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Farag F, Osman NI, Pang KH, Castro-Diaz D, Chapple CR, Cruz F, Gamé X, Goldman H, Greenwell T, Hampel C, Scailteux LM, Roovers JP, Welk B, Heesakkers J. Complications of Synthetic Midurethral Slings: Is There a Relevant Discrepancy Between Observational Data and Clinical Trials? Eur Urol Focus 2023:S2405-4569(23)00244-4. [PMID: 37973453 DOI: 10.1016/j.euf.2023.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 09/24/2023] [Accepted: 11/03/2023] [Indexed: 11/19/2023]
Abstract
CONTEXT The complications of synthetic midurethral slings (MUSs) in women with stress urinary incontinence (SUI) have become a globally debated issue. OBJECTIVE To systematically review the short- and long-term complications of mesh slings reported in observational data compared with clinical trial data, to determine whether the complication rates from clinical trials reflects "real-world" observational data. EVIDENCE ACQUISITION PubMed and Cochrane Library were searched. Methods as detailed in Preferred Reporting Items for Systematic Reviews and Meta-analyses and Cochrane Handbook for Systematic Reviews of Interventions were followed. EVIDENCE SYNTHESIS Thirty registries/databases including 709 335 MUS procedures (1-22 yr of follow-up) were identified. MUS procedures were associated with intraoperative bladder perforation in 0.86-3.6%, urethral perforation in 0-0.1%, vascular injury in 0.04-0.1%, voiding lower urinary tract symptoms (LUTS) in 1.47-3.5%, vaginal exposure in 0.2-1.9%, and reoperation in up to 9% of cases. Forty-three randomised clinical trials were identified, including 6284 women who underwent MUS procedures and 2177 women who underwent other interventions (1-10 yr of follow-up). MUS procedures were associated with urinary tract perforation in 2.58%, vaginal injury in 1.43%, de novo voiding LUTS in 4.37%, de novo storage LUTS in 5.41%, mesh extrusion/exposure (vaginal/urinary tract) in 2.54%, dyspareunia in 2.26%, pain (pelvic/suprapubic/perineal) in 2.83%, and reoperation for complications required in 1.82% of cases. Meta-analyses of the randomised controlled trials revealed that retropubic MUSs were associated with more events of urinary tract perforation (risk ratio [RR] 9.81, 95% confidence interval [CI] 5.05-19.04, high certainty of evidence [COE]) and voiding LUTS (RR 1.57, 95% CI 1.19-2.07, high COE) than transobturator MUSs. MUSs were associated with more events of pain than mini-slings (RR 1.72, 95% CI 1.04-2.87, moderate COE). CONCLUSIONS Short- and long-term data on complications of polypropylene mesh used for female SUI are fairly comparable when using outcome data from well-designed clinical trials or from less structured prospective or retrospective registries. Comparisons have to be made with caution since the two systems of data collection are inherently incomparable. This knowledge should be incorporated in the discussion on how to implement polypropylene mesh for female stress incontinence. PATIENT SUMMARY In order to know whether mesh tapes used for treating stress incontinence work well and are safe, high-quality information is important. It appears that well-designed clinical studies give similar results to large registration databases. These data should be interpreted with caution in view of the different ways the information was collected. These results will help physicians and patients understand the risks of mesh tapes.
