of Medicine
| | - Janine Oliver
- Urology & Urodynamics Clinic, University of Colorado Hospital, Aurora, CO
| | - Phyllis Glanc
- Department of Imaging, University of Toronto Sunnybrook Health Science Center, Toronto, ON
| | - Gaurav Khatri
- Department of Radiology, University of Texas Southwestern, Dallas, TX
| | - Anjuli Bagley
- Department of Radiology, University of Colorado School of Medicine
| | - Nayana Patel
- Department of Radiology, University of Colorado School of Medicine
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Ghoniem G, Farhan B, Chowdhury ML, Chen Y. Safety and efficacy of polydimethylsiloxane (Macroplastique®) in women with stress urinary incontinence: analysis of data from patients who completed three years follow-up. Int Urogynecol J 2021; 32:2835-2840. [PMID: 34100973 PMCID: PMC8455384 DOI: 10.1007/s00192-021-04827-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 04/26/2021] [Indexed: 11/29/2022]
Abstract
Introduction and hypothesis This study aimed to report 3-year completed follow-up of the safety and efficacy of Macroplastique® (MPQ) in women with stress urinary incontinence (SUI) due to intrinsic sphincter deficiency (ISD). Methods This is a retrospective analysis of all women who completed 3-year follow-up post-MPQ injection(s) at ten medical centers. We used the ROSE registry data report of Macroplastique® [Macroplastique® Real-time Observation of Safety and Effectiveness (ROSE) registry P040050/PAS001 on 2017]. Subjective incontinence outcome and adverse effects were assessed. Results The study included all patients (n = 70) who completed 3-year follow-up after the last MPQ injection. Twenty-four of 70 (34%) patients had two injections; 21/70 (30%) patients reported Stamey grade 0 and 28/70 (40%) reported Stamey grade 1. The overall patient satisfaction was 68% who completed 3-year follow-up. The composite success rate (I-QoL, PGI-S, and Stamey grade improvement) was 51.4%. No serious adverse events (AE) were reported within the completed 3-year follow-up. Conclusions MPQ was found to be safe and efficacious for the treatment of SUI secondary to ISD in women. The overall high satisfaction rate was sustained from baseline to 3 years post-injection. Most complications were minor and transient without sequelae.
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Affiliation(s)
- Gamal Ghoniem
- Department of Urology, University of California Irvine (UCI), Irvine, CA, USA. .,Division of Female Urology, Pelvic Reconstructive Surgery & Voiding Dysfunction, Department of Urology, UC Irvine Health, 333 City Blvd. West, Suite 2100, Orange, CA, 92868, USA.
| | - Bilal Farhan
- Department of Urology, University of California Irvine (UCI), Irvine, CA, USA.,Urology Division, University of Texas, Medical Branch, Galveston, TX, USA
| | | | - Yanjun Chen
- Institute for Clinical and Translational Science, University of California Irvine (UCI), Irvine, CA, USA
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Zhao H, Souders CP, Kuhlmann PK, Dallas K, Eilber K, Anger JT. Adverse Events Associated With Synthetic Male Slings: An Analysis of the Food and Drug Administration Manufacturer and User Facility Device Experience Database. Int Neurourol J 2021; 25:172-176. [PMID: 33957719 PMCID: PMC8255823 DOI: 10.5213/inj.2040294.147] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 10/20/2020] [Indexed: 11/29/2022] Open
Abstract
PURPOSE We sought to describe and analyze the adverse events associated with synthetic male slings reported to the U.S. Food and Drug Administration (FDA) Manufacturer and User Facility Device Experience (MAUDE) database. METHODS We queried the MAUDE database for all entries including the terms "Male Sling," "InVance," "Virtue," or "Advance" from January 1st, 2009 to December 31st, 2018. We collected and analyzed information about the event type, date received, report source, source type, and manufacturer. We reviewed and categorized the event description text for each medical device report (MDR). RESULTS A total of 497 adverse events related to the male sling were identified. The adverse events were classified as injury (95.4%), malfunction (4.2%), and other (0.4%). There were no deaths described. The slings involved were the Advance or Advance XP sling (69.8%), InVance (15.5%), Virtue Quadratic (12.3%), or unknown (2.4%). The 4 most common adverse events described were urinary incontinence (46.7%), sling erosion (9.1%), mechanical malfunction (8.2%), and pain/numbness (8.2%). There was no increase in the number of reports in the years following the FDA warnings for urogynecologic mesh. CONCLUSION There was an overall modest number of MDRs related to male slings and the majority of them were reported by the manufacturer. The reporting of adverse events for male slings does not seem to be affected by the controversy and scrutiny towards transvaginal mesh and midurethral slings. Further clinical studies and more objective and detailed databases are needed to investigate the safety of these synthetic slings.
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Affiliation(s)
- Hanson Zhao
- Division of Urology, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Colby P. Souders
- Division of Urology, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Paige K. Kuhlmann
- Division of Urology, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Kai Dallas
- Division of Urology, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Karyn Eilber
- Division of Urology, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Jennifer T. Anger
- Division of Urology, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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Developing an Advanced Alternative Payment Model for Stress Urinary Incontinence. Female Pelvic Med Reconstr Surg 2021; 27:217-222. [PMID: 33315626 DOI: 10.1097/spv.0000000000000997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Historically, our health care system has been based on a fee-for-service model, which has resulted in high-cost and fragmented care. The Center for Medicare & Medicaid Services is moving toward a paradigm in which health care providers are incentivized to provide cost-effective, coordinated, value-based care in an effort to control costs and ensure high-quality care for all patients. In 2015, the Medicare Access and Children's Health Insurance Program Reauthorization Act repealed the Sustainable Growth Rate and the fee-for-service model, replacing them with a 2-track system: Merit-based Incentive Payment System and the advanced Alternative Payment Model (aAPM) system. In 2016, the American Urogynecologic Society Payment Reform Committee was created and tasked with developing aAPMs for pelvic floor disorders. The purpose of this article is to describe the stress urinary incontinence aAPM framework, the data selected and associated data plan, and some of the challenges considered and encountered during the aAPM development.
