["Do uro-gynecology multidisciplinary team meeting modify therapeutic management?"]

INTRODUCTION

Since the banning of trans-vaginal meshes for pelvic organ prolapse treatment by the FDA in 2019, French authorities have been gradually regulating the use of prosthetic materials in urogynecology. The decision to fit a mid-urethral sling or a reinforcement implant for the cure of prolapse, as well as the management of complex genital prolapse and serious post-implant complications, must be the subject of multidisciplinary consultation and a shared medical decision. To comply with these regulations, multidisciplinary team meetings (MDTMs) have been set up. The aim of the study was to evaluate the impact of these meetings on patient management.

MATERIAL

We carried out a retrospective study in a tertiary hospital in France on all cases presented in MDTM of urogynecology over the year 2022. MDTMs were held weekly, with a "Prosthesis MDTM" focusing on slings, sacrocolpo/hysteropexies and prosthetic complications, lead by the urology team, and a "Prolapse MDTM" focusing on pelvic organ prolapse and complex prolapses, lead by the gynecology team. We compared the initial proposal of the patient's referring physician versus the final proposal of the MDTM.

RESULTS

Three hundred and seventy-five cases were presented in our center in 2022: 188 in Prosthetic MDTM and 187 in Prolapse MDTM. The Prosthetic and Static MDTMs agreed with the initial proposal in 83 and 64% of cases respectively, while the therapeutic strategy was questioned in 12 and 36% of cases respectively.

CONCLUSION

For almost a quarter (24%) of patients, the MDTM of urogynecology opted for a different management from that proposed by the referring physician. The presentation of cases to the MDTM is a legal obligation in specific indications. It also plays an educational role, enabling shared decision-making and responsibility, which is an asset in functional surgery.

LEVEL OF EVIDENCE: 4

[Miduretral sling and sexuality: a systematic review]

PURPOSE

To assess influence of miduretral sling (MUS) on patient's sexuality.

METHODS

A comprehensive literature review using Pubmed, Medline, Embase and Cochrane: "stress urinary incontinence", "sexual function", "anti-incontinence surgery", "minimaly invasive slings", "mid-urethral slings", "tension-free vaginal tape", "transobturator vaginal tape". Sixty-nine articles really dealt with the impact of MUS on sexuality.

RESULTS

The data were expressed as the median and interquartile range (IQR; 25th-75th percentile). After MUS surgery, 30% (21-37) patients had sexuality improvement, 8.5% (4.7-14) had sexuality impairment and 60% (53-73) didn't report change on their sexuality.

CONCLUSION

MUS surgery didn't seem to impair significantly patient's sexuality.