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Affiliation(s)
| | - N I Osman
- Royal Hallamshire Hospital, Sheffield, UK
| | - K H Pang
- Royal Hallamshire Hospital, Sheffield, UK
| | - D Castro-Diaz
- Hospital Universitario de Canarias/Universidad de La Laguna, La Laguna, Spain
| | - C R Chapple
- Sheffield Teaching Hospitals NHS Foundation Trust, University of Sheffield, Sheffield, UK
| | - F Cruz
- Faculty of Medicine of University of Porto, i3S institute and Hospital São João, Porto, Portugal
| | - X Gamé
- Département d'Urologie, Transplantation Rénale et Andrologie, CHU Rangueil, Toulouse, France
| | - H Goldman
- Glickman Urologic and Kidney Institute, Cleveland Clinic, Lerner College of Medicine, Cleveland, OH, USA
| | - T Greenwell
- University College London Hospitals, London, UK
| | - C Hampel
- Urologische Abteilung, Marien-Hospital Erwitte, Erwitte, Germany; Neuro-Urologie/Urologie Universitätsklinikum Bonn und Neuro-Urologie, Neurologisches Rehabilitationszentrum der Godeshöhe e. V., Bonn, Germany
| | - L M Scailteux
- Pharmacovigilance, Pharmacoepidemiology and Drug Information Centre, Department of Clinical Pharmacology, Rennes University Hospital, Rennes, France
| | - J P Roovers
- Department of Obstetrics and Gynaecology, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - B Welk
- Division of Urology, Department of Surgery, Western University, London, Ontario, Canada
| | - J Heesakkers
- Maastricht University Medical Center, Maastricht, The Netherlands
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Kowalski JT, Barber MD, Klerkx WM, Grzybowska ME, Toozs-Hobson P, Rogers RG, Milani AL. International urogynecological consultation chapter 4.1: definition of outcomes for pelvic organ prolapse surgery. Int Urogynecol J 2023; 34:2689-2699. [PMID: 37819369 DOI: 10.1007/s00192-023-05660-9] [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: 08/10/2023] [Accepted: 09/17/2023] [Indexed: 10/13/2023]
Abstract
INTRODUCTION AND HYPOTHESIS This manuscript of Chapter 4 of the International Urogynecological Consultation (IUC) on Pelvic Organ Prolapse (POP) reviews the literature and makes recommendations on the definition of success in the surgical treatment of pelvic organ prolapse. METHODS An international group containing seven urogynecologists performed an exhaustive search of the literature using two PubMed searches and using PICO methodology. The first search was from 01/01/2012-06/12/2022. A second search from inception to 7/24/2022 was done to access older references. Publications were eliminated if not relevant to the clinical definition of surgical success for the treatment of POP. All abstracts were reviewed for inclusion and any disagreements were adjudicated by majority consensus of the writing group. The resulting list of articles were used to inform a comprehensive review and creation of the definition of success in the surgical treatment of POP. OUTCOMES The original search yielded 12,161 references of which 45 were used by the writing group. Ultimately, 68 references are included in the manuscript. For research purposes, surgical success should be primarily defined by the absence of bothersome patient bulge symptoms or retreatment for POP and a time frame of at least 12 months follow-up should be used. Secondary outcomes, including anatomic measures of POP and related pelvic floor symptoms, should not contribute to a definition of success or failure. For clinical practice, surgical success should primarily be defined as the absence of bothersome patient bulge symptoms. Surgeons may consider using PASS (patient acceptable symptom state) or patient goal attainment assessments, and patients should be followed for a minimum of at least one encounter at 6-12 weeks post-operatively. For surgeries involving mesh longer-term follow-up is recommended.
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Affiliation(s)
- Joseph T Kowalski
- Department of Obstetrics and Gynecology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA.
| | - Matthew D Barber
- Department of Ob/Gyn, Duke University Medical Center, Durham, NC, USA
| | | | - Magdalena E Grzybowska
- Department of Gynecology, Obstetrics and Neonatology, Medical University of Gdańsk, Smoluchowskiego 17, 80-214, Gdańsk, Poland
| | | | | | - Alfredo L Milani
- Department of Obstetrics & Gynecology, Reinier de Graaf Hospital, 2625 AD, Delft, the Netherlands
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Zilberlicht A, Karmakar D, Dwyer PL, Chan G, Schierlitz L. Counseling for stress urinary incontinence in the era of adverse publicity around mesh usage: Results from a large-sample global survey. Int J Gynaecol Obstet 2023; 160:579-587. [PMID: 35986609 DOI: 10.1002/ijgo.14418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 08/06/2022] [Accepted: 08/10/2022] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To investigate doctors' opinions of the use of synthetic mesh for the treatment of stress urinary incontinence (SUI) and the effect on patient's attitude following recent adverse publicity and legal findings. METHODS Electronic survey approved by International Urogynecological Association (IUGA) and American Urogynecologic Society (AUGS), distributed to their members. RESULTS A total of 593 respondents completed the survey. The preferred initial surgical treatment for SUI was retropubic midurethral sling (MUS) (62%), followed by trans-obturator MUS (19%), mini-slings (10%), and then bulking agents (5%). Despite prolongation of consultation, most respondents (87%) believed that clinicians should provide a patient information leaflet (PIL) for their patients. However, only 70% of respondents were doing this. Most participants would use either the IUGA PIL or their institution PIL (61%). Only 8% felt that patients have a positive preconception of synthetic mesh for SUI. Eighty-three per cent of respondents had not changed their recommendations for treatment and the consent process. A logistic regression model identified preferences of certain geographic areas as predictors of consenting practices. CONCLUSION Despite the negative publicity and the current medicolegal litigation involving MUS for SUI treatment, the majority of respondents still prefer this as the initial surgical treatment. Most clinicians value PIL in the surgical consent process.
