1
|
Li X, Feng Y, Gong Y, Chen Y. Assessing the Reproducibility of Research Based on the Food and Drug Administration Manufacturer and User Facility Device Experience Data. J Patient Saf 2024; 20:e45-e58. [PMID: 38470959 DOI: 10.1097/pts.0000000000001220] [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: 03/14/2024]
Abstract
OBJECTIVE This article aims to assess the reproducibility of Manufacturer and User Facility Device Experience (MAUDE) data-driven studies by analyzing the data queries used in their research processes. METHODS Studies using MAUDE data were sourced from PubMed by searching for "MAUDE" or "Manufacturer and User Facility Device Experience" in titles or abstracts. We manually chose articles with executable queries. The reproducibility of each query was assessed by replicating it in the MAUDE Application Programming Interface. The reproducibility of a query is determined by a reproducibility coefficient that ranges from 0.95 to 1.05. This coefficient is calculated by comparing the number of medical device reports (MDRs) returned by the reproduced queries to the number of reported MDRs in the original studies. We also computed the reproducibility ratio, which is the fraction of reproducible queries in subgroups divided by the query complexity, the device category, and the presence of a data processing flow. RESULTS As of August 8, 2022, we identified 523 articles from which 336 contained queries, and 60 of these were executable. Among these, 14 queries were reproducible. Queries using a single field like product code, product class, or brand name showed higher reproducibility (50%, 33.3%, 31.3%) compared with other fields (8.3%, P = 0.037). Single-category device queries exhibited a higher reproducibility ratio than multicategory ones, but without statistical significance (27.1% versus 8.3%, P = 0.321). Studies including a data processing flow had a higher reproducibility ratio than those without, although this difference was not statistically significant (42.9% versus 17.4%, P = 0.107). CONCLUSIONS Our findings indicate that the reproducibility of queries in MAUDE data-driven studies is limited. Enhancing this requires the development of more effective MAUDE data query strategies and improved application programming interfaces.
Collapse
Affiliation(s)
- Xinyu Li
- From the Department of Computer Science, Vanderbilt University, Nashville, Tennessee
| | - Yubo Feng
- From the Department of Computer Science, Vanderbilt University, Nashville, Tennessee
| | - Yang Gong
- School of Biomedical Informatics, The University of Texas Health Science Center at Houston, Houston, Texas
| | | |
Collapse
|
2
|
Kakinuma T, Kakinuma K, Ueyama K, Shinohara T, Okamoto R, Imai K, Takeshima N, Yanagida K, Ohwada M. Mid-term outcomes of laparoscopic vaginal stump–round (Kakinuma method) and stump–uterosacral (Shull method) ligament fixation for pelvic organ prolapse: A retrospective comparative study. BMC Surg 2024; 24:137. [PMID: 38711094 PMCID: PMC11071197 DOI: 10.1186/s12893-024-02429-9] [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: 11/18/2023] [Accepted: 04/26/2024] [Indexed: 05/08/2024] Open
Abstract
BACKGROUND Laparoscopic sacrocolpopexy (LSC) and robot-assisted sacrocolpopexy (RSC) using mesh are popular approaches for treating pelvic organ prolapse (POP). However, it is not uncommon that native tissue repair (NTR) should be presented as an option to patients who are expected to have extensive intraperitoneal adhesion or patients for whom LSC or RSC is difficult owing to various risk factors. Laparoscopic vaginal stump-uterosacral ligament fixation (Shull method) has been introduced as a method for NTR in case of POP. However, effective repair using this surgical procedure may not be possible in severe POPs. To solve the problems of the Shull method, we devised the laparoscopic vaginal stump-round ligament fixation (Kakinuma method) in which the vaginal stump is fixed to the uterine round ligament, a histologically strong tissue positioned anatomically higher than the uterosacral ligament. This study aimed to retrospectively and clinically compare the two methods. METHODS Of the 78 patients who underwent surgery for POP between January 2017 and June 2022 and postoperative follow-up for at least a year, 40 patients who underwent the Shull method (Shull group) and 38 who underwent the Kakinuma method (Kakinuma group) were retrospectively analyzed. RESULTS No significant differences were observed between the two groups in patient background variables such as mean age, parity, body mass index, and POP-Q stage. The mean operative duration and mean blood loss in the Shull group were 140.5 ± 31.7 min and 91.3 ± 96.3 ml, respectively, whereas the respective values in the Kakinuma group were 112.2 ± 25.3 min and 31.4 ± 47.7 ml, respectively. Thus, compared with the Shull group, the operative duration was significantly shorter (P < 0.001) and blood loss was significantly less (P = 0.003) in the Kakinuma group. Recurrence was observed in six patients (15.0%) in the Shull group and two patients (5.3%) in the Kakinuma group. Hence, compared with the Shull group, recurrence was significantly less in the Kakinuma group (P = 0.015). No patients experienced perioperative complications in either group. CONCLUSIONS The results suggest that the Kakinuma method can serve as a novel and viable NTR procedure for POP.