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The impact of the 2011 US Food and Drug Administration transvaginal mesh communication on utilization of synthetic mid-urethral sling procedures. Int Urogynecol J 2020; 32:2227-2231. [PMID: 33206220 DOI: 10.1007/s00192-020-04597-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 10/26/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION AND HYPOTHESIS We sought to examine the change in utilization of the midurethral sling (MUS) for the treatment of stress urinary incontinence (SUI) after the 2011 US FDA communication regarding transvaginal mesh. METHODS This is a retrospective cohort study evaluating surgical utilization of MUS at a managed care organization of 4.5 million patients from 2008 to 2016. The primary outcome was the change in utilization of synthetic mesh MUS before and after the July 2011 FDA communication. Secondary outcomes were the changes in surgeon level MUS utilization. RESULTS MUS procedures decreased from 131 to 116 per 100,000 adult women with a decrease of 11.5% from 2010 to 2012. Year over year utilization of MUS was rapidly increasing (p < 0.01) prior the FDA communication from 116 (in 2008) to 131 (in 2010) per 100,000 women and then significantly declined (p < 0.01) after its release from 135 (in 2011) to 75 (in 2016) per 100,000 women (13% increase vs 44% decrease). The number of surgeons performing MUS increased (p < 0.01) from 172/year to 186/year from 2008 to 2010 (Table 1). This decreased (p < 0.01) from 183/year to 121/year from 2011 to 2016. CONCLUSIONS MUS for SUI drastically declined after the FDA communication. Despite the 2011 FDA communication concerning only transvaginal mesh for pelvic organ prolapse, there was a significant decrease in MUS with synthetic mesh utilization. Our findings support the importance of continued long-term outcome data regarding the safety and efficacy of MUS and highlight the impact of the FDA warning on MUS utilization.
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Abstract
PURPOSE OF REVIEW After the Food and Drug Administration Public Health Notification in 2011 regarding transvaginal mesh, there has been a decline in the use of mid-urethral slings (MUS). However, they are an effective treatment option for stress urinary incontinence (SUI) with minimal complications. The management of recurrent SUI after sling continues to be debated. RECENT FINDINGS Long-term follow-up after primary MUS confirms its efficacy and safety. There remains no level 1 evidence for the best next step after a failed MUS. Preferred treatment strategies include placing a repeat MUS with more recent evidence demonstrating no difference in cure rates between transobturator tape and retropubic approach. Pubovaginal slings (PVS) and urethral bulking agents are also acceptable treatment options. A newer bulking agent, polyacrylamide hydrogel, demonstrated excellent short-term success rates in patients after a failed sling. SUMMARY MUS is an effective treatment option for SUI. Patients who develop recurrent urinary incontinence are a heterogeneous population who must be evaluated for detrusor overactivity, misplaced sling, unrecognized ISD. Patients with ISD are more likely to benefit by a PVS. Other patients with demonstrated recurrent SUI will likely do well with a repeat MUS.
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Siegal AR, Huang Z, Gross MD, Mehraban-Far S, Weissbart SJ, Kim JM. Trends of Mesh Utilization for Stress Urinary Incontinence Before and After the 2011 Food and Drug Administration Notification Between FPMRS-Certified and Non-FPMRS-Certified Physicians: A Statewide All-Payer Database Analysis. Urology 2020; 150:151-157. [PMID: 32663554 DOI: 10.1016/j.urology.2020.06.053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 06/22/2020] [Accepted: 06/28/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To investigate the utilization of mesh slings for stress urinary incontinence (SUI) across time - before and after the 2011 US Food and Drug Administration (FDA) public health notification regarding an increase in adverse events related to transvaginal mesh (TVM) for pelvic organ prolapse (POP) repair - and among FPMRS-certified urologists and gynecologists and non-FPMRS counterparts using a statewide database. METHODS The New York Statewide Planning and Research Cooperative System all-payer database was utilized to extract outpatient Current Procedural Terminology procedure codes for SUI mesh sling utilization and revision or removal performed between 2007 and 2015. RESULTS After the 2011 FDA warning on POP with TVM, sling placement decreased by 43% from 5214 cases in 2011 to 2958 in 2015. However, over the study period, the rate of sling revision remained stable relative to total sling placement. The rise and fall in mesh sling usage for SUI was primarily driven by non-FPMRS providers. FPMRS providers performed a higher proportion of sling procedures. The number of FPMRS physicians also increased from 2011 to 2015, and each individual physician had a higher median case volume for sling placements and revisions. CONCLUSION In New York state, utilization of mesh slings for SUI has significantly decreased since the 2011 FDA public health notification, without any specific warning for the utilization of mesh in this setting. This trend was mainly driven by a decrease in mesh usage among non-FPMRS physicians, although the specific causality is likely complex.
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Affiliation(s)
- Alexandra R Siegal
- Renaissance School of Medicine at Stony Brook University, Stony Brook, NY.
| | - Zhenyue Huang
- Department of Urology, Stony Brook University Medical Center, Stony Brook, NY
| | - Michael D Gross
- Renaissance School of Medicine at Stony Brook University, Stony Brook, NY
| | - Sina Mehraban-Far
- Renaissance School of Medicine at Stony Brook University, Stony Brook, NY
| | - Steven J Weissbart
- Department of Urology, Stony Brook University Medical Center, Stony Brook, NY
| | - Jason M Kim
- Department of Urology, Stony Brook University Medical Center, Stony Brook, NY
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Balancing the possibility of needing a future incontinence procedure versus a future urethral sling revision surgery: a tradeoff analysis for continent women undergoing pelvic organ prolapse surgery. Int Urogynecol J 2020; 31:1141-1150. [PMID: 32125489 DOI: 10.1007/s00192-020-04226-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 01/14/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Although urinary incontinence surgery has potential benefits such as preventing de novo stress urinary incontinence in women undergoing pelvic organ prolapse (POP) surgery, it comes with the potential cost of overtreatment and complications. We compared future surgery rates in a population cohort of women undergoing vaginal pelvic organ prolapse surgery. METHODS All women undergoing POP repair in California from 2005 to 2011 were identified from the Office of Statewide Health Planning and Development databases. Rates of repeat surgery in those with and without concomitant urethral sling procedures were compared. To control for confounding effects, multivariate mixed effects logistic regression models were constructed to compare each woman's individualized risk of undergoing either sling revision surgery or future incontinence surgery. RESULTS In the cohort, 38,456 underwent a sling procedure at the time of POP repair and 42,858 did not. The future surgery rate was higher for sling-related complications in the POP + sling cohort compared with future incontinence surgery in the POP alone cohort (3.5% versus 3.0% respectively, p < 0.001). The difference persisted in multivariate modeling, where most women (60%) are at a higher risk of requiring sling revision surgery compared with needing a future primary incontinence procedure (40%). CONCLUSIONS Women who undergo vaginal prolapse repair without an incontinence procedure are at a low risk of future incontinence surgery. Women without urinary incontinence who are considering vaginal POP surgery should be informed of the risks and benefits of including a sling procedure.