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Affiliation(s)
- Ariel Zilberlicht
- Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynecology, The Lady Davis Carmel Medical Center, Technion University, Rappaport Faculty of Medicine, Haifa, Israel
| | - Debjyoti Karmakar
- Department of Urogynaecology, Mercy Hospital for Women, Melbourne, Victoria, Australia
| | - Peter L Dwyer
- Department of Urogynaecology, Mercy Hospital for Women, Melbourne, Victoria, Australia
| | - Garson Chan
- Division of Urology, Department of Surgery, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Lore Schierlitz
- Department of Urogynaecology, Mercy Hospital for Women, Melbourne, Victoria, Australia
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Osborne LA, Emery S, Vij M, Purwar B, Reed P. Acceptability and effectiveness of a multidisciplinary team approach involving counselling for mesh-removal patients. J OBSTET GYNAECOL 2021; 42:1431-1436. [PMID: 34939523 DOI: 10.1080/01443615.2021.1990230] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Patients with complications following mesh removal risk a variety of symptoms, and can view medical intervention negatively. This study explored the patient-acceptability of a Multidisciplinary Team (MDT), and whether the presence of a Counsellor would be accepted and effective. Twenty consecutively referred women, who had undergone mesh-removal but experienced complications were interviewed about their experiences, and completed the Queensland scale for pelvic floor symptoms, McGill Pain Questionnaire, and Hospital Anxiety and Depression Scales, before and after treatment. Patients had high levels of pelvic-floor symptoms, sensory and affective pain, anxiety, and depression. 70% reported a positive MDT experience; predicted by higher anxiety, and lower depression. 60% elected to receive Counselling, which commenced within one week of referral, typically lasted 1-4 sessions, and reduced pelvic-floor symptoms, affective pain, anxiety, and depression. Results suggest that the MDT approach is generally acceptable for this patient group, and that mesh-removal patients accept and benefit from input by a Counsellor.Impact statementWhat is already known on this subject? Concerns have been raised regarding the safety of mesh insertion. Multidisciplinary Teams (MDTs) are suggested to offer a strong approach to managing many women's health conditions, but no studies have examined mesh-removal patients, making generalisation difficult to the current patient group. Furthermore, it is unknown whether an MDT approach, including a Counsellor, would be acceptable to mesh-removal patients.What do the results of this study add? Patients had high levels of pelvic-floor symptoms, pain, anxiety, and depression. 70% reported the MDT experience as positive, predicted by higher anxiety, and lower depression. 60% elected to receive Counselling, which reduced pelvic-floor symptoms, affective pain, anxiety, and depression.What are the implications of these findings for clinical practice and/or further research? The Counselling provided as part of the MDT approach was able to commence quickly, did not require many sessions, and reduced reported pelvic-floor symptoms, affective pain, anxiety, and depression. These findings suggest that an MDT approach involving Counselling is generally acceptable, and that mesh-removal patients accept and benefit from the input of a Counsellor, as part of their treatment.