Collapse
Affiliation(s)
- Toshiyuki Kakinuma
- Department of Obstetrics and Gynecology, International University of Health and Welfare Hospital, 537-3, Iguchi, Nasushiobara-City, 329-2763, Tochigi, Japan.
| | - Kaoru Kakinuma
- Department of Obstetrics and Gynecology, International University of Health and Welfare Hospital, 537-3, Iguchi, Nasushiobara-City, 329-2763, Tochigi, Japan
| | - Kyouhei Ueyama
- Department of Obstetrics and Gynecology, International University of Health and Welfare Hospital, 537-3, Iguchi, Nasushiobara-City, 329-2763, Tochigi, Japan
| | - Takumi Shinohara
- Department of Obstetrics and Gynecology, International University of Health and Welfare Hospital, 537-3, Iguchi, Nasushiobara-City, 329-2763, Tochigi, Japan
| | - Rora Okamoto
- Department of Obstetrics and Gynecology, International University of Health and Welfare Hospital, 537-3, Iguchi, Nasushiobara-City, 329-2763, Tochigi, Japan
| | - Ken Imai
- Department of Obstetrics and Gynecology, International University of Health and Welfare Hospital, 537-3, Iguchi, Nasushiobara-City, 329-2763, Tochigi, Japan
| | - Nobuhiro Takeshima
- Department of Obstetrics and Gynecology, International University of Health and Welfare Hospital, 537-3, Iguchi, Nasushiobara-City, 329-2763, Tochigi, Japan
| | - Kaoru Yanagida
- Department of Obstetrics and Gynecology, International University of Health and Welfare Hospital, 537-3, Iguchi, Nasushiobara-City, 329-2763, Tochigi, Japan
| | - Michitaka Ohwada
- Department of Obstetrics and Gynecology, International University of Health and Welfare Hospital, 537-3, Iguchi, Nasushiobara-City, 329-2763, Tochigi, Japan
| |
Collapse
|
3
|
Buchanan LM, Domingo MJ, White SE, Vanoven TN, Karbasion N, Bersi MR, Pence IJ, Florian-Rodriguez M, Miller KS. Advances in vaginal bioengineering: Applications, techniques, and needs. Curr Res Physiol 2023; 6:100111. [PMID: 38107786 PMCID: PMC10724214 DOI: 10.1016/j.crphys.2023.100111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 10/05/2023] [Accepted: 10/13/2023] [Indexed: 12/19/2023] Open
Affiliation(s)
- Lily M. Buchanan
- University of Texas at Dallas, Department of Bioengineering, 800 W. Campbell Rd, Richardson, TX, 75080, USA
| | - Mari J.E. Domingo
- Tulane University, Department of Biomedical Engineering, 6823 St. Charles Ave, New Orleans, LA, 70118, USA
| | - Shelby E. White
- Tulane University, Department of Biomedical Engineering, 6823 St. Charles Ave, New Orleans, LA, 70118, USA
| | - Triniti N. Vanoven
- University of Texas at Dallas, Department of Bioengineering, 800 W. Campbell Rd, Richardson, TX, 75080, USA
- University of Texas Southwestern Medical Center, Department of Biomedical Engineering, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA
| | - Niyousha Karbasion
- Washington University at St. Louis, Department of Mechanical Engineering and Materials Science, 1 Brookings Dr, St. Louis, MO, 63130, USA
| | - Matthew R. Bersi
- Washington University at St. Louis, Department of Mechanical Engineering and Materials Science, 1 Brookings Dr, St. Louis, MO, 63130, USA
| | - Isaac J. Pence
- University of Texas at Dallas, Department of Bioengineering, 800 W. Campbell Rd, Richardson, TX, 75080, USA
- University of Texas Southwestern Medical Center, Department of Biomedical Engineering, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA
- University of Texas Southwestern Medical Center, Charles and Jane Pak Center for Mineral Metabolism and Clinical Research, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA
- University of Texas Southwestern Medical Center, Department of Internal Medicine, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA
| | - Maria Florian-Rodriguez
- University of Texas Southwestern Medical Center, Department of Obstetrics and Gynecology, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA
- University of Texas Southwestern Medical Center, Cecil H. and Ida Green Center for Reproductive Biology Sciences, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA
| | - Kristin S. Miller
- University of Texas at Dallas, Department of Bioengineering, 800 W. Campbell Rd, Richardson, TX, 75080, USA
- University of Texas Southwestern Medical Center, Department of Biomedical Engineering, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA
- University of Texas Southwestern Medical Center, Department of Obstetrics and Gynecology, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA
- University of Texas at Dallas, Department of Mechanical Engineering, 800 W. Campbell Rd, Richardson, TX, 75080, USA
| |
Collapse
|
4
|
Kakinuma T, Kaneko A, Kakinuma K, Imai K, Takeshima N, Ohwada M. New native tissue repair for pelvic organ prolapse: Medium-term outcomes of laparoscopic vaginal stump–round ligament fixation. World J Clin Cases 2023; 11:3457-3463. [PMID: 37383910 PMCID: PMC10294204 DOI: 10.12998/wjcc.v11.i15.3457] [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: 01/09/2023] [Revised: 03/02/2023] [Accepted: 04/14/2023] [Indexed: 05/25/2023] Open
Abstract
BACKGROUND Laparoscopic sacrocolpopexy for pelvic organ prolapse (POP) is a new and widely used approach; however, ever since the United States Food and Drug Administration warned against the use of surgical mesh, repairs performed using patients’ tissues [i.e. native tissue repair (NTR)] instead of mesh have attracted much attention. At our hospital, laparoscopic sacrocolpopexy (the Shull method) was introduced in 2017. However, patients with more severe POP who have a long vaginal canal and overextended uterosacral ligaments may not be candidates for this procedure.