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Keslar M, Margossian H, Katz JE, Lakhi N. A comprehensive look at risk factors for mid-urethral sling revision surgery. Int Urogynecol J 2020; 31:779-784. [PMID: 32034459 DOI: 10.1007/s00192-020-04233-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Accepted: 01/20/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The objective of this study was to identify risk factors and urodynamic parameters predictive of mid-urethral sling (MUS) revision surgery that can be used for counseling patients and individualizing risk prediction. METHODS Retrospective case-control analysis of 40 sling revisions performed during the 12-year study period were compared to 123 control cases that did not require revision to obtain a 1:3 case-to-control ratio. Demographic, perioperative, and urodynamic data were analyzed, with p < 0.05 as significant. Independent predictors of sling revision were assessed by binary logistic regression models, with risk expressed as adjusted odds ratios. RESULTS After multiple regression analysis, younger age at time of index MUS placement (aOR 0.93, 95% CI 0.88-0.97), increasing number of cesarean deliveries (CD) (aOR 2.00, 95% CI 1.01-3.96), and concomitant apical prolapse repair during index MUS procedure (aOR 4.63, 95% CI 1.34-15.93) were significant predictors of sling revision. CONCLUSIONS Young age at the time of placement, multiple CD, and concomitant apical prolapse repair were independent factors predictive of sling revision. Giving consideration to risk factors could improve patient counseling and surgical candidate selection.
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Affiliation(s)
- Melissa Keslar
- Department of Obstetrics and Gynecology, Richmond University Medical Center, 355 Bard Avenue, Staten Island, NY, 10310, USA.
| | - Haroutyoun Margossian
- Department of Obstetrics and Gynecology, Richmond University Medical Center, 355 Bard Avenue, Staten Island, NY, 10310, USA
| | - Justin E Katz
- Department of Obstetrics and Gynecology, Richmond University Medical Center, 355 Bard Avenue, Staten Island, NY, 10310, USA
| | - Nisha Lakhi
- Department of Obstetrics and Gynecology, Richmond University Medical Center, 355 Bard Avenue, Staten Island, NY, 10310, USA.,New York Medical College, Valhalla, NY, USA
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17
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Making surgery safer through adequate communication with the stakeholders: vaginal slings. World J Urol 2019; 38:1351-1358. [PMID: 31273442 DOI: 10.1007/s00345-019-02859-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 06/24/2019] [Indexed: 10/26/2022] Open
Abstract
PURPOSE In this review, we explore the evidence behind mid-urethral sling (MUS) surgery, review the rising reports of complications and the subsequent US Food and Drug Administration (FDA) and society statements, and evaluate risk perception and communication with patients, doctors, governing bodies, manufacturers and insurance companies. Our aim was to explore the pitfalls in communication that may be contributing to the decline in MUS use, and develop strategies to make MUS surgery safer. METHODS We searched the English language literature using PubMed for articles related to the management of stress urinary incontinence (SUI), MUS, safety and monitoring of transvaginal mesh (TVM), and reviewed all online FDA publications and international position statements regarding MUS for SUI. RESULTS Polypropylene mesh has been used in MUS since the 1990s, with robust evidence to support its use. There has been a decline in the use of MUS ever since the FDA notifications. In response to the controversy surrounding TVM, position statements have been released portending the safety of, and advocating for the continued use of, MUS for the management of SUI. CONCLUSIONS MUS is a viable, effective and safe treatment for SUI management. Physicians should obtain and document informed consent, be adequately trained, and monitor and report their outcomes using registries. With publication of registry results and ongoing health advocacy, the perception of the safety of MUS can improve and MUS can still be offered as a treatment option for SUI.
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Palmerola R, Peyronnet B, Rebolos M, Khan A, Sussman RD, Escobar C, Smith S, Rosenblum N, Nitti VW. Trends in Stress Urinary Incontinence Surgery at a Tertiary Center: Midurethral Sling Use Following the AUGS/SUFU Position Statement. Urology 2019; 131:71-76. [PMID: 31229514 DOI: 10.1016/j.urology.2019.04.050] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 03/29/2019] [Accepted: 04/01/2019] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To investigate trends in stress urinary incontinence (SUI) surgery before and after the 2011 Foods and Drug Administration notification and the 2014 (American Urogynecologic Society [AUGS]/Society for Urodynamics Female Pelvic Medicine and Urogenital Reconstruction [SUFU]) position statement. METHODS A retrospective chart review was performed to identify patients presenting for evaluation of SUI by 2 Female Pelvic Medicine and Reconstructive Surgery specialists between June 1, 2010 and May 31, 2017. Rates of surgical treatment modality (synthetic midurethral slings [MUS] versus autologous fascial pubovaginal sling versus bulking agents) were analyzed at 6-month intervals. RESULTS Over fourteen 6-month intervals, the number of new patients presenting for evaluation of SUI increased consistently. There was a decrease in the proportion of new patients who underwent antiincontinence surgical procedures, specifically MUS, between December 2011 and December 2013. After the integration of the 2014 AUGS/SUFU position statement in patient counseling, this trend reverted and we noted a sustained increase in the proportion of patients electing surgical management. This paralleled an increase in new patient visits for SUI and MUS. The number autologous fascial pubovaginal sling remained stable throughout the study period. Conversely, MUS composed the highest proportion of procedures performed, accounting for 60 %-87.2% off all antiincontinence procedures. CONCLUSION After the Foods and Drug Administration Public Health Notification in 2011, we observed a decline in the number of new patients presenting with SUI electing surgical management, specifically MUS. However, after the AUGS/SUFU position statement publication and integration into counseling, we observed a reversal in the previous year's trends, noting a resurgence of MUS utilization.