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Affiliation(s)
- Lisa A Osborne
- School of Psychology and Counselling, The Open University, UK.,Department of Women's Health, Swansea Bay University Health Board, UK
| | - Simon Emery
- Department of Women's Health, Swansea Bay University Health Board, UK
| | - Monika Vij
- Department of Women's Health, Swansea Bay University Health Board, UK
| | - Bhawana Purwar
- Department of Women's Health, Swansea Bay University Health Board, UK
| | - Phil Reed
- Department of Psychology, Swansea University, UK
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Toozs-Hobson P, Bach F, Daly JO, Klarskov N. Minimum standards for reporting outcomes of surgery in urogynaecology. Int Urogynecol J 2021; 32:1387-1390. [PMID: 33112967 PMCID: PMC7592142 DOI: 10.1007/s00192-020-04575-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 10/15/2020] [Indexed: 11/08/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The IUGA special interest group (SIG) identified a need for a minimum data set (MDS) to inform outcome measurements to be included and simplify data capture and standardise reporting for data collection systems. To define a minimum data set for urogynaecological surgical registries. METHODS Existing registries provide an inventory of items. A modified Delphi approach was used to identify a MDS. At each stage reviewers ranked data points and used free text to comment. The rating used a scale of 0-10 at each review and a traffic light system rated the scores as desirable, highly desirable and mandatory. The scores were collated and reported back to clinicians prior to the further rounds. Outliers were highlighted and reviewers re-assessed prior to repeating the process. A comparison of the MDS was made with published outcomes. RESULTS Reviewers were from the outcome SIG with emphasis on widespread representation. Fifteen clinicians from eight countries were involved. Four reviewers dissected the existing databases. Eighty data points were considered in four categories, background, preoperative, intraoperative and postoperative. Consensus was reached by the third round. Two points were added on review (date of surgery and urodynamics). Three background points, five preoperative points, seven intraoperative points and nine postoperative points were identified giving 24 minimum data points in the final recommendation. CONCLUSIONS An MDS has been developed for urogynaecological surgical registries. These should be mandatory points which then allow larger varying points to be assessed. These points correspond well to data points used in published papers from established databases.
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Affiliation(s)
| | - Fiona Bach
- Christchurch Women's Hospital, Christchurch, New Zealand
| | - J Oliver Daly
- Department of Obstetrics and Gynaecology, Sunshine Hospital, Western Health, Melbourne, Victoria, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Niels Klarskov
- Department of Obstetrics and Gynecology, Herlev and Gentofte Hospital, Herlev, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Healthcare professional's choice for surgical management of stress urinary incontinence in a U.K. tertiary hospital. Eur J Obstet Gynecol Reprod Biol 2021; 263:7-14. [PMID: 34129963 DOI: 10.1016/j.ejogrb.2021.05.039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 05/20/2021] [Accepted: 05/21/2021] [Indexed: 11/21/2022]
Abstract
OBJECTIVE In July 2018, NHS England, introduced a pause on vaginal mesh, including the mid-urethral sling (MUS) for treatment of stress urinary incontinence (SUI). NICE guidelines recommend MUS as one of the surgical options for SUI. The aim of our study was to investigate healthcare professionals choices for surgical treatment of SUI, if conservative measures failed. STUDY DESIGN The urogynaecology department at our tertiary level hospital devised a questionnaire using SurveyMonkey. This was distributed via email to 1058 healthcare professionals of different medical backgrounds. The surgical options were based on the NICE guideline and its patient decision making aid. We also used surgical information from the British society of Urogynaecology (BSUG) and British association of urological surgeons (BAUS). RESULTS We received 214 responses of which 204 were complete. Twenty six percent of replies were from obstetricians and gynaecologists, 36 % had over 20 years experience and 79 % were female. Forty four percent had no previous knowledge of surgical options. Mid-urethral sling was the most popular choice based on description, success and specific complications. Urethral bulking agent was the only option that increased in popularity after describing complications. Twenty two percent would avoid surgery due to the risk of complications. CONCLUSION This is the first study evaluating healthcare professionals surgical choice for SUI. Despite negative media publicity and NHS pause on MUS, it was still the most popular choice before and after informing of specific complications. The urethral bulking agent was the only surgical treatment, which increased in popularity after considering complications.
