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Chou TF, Hsia YF, Hwang TL, Lin WC, Chen DTL, Huang CF, Kuo CC, Chen HY, Chiang HY. Risk factors for 5-year complications after midurethral sling surgery for stress urinary incontinence: a retrospective cohort study from Taiwan. Sci Rep 2023; 13:21431. [PMID: 38052921 PMCID: PMC10697946 DOI: 10.1038/s41598-023-48558-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 11/28/2023] [Indexed: 12/07/2023] Open
Abstract
Midurethral sling surgery is the current gold standard worldwide for stress urinary incontinence (SUI) surgery, with over 90% of surgeons worldwide using the midurethral sling for SUI between 2008 and 2018. However, concerns surround mesh-related adverse events associated with the midurethral sling. The decision to use the midurethral sling for surgical treatment has become a challenging one for clinicians, surgeons and patients. We sought to determine the factors for 5-year complications after midurethral sling surgery, to improve the clinical decision-making process. Records were reviewed from a total of 1961 female patients who underwent their first midurethral sling surgery for SUI between 2003 and 2018 at a single teaching hospital in Taiwan. A multivariable Cox proportional hazard model calculated the hazard ratios of risk factors for surgical complications, after adjusting for confounders. Surgical complications (i.e., secondary surgery and urinary retention) occurred in 93 (4.7%) patients within 5 years following the index operations. These patients were more likely to be older, to have a history of menopausal syndrome within 1 year prior to the index operation, a medication history of oral antidiabetic drug use, hormone replacement therapy (HRT), slower average flow rate, and longer voiding time compared with patients without surgical complications. In the multivariate analysis, HRT (adjusted hazard ratio, 1.787; 95% confidence interval, 1.011-3.158, p = 0.04) was significantly associated with surgical complications at 5 years, after adjusting for age, gender, diabetes, menopause syndrome, average flow rate, and sling type. Our findings suggest that a medication history of HRT may be a risk factor associated with surgical complications, especially urinary retention, at 5 years in women undergoing midurethral sling surgery for SUI.
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Affiliation(s)
- Tai-Fu Chou
- Department of Obstetrics and Gynecology, China Medical University Hospital, Taichung, 40447, Taiwan
| | - Ying-Fang Hsia
- Big Data Center, China Medical University Hospital, Taichung, 40447, Taiwan
| | - Tseh-Lee Hwang
- Department of Obstetrics and Gynecology, China Medical University Hospital, Taichung, 40447, Taiwan
| | - Wu-Chou Lin
- Department of Obstetrics and Gynecology, China Medical University Hospital, Taichung, 40447, Taiwan
| | - Daniel Tzu-Li Chen
- School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan
- Graduate Institute of Biomedicine, College of Medicine, China Medical University, Taichung, Taiwan
- Department of Psychiatry and Mind-Body Interface Laboratory, China Medical University Hospital, Taichung, Taiwan
| | - Chien-Fong Huang
- Big Data Center, China Medical University Hospital, Taichung, 40447, Taiwan
| | - Chin-Chi Kuo
- Big Data Center, China Medical University Hospital, Taichung, 40447, Taiwan
- Kidney Institute, China Medical University Hospital, Taichung, Taiwan
- Department of Medical Research, China Medical University Hospital, Taichung, Taiwan
| | - Huey-Yi Chen
- Department of Obstetrics and Gynecology, China Medical University Hospital, Taichung, 40447, Taiwan.
| | - Hsiu-Yin Chiang
- Big Data Center, China Medical University Hospital, Taichung, 40447, Taiwan.
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Lo TS, Tan YL. Towards conservative treatment for stress urinary incontinence and pelvic organ prolapse: An Asian perspective footnote from the Pan-Asia meeting. Int Urogynecol J 2022. [PMID: 35947189 DOI: 10.1007/s00192-022-05323-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/29/2022] [Indexed: 10/15/2022]
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Abrar S, Razzak L, Mohsin R. The practice of Burch Colposuspension versus Mid Urethral Slings for the treatment of Stress Urinary Incontinence in developing country. Pak J Med Sci 2021; 37:1359-1364. [PMID: 34475912 PMCID: PMC8377912 DOI: 10.12669/pjms.37.5.4017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 04/24/2021] [Accepted: 05/02/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES To compare the effectiveness and complications of Burch colposuspension and Mid Urethral Slings (MUS) for the treatment of Stress Urinary Incontinence (SUI). METHODS We conducted a cross-sectional study of 162 patients who underwent surgery for SUI with Burch colposuspension (n=40), tension free vaginal tape (TVT) (n= 59) or transobturator tape (TOT) (n=63), from 2006 to 2014 at the Aga Khan University Hospital- Karachi. All three groups were assessed in terms of demographics, cure rates, intraoperative and postoperative complications at one and five years using incontinence impact questionnaire-short form-7 (IIQ-7) and urogenital distress inventory -short form-6 (UDI-6). RESULTS Mean age of the participants in Burch, TVT and TOT group was 44.1 ± 7.4, 48.3 ± 8.9, 53.0 ± 9.4 respectively. Majority of patients in TVT group were premenopausal (59.3%) and postmenopausal in TOT group (53.9%). Most abdominal hysterectomies were done in Burch group (40) while vaginal hysterectomies and anterior and posterior colporrhaphy in TOT group (55). All the procedures had both subjective and objective cure rate of more than 82% at one year, with TVT having the highest success rate of 96.61%. The objective cure rate in Burch, TVT and TOT group at five years was 74.19%, 90.30% and 81.25% respectively. Intraoperative complications included hemorrhage in one patient during Burch procedure and bladder perforation in two cases of TVT, with no significant difference in short or long-term complications with either procedure. CONCLUSIONS All the three procedures have equal efficacy and complication rates. Even though TVT is the new gold standard but in view of current debate regarding mesh related complications, there is a need to readdress Burch colposuspension for treatment of SUI.
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Affiliation(s)
- Saida Abrar
- Dr. Saida Abrar Clinical Fellow Urogynecology and Pelvic Reconstructive Surgery, Department of OBGYN, Aga Khan University Hospital Karachi, Karachi, Pakistan
| | - Lubna Razzak
- Dr. Lubna Razzak Clinical Fellow Urogynecology and Pelvic Reconstructive Surgery, Department of OBGYN, Aga Khan University Hospital Karachi, Karachi, Pakistan
| | - Raheela Mohsin
- Dr. Raheela Mohsin Rizvi Associate Professor Urogynecology, Department of OBGYN, Aga Khan University Hospital Karachi, Karachi, Pakistan
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