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Affiliation(s)
- Ricardo Palmerola
- Departments of Urology and Obstetrics & Gynecology, New York University, New York, NY.
| | - Benoit Peyronnet
- Departments of Urology and Obstetrics & Gynecology, New York University, New York, NY
| | - Mark Rebolos
- Departments of Urology and Obstetrics & Gynecology, New York University, New York, NY
| | - Aqsa Khan
- Department of Urology, Mayo Clinic, Phoenix, AZ
| | - Rachael D Sussman
- Departments of Urology and Obstetrics & Gynecology, New York University, New York, NY
| | - Christina Escobar
- Departments of Urology and Obstetrics & Gynecology, New York University, New York, NY
| | | | - Nirit Rosenblum
- Departments of Urology and Obstetrics & Gynecology, New York University, New York, NY
| | - Victor W Nitti
- Departments of Urology and Obstetrics & Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA
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19
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20
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Can Urodynamic Parameters Predict Sling Revision for Voiding Dysfunction in Women Undergoing Synthetic Midurethral Sling Placement? Female Pelvic Med Reconstr Surg 2019; 25:63-66. [DOI: 10.1097/spv.0000000000000521] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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21
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Abstract
Urethral injection is a safe and minimally invasive method of treating female stress urinary incontinence with multiple bulking agents currently commercially available. Although there are numerous studies that demonstrate efficacy, long-term success is not yet proven. This article aims to describe the mechanism of action and properties of various agents, patient selection factors, available techniques for injection, outcomes of urethral injections, and complications associated with the procedure.
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Affiliation(s)
- Hanhan Li
- Department of Urology, MD Anderson Cancer Center, Unit 1373, 1515 Holcombe Boulevard, Houston, TX 77030, USA
| | - Ouida Lenaine Westney
- Urinary Tract and Pelvic Reconstruction, Department of Urology, MD Anderson Cancer Center, Unit 1373, 1515 Holcombe Boulevard, Houston, TX 77030, USA.
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22
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Limberger LF, Faria FP, Campos LS, Anzolch KMJ, Fornari A. Costs analysis of surgical treatment of stress urinary incontinence in a brazilian public hospital, comparing burch and synthetic sling techniques. Int Braz J Urol 2018; 44:109-113. [PMID: 29135411 PMCID: PMC5815540 DOI: 10.1590/s1677-5538.ibju.2017.0232] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Accepted: 08/07/2017] [Indexed: 11/23/2022] Open
Abstract
Introduction Surgical treatment of urinary incontinence progressed significantly with the introduction of synthetic slings. However, in some public Brazilian hospitals, the costs of these materials prevent their routine use. Objective To compare the costs of ambulatory synthetic sling surgery with an historical series of patients submitted to Burch surgery in a Brazilian public hospital. Materials and Methods Twenty nine incontinent patients were selected to synthetic sling surgery. Demographic data were prospectively collected and also the costs of the procedure, including drugs and materials, use of surgical and recovery wards, medical staff and hospitalization. These data were compared to the costs of 29 Burch surgeries performed before the introduction of synthetic slings. Results Demographic data were similar, although median age was lower in the group submitted to Burch surgery (46.3±8.6 versus 56.2±11.3 (p<0.001)). Cost was significantly lower in patients submitted to sling in all items, except for time spent in recovery ward. Total value of 29 Burch surgeries was R$ 217.766.12, and of R$ 68.049.92 of 29 patients submitted to sling surgery (p<0.001). Conclusion Burch surgery was more expensive than ambulatory synthetic transobturator sling surgery, even when the cost of the synthetic sling was considered.
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Affiliation(s)
| | | | | | | | - Alexandre Fornari
- Hospital Moinhos de Vento, Porto Alegre, RS, Brasil.,Ambulatório de Disfunções miccionais da Santa Casa de Porto Alegre, Porto Alegre, RS, Brasil
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23
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Road to recovery after transvaginal surgery for urethral mesh perforation: evaluation of outcomes and subsequent procedures. Int Urogynecol J 2018; 29:887-892. [PMID: 29379998 DOI: 10.1007/s00192-018-3563-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 01/10/2018] [Indexed: 10/18/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Urethral injury resulting from transvaginal mesh slings is a rare complication with an estimated incidence of <1%. Our objective was to review the surgical management and functional outcomes of women presenting with urethral mesh perforation following midurethral sling (MUS) placement. METHODS This was a retrospective multicenter review of women who from January 2011 to March 2016 at two institutions underwent mesh sling excision for urethral perforation with Female Pelvic Medicine and Reconstructive Surgery fellowship-trained surgeons. Data comprising preoperative symptoms, operative details, and postoperative outcomes were collected by telephone (n 13) or based on their last follow-up appointment. RESULTS OBTAINED Nineteen women underwent transvaginal sling excision for urethral mesh perforation. Eight (42%) patients had undergone previous sling revision surgery. Sixty percent of women had resolution of their pelvic pain postoperatively. At follow-up, 92% reported urinary incontinence (UI), and three had undergone five additional procedures for vaginal prolapse mesh exposure (n 1), incontinence (onabotulinum toxin injection n 1, rectus fascia autologous sling n 1), prolapse (colpopexy n 1), and pain (trigger-point injection n 1). Patient global impression of improvement data was available for 13 patients, of whom seven (54%) rated their postoperative condition as Very much better or Much better. CONCLUSIONS The management of urethral mesh perforation is complex. Most women reported resolution of their pelvic pain and a high rate of satisfaction with their postoperative condition despite high rates of incontinence.