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Mathieson R, Kippen R, Manning T, Brennan J. Stress urinary incontinence in the mesh complication era: current Australian trends. BJU Int 2020; 128:95-102. [PMID: 33226698 DOI: 10.1111/bju.15302] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVES To examine available data relating to the surgical management of stress urinary incontinence (SUI) in Australia before, during and after a well-publicized Senate Inquiry into transvaginal mesh use and to consider outcomes in the context of global guideline changes. PATIENTS AND METHODS The annual number of surgical procedures for the management of SUI by procedure type and age group for the years 2008/2009-2017/2018 was obtained from the Australian Government Department of Human Services database using Medicare Benefits Schedule item numbers. The data extracted were limited to women aged 25 years and older. These data were used to calculate age-specific and age-standardized rates, so as to accurately analyse trends in the usage of different procedures. Hospital Episode Statistics for mid-urethral sling (MUS) insertions were obtained for England's National Health Service from the Health and Social Care Information Centre for the years 2008/2009-2016/2017. These data were also used to calculate annual age-standardized rates for comparison purposes. RESULTS Rates declined for most SUI procedures over time (MUS, colposuspension, fascial slings) except for urethral bulking agents. The absolute number of MUSs implanted in 2008/2009 was 5729, which decreased to 3127 in the 2017/2018 financial year. Over the decade, the annual rate for MUS implantation per 100 000 population halved from 78 to 36. Over this same period, the rate of usage of bulking agents doubled, although represented a low volume of procedures (overall numbers increased from 304 to 698, representing an increase from four to eight procedures per 100 000 population). The age-specific peak rate for MUS and Burch colposuspension changed over the decade from 55-64 years to 65-74 years, suggesting that women are deferring surgical treatment until later in life. Over the last decade, the total number of surgical procedures performed in Australia to treat SUI has decreased markedly from 6812 to 4279. This represents a decrease in the annual rate per 100 000 population from 93 to 49. CONCLUSIONS There are clear changes evident for SUI management in the past decade in Australia, including an overall decline in operative numbers, which correlate with international advisory notifications and local investigations. The results of the Australian Senate inquiry, including removal of single-incision mini-slings, greater availability of patient resources, and greater regulation of SUI procedures, will probably have ongoing effects. Surgeons need to ensure that sufficient training and patient education continue in order to maintain appropriate access to treatment of SUI in the future.
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Affiliation(s)
| | - Rebecca Kippen
- School of Rural Health, Monash University, Bendigo, Vic., Australia
| | | | - Janelle Brennan
- Bendigo Health, Bendigo, Vic., Australia.,School of Rural Health, Monash University, Bendigo, Vic., Australia.,St Vincent's Hospital Melbourne, Fitzroy, Vic., Australia
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Savvas C, Araklitis G, Hunter J, Robinson D, Cardozo L. An unusual late complication with tension-free vaginal tape (TVT): A case report. Case Rep Womens Health 2020; 28:e00252. [PMID: 32939345 PMCID: PMC7479271 DOI: 10.1016/j.crwh.2020.e00252] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 08/18/2020] [Accepted: 08/19/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Stress urinary incontinence is a common problem affecting women's quality of life. The retropubic mid-urethral sling accounts for the majority of surgical interventions for stress incontinence. Complications of the procedure are rare. We present an unusual late complication with tension-free vaginal tape (TVT). CASE Two years after insertion of a TVT for stress incontinence, a patient noticed a foreign body intermittently exiting through her anus. Initial clinical examinations and investigations were unremarkable. Five years after insertion she represented with faecal matter in the vagina and a TVT erosion. Imaging confirmed a colo-vaginal fistula. She underwent a vaginal excision of the TVT but this did not cure her problem and she subsequently had a laparoscopic sigmoid colectomy. Thereafter she remained well and asymptomatic. CONCLUSION This case report describes an unusual late complication. It is likely that the left arm of the mesh entered the serosa of the sigmoid colon and eroded into it over time. Complications associated with TVT are rare, but when they occur they need to be recorded. Only surgeons who have experience and expertise in the procedure should perform it, such as subspecialty trained urogynaecologists.