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The Truth Behind Transvaginal Mesh Litigation: Devices, Timelines, and Provider Characteristics. Female Pelvic Med Reconstr Surg 2018; 24:21-25. [DOI: 10.1097/spv.0000000000000433] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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25
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Chang J, Lee D. Midurethral slings in the mesh litigation era. Transl Androl Urol 2017; 6:S68-S75. [PMID: 28791224 PMCID: PMC5522799 DOI: 10.21037/tau.2017.04.06] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2016] [Accepted: 03/26/2017] [Indexed: 01/04/2023] Open
Abstract
Stress urinary incontinence (SUI) has always been a major health issue for women. With the progression of technology and surgical techniques, mid urethral slings (MUS) used in both transvaginal and transobturator routes have become the gold standard in the treatment of SUI. There is ample short to mid-term data confirming the efficacy and safety in using MUS in treating SUI in women. However, long-term data supporting the use of MUS in women to treat SUI is scarce. There has been much controversy surrounding the US Food and Drug Administrations' (FDA) public notification of potential complications surrounding the use of transvaginal mesh, which has been magnified and generalised by the media; but despite this there has still been substantial growth and uptake of MUS for treating SUI. In this review, we aim to explore some of the issues with MUS, the factors around litigation with mesh use, the impact of FDA's notification on the uptake of MUS and ultimately, the results and efficacy of MUS for the treatment of SUI.
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Affiliation(s)
- John Chang
- Department of Urology, St George Hospital, Kogarah, Australia
| | - Dominic Lee
- Department of Urology, St George Hospital, Kogarah, Australia
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26
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Ramart P, Ackerman AL, Cohen SA, Kim JH, Raz S. The Risk of Recurrent Urinary Incontinence Requiring Surgery After Suburethral Sling Removal for Mesh Complications. Urology 2017; 106:203-209. [PMID: 28476681 DOI: 10.1016/j.urology.2017.01.060] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Revised: 01/23/2017] [Accepted: 01/27/2017] [Indexed: 11/16/2022]
Abstract
OBJECTIVE We sought to examine the risk of recurrent stress urinary incontinence (SUI) after suburethral sling mesh removal or excision. MATERIALS AND METHODS We conducted a retrospective cohort study of patients who were continent before removal or excision of synthetic midurethral slings; this cohort of 278 subjects was much larger than seen in previous such studies. Patients with preoperative incontinence, additional vaginal mesh placements, prior mesh revision/excision, existing SUI, and prior pelvic radiation or fistula were excluded. Only patients with follow-up detailing continence status within 1 year of mesh removal were examined. RESULTS Of 278 patients, 117 (70 retropubic and 47 transobturator) midurethral sling removals met inclusion criteria. Demographic data were comparable between groups. Presenting symptoms were also similar, with similar extrusion rates. Chronic pain was the reason for mesh removal in 80% of cases. In 1 year of follow-up, 38.6% (27/70) retropubic and 34.0% (16/47) transobturator sling removals had SUI requiring an anti-incontinence procedure. Total sling mesh removal was performed in 51.4% of retropubic vaginal mesh and 51.1% of transobturator mesh cases. CONCLUSION In this continent population with sling complications, approximately 1/3 developed significant SUI within 1 year of mesh removal requiring anti-incontinence surgery, regardless of the amount or type of mesh removed. Total mesh removal did not increase SUI risk.
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Affiliation(s)
- Patkawat Ramart
- Division of Urology, Department of Surgery, Siriraj Hospital, Mahidol University, Thailand
| | - A Lenore Ackerman
- Department of Surgery, Division of Urology, Cedars-Sinai Medical Center, Los Angeles, CA.
| | - Seth A Cohen
- Division of Urology and Urologic Oncology, Department of Surgery, City of Hope, Duarte, CA
| | - Ja-Hong Kim
- Division of Urology and Urologic Oncology, Department of Surgery, City of Hope, Duarte, CA
| | - Shlomo Raz
- Division of Urology and Urologic Oncology, Department of Surgery, City of Hope, Duarte, CA
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27
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Khan AA, Rosenblum N, Brucker B, Nitti V. Changes in management of stress urinary incontinence following the 2011 FDA Health Notification. JOURNAL OF CLINICAL UROLOGY 2017. [DOI: 10.1177/2051415817691662] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose: We sought to assess for impact on management trends in new patients presenting to our institution with stress urinary incontinence (SUI) following the release of the FDA Health Notification in July 2011 for vaginal mesh. Materials and methods: Chart analysis was performed on patients assigned a primary International Classification of Diseases (ICD-9) diagnosis code of 625.6 for SUI at initial consultation by two providers at our institution between June 1, 2010 and November 30, 2014. Rates of treatment and types of procedures performed were analyzed: urethral bulking, mesh sling, or pubovaginal sling. Results: A total of 333 new patients were identified with an increasing trend over time. One hundred and twenty-three patients underwent 153 procedures for stress incontinence. The mean proportion that had a procedure per six-month period was 37%, with decreasing proportions over time. Initially all procedures were midurethral mesh slings, with a decline at the time of and after the notification, and a temporary increase in bulking procedures. Subsequently, there was a rise again in sling placement, namely with an increase in pubovaginal slings. Of the 20 pubovaginal slings placed, 13 were placed in patients who had a prior anti-incontinence surgery (eight for sling failure, vaginal mesh, or fixed urethra, and two in patients with mesh extrusion/erosion). Seven were performed in patients who had never had prior surgery (two for very high-grade incontinence, two with urethral diverticulectomy, and three in patients who expressed concern about mesh). Conclusions: Although there were an increasing number of patients seen for management of SUI over time, there was a progressive decrease in the proportion of patients having anti-incontinence procedures after release of the FDA notification. There was an overall decrease in the use of mesh slings and an increase in bulking, and more notably, placement of pubovaginal slings.