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Affiliation(s)
- Christopher Savvas
- Department of Urogynaecology, Suite 8, Golden Jubilee Wing, King's College Hospital, London SE5 9RS, UK
| | - George Araklitis
- Department of Urogynaecology, Suite 8, Golden Jubilee Wing, King's College Hospital, London SE5 9RS, UK
| | - Jo Hunter
- Department of Urogynaecology, Suite 8, Golden Jubilee Wing, King's College Hospital, London SE5 9RS, UK
| | - Dudley Robinson
- Department of Urogynaecology, Suite 8, Golden Jubilee Wing, King's College Hospital, London SE5 9RS, UK
| | - Linda Cardozo
- Department of Urogynaecology, Suite 8, Golden Jubilee Wing, King's College Hospital, London SE5 9RS, UK
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Serati M, Mancini V, Balzarro M. Urethral bulking agents for the treatment of female stress urinary incontinence. Int Urogynecol J 2020; 31:1493-1494. [PMID: 31900546 DOI: 10.1007/s00192-019-04221-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Maurizio Serati
- Department of Obstetrics and Gynecology, University of Insubria, Piazza Biroldi 1, 21100, Varese, Italy.
| | - Vito Mancini
- Department of Urology and Renal Transplantation, Università di Foggia, Foggia, Italy
| | - Matteo Balzarro
- Department of Urology, Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
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Duckett J, Thakar R, Shah V, Stephenson J, Balachandran A. The Use of Imaging for Synthetic Midurethral Slings. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2020; 39:1497-1506. [PMID: 32125008 DOI: 10.1002/jum.15254] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 01/29/2020] [Accepted: 02/03/2020] [Indexed: 06/10/2023]
Abstract
Ultrasound and magnetic resonance imaging can be used to image midurethral slings, which have may have complications such as pain. There is considerable misunderstanding regarding the utility of the different modalities. This article aims to review the current literature to identify the benefits and limitations of each imaging modality and identify the place that each should have for patients with midurethral sling complications. A literature search was performed, and all relevant articles were identified and reviewed. Different imaging modalities are complementary, but more research is required in this area.
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Affiliation(s)
- Jonathan Duckett
- Department of Obstetrics and Gynecology, Medway Maritime Hospital, Gillingham, Kent, England
| | - Ranee Thakar
- Croydon Urogynecology and Pelvic Floor Reconstruction Unit, Croydon University Hospital, Croydon, Surrey, England
| | - Vikas Shah
- Gastrointestinal Imaging Group, Glenfield General Hospital, University Hospitals of Leicester, Leicester, England
| | - James Stephenson
- Gastrointestinal Imaging Group, Glenfield General Hospital, University Hospitals of Leicester, Leicester, England
| | - Aswini Balachandran
- Croydon Urogynecology and Pelvic Floor Reconstruction Unit, Croydon University Hospital, Croydon, Surrey, England
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The effect of advisory documents on mid-urethral sling case acquisition to the British Society Urogynaecology (BSUG) database in England. Int Urogynecol J 2020; 32:135-140. [PMID: 32556850 DOI: 10.1007/s00192-020-04388-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 06/08/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Many advisory documents have recommended uploading of all mid-urethral sling (MUS) cases onto the British Society of Urogynaecology (BSUG) or British Association of Urological Surgeons (BAUS) database. The aim of this study was to determine whether these documents have resulted in an increase in database case acquisition for MUS surgery. METHOD We determined the number of cases uploaded onto the BSUG and BAUS databases and cases acquired by Hospital Episode Statistics (HES) over the period January 2011-March 2017 for the 6 months prior to each document and 6 months afterwards. RESULTS There was an upsurge in data acquisition in 2013, which then declined after year end. There was a significant upsurge in case acquisition associated with the following documents: NHS Medical Director letter (p < 0.00001), the Healthcare Quality Improvement Partnership (HQIP) audit (p < 0.00001). There was a significant drop in case acquisition following the end of the HQIP audit (p < 0.00001) and the Mesh Working Group Interim report (p = 0.00325). CONCLUSION There was a significant increase in case acquisition with the HQIP audit and decline after it. The significant increase in case acquisition seen after the NHS MD letter in November 2012 may have been due to an overlap in the data capture between it and the HQIP audit. The levels of case acquisition do not compare to registries that are essentially compulsory and therefore we believe that voluntary databases are not effective for device post-market surveillance.
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12
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Which procedure for stress urinary incontinence? Colposuspension. Curr Opin Urol 2020; 30:279-280. [PMID: 31913204 DOI: 10.1097/mou.0000000000000720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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