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Affiliation(s)
- Aqsa A Khan
- Department of Urology, Mayo Clinic Arizona Phoenix, USA
| | - Nirit Rosenblum
- Division of Female Pelvic Medicine & Reconstructive Surgery, Department of Urology, New York University Langone Medical Center, USA
| | - Benjamin Brucker
- Division of Female Pelvic Medicine & Reconstructive Surgery, Department of Urology, New York University Langone Medical Center, USA
| | - Victor Nitti
- Division of Female Pelvic Medicine & Reconstructive Surgery, Department of Urology, New York University Langone Medical Center, USA
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28
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Slopnick EA, Hijaz AK, Nguyen CT, Abouassaly R, Gonzalez CM, Mahajan ST, Henderson JW, Bream MJ, Kim SP. National Surgical Trends and Perioperative Outcomes of Midurethral Sling Placement for Stress Urinary Incontinence. Urology 2016; 99:57-61. [PMID: 27669653 DOI: 10.1016/j.urology.2016.07.027] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Revised: 07/14/2016] [Accepted: 07/21/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To determine contemporary trends, patient characteristics, and outcomes for midurethral sling placement (MUS) at inpatient and ambulatory facilities from a national database. MATERIALS AND METHODS Using the American College of Surgeons National Surgical Quality Improvement Program database, we identified 7767 women who underwent isolated MUS 2006-2012. We stratified patients by hospitalization type (outpatient vs hospitalization). Primary outcomes were 30-day complications, readmissions, and reoperations. Multivariable logistic regression was used to determine patient and surgery factors associated with adverse perioperative outcomes. RESULTS Among the 7767 women undergoing MUS, 84.3% underwent outpatient surgery (n = 6547), with greater use of outpatient facilities over time (P < .001). Overall, 3.9% of patients (n = 300) experienced one or more postoperative complications. Complications were more likely among inpatients (7.4% vs 3.2%; odds ratio [OR] 0.48, confidence interval [CI] 0.36-0.64, P < .001), with gynecologists as compared to urologists (4.4% vs 3.1%; OR 1.53, CI 1.16-2.02, P = .003), and with resident participation (5.1% vs 3.7%; OR 1.32, CI 1.01-1.73, P = .04). On multivariable analysis, outpatients were less likely to experience readmissions (0.9% vs 2.8%; OR 0.2, CI 0.09-0.56, P = .002) or undergo reoperation (0.3% vs 3.1%; OR 0.10, CI 0.02-0.38, P = .001). CONCLUSION Use of outpatient surgical centers for MUS is increasing, with lower rates of complications, readmissions, and reoperations compared to inpatient treatment. Although there is a difference in complications by specialty and with resident involvement, overall incidence of complications is low.
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Affiliation(s)
| | - Adonis K Hijaz
- Urology Institute, University Hospitals Cleveland Medical Center, Cleveland, OH
| | | | - Robert Abouassaly
- Urology Institute, University Hospitals Cleveland Medical Center, Cleveland, OH
| | | | - Sangeeta T Mahajan
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of OB/GYN, University Hospitals Cleveland Medical Center, Cleveland, OH
| | - J Welles Henderson
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of OB/GYN, University Hospitals Cleveland Medical Center, Cleveland, OH
| | - Matthew J Bream
- Urology Institute, University Hospitals Cleveland Medical Center, Cleveland, OH
| | - Simon P Kim
- Urology Institute, University Hospitals Cleveland Medical Center, Cleveland, OH.
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29
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Rac G, Younger A, Clemens JQ, Kobashi K, Khan A, Nitti V, Jacobs I, Lemack GE, Brown ET, Dmochowski R, MacLachlan L, Mourtzinos A, Ginsberg D, Koski M, Rames R, Rovner ES. Stress urinary incontinence surgery trends in academic female pelvic medicine and reconstructive surgery urology practice in the setting of the food and drug administration public health notifications. Neurourol Urodyn 2016; 36:1155-1160. [PMID: 27460448 DOI: 10.1002/nau.23080] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 07/05/2016] [Indexed: 11/10/2022]
Affiliation(s)
- Goran Rac
- Department of Urology; Medical University of South Carolina; Charleston South Carolina
| | - Austin Younger
- Department of Urology; Medical University of South Carolina; Charleston South Carolina
| | - James Q. Clemens
- Department of Urology; University of Michigan Health Science Center; Ann Arbor Michigan
| | - Kathleen Kobashi
- Section of Urology and Renal Transplantation; Virginia Mason Medical Center; Seattle Washington
| | - Aqsa Khan
- Department of Urology; New York University Langone Medical Center; New York New York
| | - Victor Nitti
- Department of Urology; New York University Langone Medical Center; New York New York
| | - Ilana Jacobs
- Department of Urology; University of Texas Southwestern Medical Center; Dallas Texas
| | - Gary E. Lemack
- Department of Urology; University of Texas Southwestern Medical Center; Dallas Texas
| | - Elizabeth T. Brown
- Department of Urologic Surgery; Vanderbilt University Medical Center; Nashville Tennessee
| | - Roger Dmochowski
- Department of Urologic Surgery; Vanderbilt University Medical Center; Nashville Tennessee
| | - Lara MacLachlan
- Institute of Urology; Lahey Hospital and Medical Center; Burlington Massachusetts
| | - Arthur Mourtzinos
- Institute of Urology; Lahey Hospital and Medical Center; Burlington Massachusetts
| | - David Ginsberg
- Institute of Urology; Keck Medicine of University of Southern California; Los Angeles California
| | - Michelle Koski
- Urology of Kaiser Permanente Medical Center; San Diego California
| | - Ross Rames
- Department of Urology; Medical University of South Carolina; Charleston South Carolina
| | - Eric S. Rovner
- Department of Urology; Medical University of South Carolina; Charleston South Carolina
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Autologous Transobturator Urethral Sling Placement for Female Stress Urinary Incontinence: Short-term Outcomes. Urology 2016; 93:55-9. [DOI: 10.1016/j.urology.2016.03.025] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Revised: 03/09/2016] [Accepted: 03/17/2016] [Indexed: 11/20/2022]
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31
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Evaluation of the local carcinogenic potential of mesh used in the treatment of female stress urinary incontinence. Int Urogynecol J 2016; 27:1333-6. [DOI: 10.1007/s00192-016-2961-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 01/18/2016] [Indexed: 11/26/2022]
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32
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Surgery for stress urinary incontinence in Finland 1987–2009. Int Urogynecol J 2015; 27:1021-7. [DOI: 10.1007/s00192-015-2926-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Accepted: 12/02/2015] [Indexed: 11/26/2022]
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[Evolution of surgical activity related to the female stress urinary incontinence (SUI) with regard to the ageing of the French female population]. Prog Urol 2015; 25:396-403. [PMID: 25934592 DOI: 10.1016/j.purol.2015.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Revised: 02/06/2015] [Accepted: 03/14/2015] [Indexed: 11/22/2022]
Abstract
INTRODUCTION AND OBJECTIVE One of the main factors associated with urinary incontinence of women is aging. The total female French population seems to grow for 10 years, with more and more women over 60 years. The authors wanted to assess the evolution of the surgical activity related to the treatment of the urinary incontinence with regard to the aging of the female French population. MATERIALS AND METHODS The number of surgical procedures for the treatment of stress urinary incontinence was obtained by querying the database of the Agence Technique de l'Information sur l'Hospitalisation (ATIH) for the period 2002-2013. The Catalogue Des Actes Médicaux (CDAM) and the Classification Commune des Actes Médicaux (CCAM) were used to extract the codes relating to surgery of the female urinary incontinence during this period. Demographics data were obtained from the website of the National Institute of Demographic studies (INED). The results were then compared. RESULTS On the 2002-2010 period, the total female French population increased by 5%. In the class of age over 60 years, it increased by 12.7%. Support-related surgical activity continued to decrease until 2013 with 17.3% interventions less than in 2002. CONCLUSION The evolution of surgical activity does not seem to follow the evolution of the ageing of the population, even if age is a risk factor essential for the female urinary incontinence. The improvement of risk factors (gynecological, obstetrical), over the past decade, could explain this evolution. LEVEL OF EVIDENCE 3.
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Gibson W, Wagg A. Are older women more likely to receive surgical treatment for stress urinary incontinence since the introduction of the mid-urethral sling? An examination of Hospital Episode Statistics data. BJOG 2015; 123:1386-92. [DOI: 10.1111/1471-0528.13338] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2014] [Indexed: 11/27/2022]
Affiliation(s)
- W Gibson
- Division of Geriatric Medicine; University of Alberta; Edmonton AB Canada
| | - A Wagg
- Division of Geriatric Medicine; University of Alberta; Edmonton AB Canada
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Perkins CE, Warrior K, Eilber KS, McClelland L, Anger JT. The Role of Mid-urethral Slings in 2014: Analysis of the Impact of Litigation on Practice. CURRENT BLADDER DYSFUNCTION REPORTS 2015. [DOI: 10.1007/s11884-014-0278-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Thubert T, Daher N, Mansoor A, Debodinance P, Fernandez H, Deffieux X. Outcomes associated with the use of midurethral slings for stress incontinence surgery according to the type of hospitalization. Int J Gynaecol Obstet 2015; 129:123-7. [DOI: 10.1016/j.ijgo.2014.11.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2014] [Revised: 11/11/2014] [Accepted: 01/20/2015] [Indexed: 10/24/2022]
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Linder BJ, Elliott DS. Autologous transobturator urethral sling placement for female stress urinary incontinence. J Urol 2014; 193:991-6. [PMID: 25444955 DOI: 10.1016/j.juro.2014.08.125] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2014] [Indexed: 11/30/2022]
Abstract
PURPOSE We describe and evaluate a transobturator approach to urethral sling placement using autologous rectus fascia for the management of female stress urinary incontinence. MATERIALS AND METHODS We performed a feasibility study of 10 cases of autologous transobturator mid urethral sling placement for stress urinary incontinence. The procedure includes an anterior vaginal dissection performed in the standard fashion for a mid urethral sling and harvest of a strip of rectus fascia. A trocar is passed through each obturator foramen and the fascial stay sutures are retracted through the skin incisions. The sling is appropriately tensioned and the stay sutures are tied. Patient outcomes were measured by a 24-hour pad weight test and ICIQ-FLUTS score. RESULTS Median patient age was 57 years (IQR 48, 69.5) and median body mass index was 30.3 kg/m(2) (IQR 25.2, 32.4). Median followup was 4 months (range 3 to 5). All patients demonstrated a reduction in leakage with 80% being completely dry (0 gm on 24-hour pad test and not wearing pads). Overall there was significant improvement in postoperative vs preoperative 24-hour pad weight (p=0.02). Likewise, all subscores of the ICIQ-FLUTS were significantly improved after surgery, including frequency (p=0.006), voiding (p=0.04) and incontinence (p=0.002). Of the 9 eligible cases 6 (67%) were performed on an outpatient basis. One patient performed intermittent self-catheterization for 24 hours after sling placement. No patients experienced severe (Clavien III-V) postoperative complications or required urethrolysis. CONCLUSIONS Autologous transobturator urethral sling placement appears to be technically feasible with excellent short-term outcomes. Longer followup and larger series are needed for validation.
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Affiliation(s)
- Brian J Linder
- Department of Urology, Mayo Clinic, Rochester, Minnesota
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Raman SV, Raker CA, Sung VW. Concomitant apical prolapse repair and incontinence procedures: trends from 2001-2009 in the United States. Am J Obstet Gynecol 2014; 211:222.e1-5. [PMID: 24713239 DOI: 10.1016/j.ajog.2014.04.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2013] [Revised: 03/13/2014] [Accepted: 04/03/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Recent evidence supports improved outcomes in women who undergo an incontinence procedure at the time of apical prolapse repair compared with apical repair alone. Our primary objective was to describe national trends in concomitant apical repair and incontinence procedures that were performed in the United States from 2001-2009. A secondary objective was to describe complications and length of stay. STUDY DESIGN We used the Nationwide Inpatient Sample to collect data on hospital discharges for women who had inpatient apical prolapse surgery from 2001-2009. We included women whose records included the International Classification of Disease-9 Clinical Modification procedure codes for apical procedures with and without incontinence procedures. We examined annual trends in the proportion of concomitant procedures using chi-square testing and multiple logistic regression. RESULTS Of all apical procedures, the percentage of concomitant incontinence procedures performed increased from 37.9% in 2001 to 47% in 2009 (P = .0002 for trend). In-hospital complications (hemorrhage, bowel obstruction, and/or abscess) were less common with concomitant procedures (6.8% vs 11.7%; P = .02). All geographic regions had increasing trends of concomitant incontinence procedures with no difference among regions (P = .7 for interaction). Both community and academic institutions had increasing trends of concomitant procedures over the study period, with no difference among the types of institutions. Age was not associated with increasing trends in concomitant procedures. CONCLUSION The proportion of concomitant apical and incontinence procedures increased in the United States from 2001-2009. Length of stay was slightly longer for the concomitant group, but complications were not increased.
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Wu CJ, Tong YC, Hsiao SM, Liang CC, Liang SJ, Weng SF, Wu MP. The surgical trends and time-frame comparison of primary surgery for stress urinary incontinence, 2006-2010 vs 1997-2005: a population-based nation-wide follow-up descriptive study. Int Urogynecol J 2014; 25:1683-91. [PMID: 24973098 DOI: 10.1007/s00192-014-2443-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Accepted: 05/13/2014] [Indexed: 10/25/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The purpose of our study was to describe the surgical trends for female stress urinary incontinence (SUI) during 2006-2010, and a time-frame comparison with 1997-2005, based upon the National Health Insurance (NHI) claims data in Taiwan. METHODS Women who underwent various primary surgeries for SUI during 2006-2010 were identified, with a total of 15,099 inpatients. The variables included surgical types, patient age, surgeon age and gender, specialty, and hospital accreditation levels. Chi-squared tests and SAS version 9.3.1 were used for statistical analysis. RESULTS During the follow-up study, midurethral sling (MUS) application increased significantly from 53.09 % in 2006 to 78.74 % in 2010. It was associated concomitantly with a decrease in retropubic urethropexy (RPU) from 29.68 % to 12.99 %, and pubovaginal sling treatment (PVS) from 9.33 % to 3.46 %. MUS was most commonly used among all patients' and surgeons' age groups, and different accreditation hospital levels. MUS was more commonly used by gynecologists (71.38 %) than urologists (57.91 %); while PVS and periurethral injection were more commonly performed by urologists than gynecologists. Similar surgical trends were found during time-frame comparison, 2006-2010 vs 1997-2005. SUI surgeries increased in patients aged ≥60, surgeons aged ≥ 50, and in regional hospitals. CONCLUSION This follow-up study depicts the increase in popularity of MUS and offers evidence of surgical trends and a paradigm shift for female SUI surgery. More older women were willing to seek healthcare and undergo surgery. The surgical skills and knowledge spread from medical centers into regional hospitals. The time-frame shift may have a profound impact on patients, as well as the healthcare providers.
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Affiliation(s)
- Chia-Jen Wu
- Department of Obstetrics and Gynecology, Chi Mei Medical Center, Liouying, Tainan, Taiwan
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Hou JC, Alhalabi F, Lemack GE, Zimmern PE. Outcome of transvaginal mesh and tape removed for pain only. J Urol 2014; 192:856-60. [PMID: 24735934 DOI: 10.1016/j.juro.2014.04.006] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2014] [Indexed: 01/19/2023]
Abstract
PURPOSE Because there is reluctance to operate for pain, we evaluated midterm outcomes of vaginal mesh and synthetic suburethral tape removed for pain as the only indication. MATERIALS AND METHODS After receiving institutional review board approval we reviewed a prospective database of women without a neurogenic condition who underwent surgery for vaginal mesh or suburethral tape removal with a focus on pain as the single reason for removal and a minimum 6-month followup. The primary outcome was pain level assessed by a visual analog scale (range 0 to 10) at baseline and at each subsequent visit with the score at the last visit used for analysis. Parameters evaluated included demographics, mean time to presentation and type of mesh or tape inserted. RESULTS From 2005 to 2013, 123 patients underwent surgical removal of mesh (69) and suburethral tape (54) with pain as the only indication. Mean followup was 35 months (range 6 to 59) in the tape group and 22 months (range 6 to 47) in the mesh group. The visual analog scale score decreased from a mean preoperative level of 7.9 to 0.9 postoperatively (p = 0.0014) in the mesh group and from 5.3 to 1.5 (p = 0.00074) in the tape group. Pain-free status, considered a score of 0, was achieved in 81% of tape and 67% of mesh cases, respectively. No statistically significant difference was found between the groups. CONCLUSIONS When pain is the only indication for suburethral tape or vaginal mesh removal, a significant decrease in the pain score can be durably expected after removal in most patients at midterm followup.
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Affiliation(s)
- Jack C Hou
- Department of Urology, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas
| | - Feras Alhalabi
- Department of Urology, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas
| | - Gary E Lemack
- Department of Urology, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas
| | - Philippe E Zimmern
- Department of Urology, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas.
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Osborn DJ, Dmochowksi R. Safety of synthetic mesh in pelvic surgery. World J Clin Urol 2013; 2:15-19. [DOI: 10.5410/wjcu.v2.i3.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2013] [Revised: 09/13/2013] [Accepted: 10/16/2013] [Indexed: 02/06/2023] Open
Abstract
Mesh in the form of a midurethral sling is an acceptable and generally safe treatment option for stress urinary incontinence in patients who have failed conservative treatment options such as weight loss and pelvic floor muscle training. In patients with pelvic organ prolapse, when outcomes are measured in terms of improvement in postoperative physical exam (anatomic success), many studies have demonstrated that mesh augmented repairs are superior to prolapse repairs not using mesh (native tissue). However, from a symptomatic standpoint, the outcomes of mesh and native tissue repairs are equivalent. This means that even though the physician may see more prolapse on physical exam after native tissue repair, most patients do not perceive this as a problem because their sensation of a vaginal bulge is gone. The vaginal bulge is one of the most common complaints of a patient prior to pelvic organ prolapse repair. Based on interpretation of the available literature, it does not appear that mesh is superior to native tissue repair for anterior (cystocele) and posterior (rectocele) compartment pelvic organ prolapse repair. However, for apical repairs the native tissue repairs are more technically challenging and it appears that suspension of the apex of the vagina with mesh to the sacrum (sacrocolpopexy) may yield better outcomes. Unfortunately, like all mesh surgeries there is a significant risk of mesh complications with sacrocolpopexy. Surgeons should thoroughly counsel their patients about the permanent nature of synthetic mesh and the potential serious complications related to its use. Mesh augmented pelvic organ prolapse repairs carry unique complications that are not present with native tissue repairs and may not provide better outcomes.
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