AIM To validate a new NTR treatment for POP, we examined patients undergoing laparoscopic vaginal stump–round ligament fixation (the Kakinuma method).
METHODS The study patients were 30 individuals with POP who underwent surgery using the Kakinuma method between January 2020 and December 2021 and who were followed up for > 12 mo after surgery. We retrospectively examined surgical outcomes for surgery duration, blood loss, intraoperative complications, and incidence of recurrence. The Kakinuma method involves round ligament suturing and fixation on both sides, effectively lifting the vaginal stump after laparoscopic hysterectomy.
RESULTS The patients’ mean age was 66.5 ± 9.1 (45-82) years, gravidity was 3.1 ± 1.4 (2-7), parity was 2.5 ± 0.6 (2-4) times, and body mass index was 24.5 ± 3.3 (20.9-32.8) kg/m2. According to the POP quantification stage classification, there were 8 patients with stage II, 11 with stage III, and 11 with stage IV. The mean surgery duration was 113.4 ± 22.6 (88-148) min, and the mean blood loss was 26.5 ± 39.7 (10-150) mL. There were no perioperative complications. None of the patients exhibited reduced activities of daily living or cognitive impairment after hospital discharge. No cases of POP recurrence were observed 12 mo after the operation.
CONCLUSION The Kakinuma method, similar to conventional NTR, may be an effective treatment for POP.
Collapse
Affiliation(s)
- Toshiyuki Kakinuma
- Department of Obstetrics and Gynecology, International University of Health and Welfare, Nasushiobara 329-2763, Japan
| | - Ayaka Kaneko
- Department of Obstetrics and Gynecology, International University of Health and Welfare, Nasushiobara 329-2763, Japan
| | - Kaoru Kakinuma
- Department of Obstetrics and Gynecology, International University of Health and Welfare, Nasushiobara 329-2763, Japan
| | - Ken Imai
- Department of Obstetrics and Gynecology, International University of Health and Welfare, Nasushiobara 329-2763, Japan
| | - Nobuhiro Takeshima
- Department of Obstetrics and Gynecology, International University of Health and Welfare, Nasushiobara 329-2763, Japan
| | - Michitaka Ohwada
- Department of Obstetrics and Gynecology, International University of Health and Welfare, Nasushiobara 329-2763, Japan
| |
Collapse
|
5
|
[Slings in the era of the mesh ban: now what?]. UROLOGIE (HEIDELBERG, GERMANY) 2023; 62:165-170. [PMID: 36607437 DOI: 10.1007/s00120-022-02017-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/19/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND Use of midurethral slings (MUS) as gold standard for stress urinary incontinence declined after the recent US Food and Drug Administration (FDA) communication. OBJECTIVES What is the current status in the surgical treatment of stress urinary incontinence? What impact do regular FDA communications and numerous restrictions around the world have? MATERIALS AND METHODS The current literature on surgical treatment of incontinence was evaluated; medical press information and literature regarding the FDA communication were assessed. The legal situation is illustrated using the example of the Montgomery case in England. RESULTS Despite positive results from literature and gynecological and urological societies, there has been a significant decline in the use of MUS. The current 2022 German interdisciplinary 2k-guideline for the treatment of female stress urinary incontinence confirms the efficacy and safety of MUS. CONCLUSION Analysis of recent literature supports the importance of continued long-term outcome data regarding the safety and efficacy of suburethral slings for treatment of female stress urinary incontinence.
Collapse
|
6
|
Zhou Q, Lu M, Li GS, Peng GL, Song YF. Knowledge mapping and visualization analysis of pelvic organ prolapse repair with mesh from 2001 to 2021. Front Bioeng Biotechnol 2023; 11:1104724. [PMID: 37091336 PMCID: PMC10113510 DOI: 10.3389/fbioe.2023.1104724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 03/22/2023] [Indexed: 04/25/2023] Open
Abstract
Aims: In recent decades, extensive attention has been paid to the application of mesh to repair pelvic floor defects. However, a large body of related literature has not been system summarized. The purpose of this study is to summarize and visualize the literature on pelvic organ prolapse (POP) repair with mesh using bibliometrics. Methods: Medical literature regarding POP repair with mesh were searched and obtained in the Web of Science™ Core (WoSCC) database from 2001 to 2021. Microsoft Excel 2020, CiteSpace and VOSviewer were used to conduct the bibliometric and knowledge-map analysis. Results: In the past 20 years, a total of 2,550 articles and reviews have been published in 35 journals, and the published and cited results show a growing trend. Cosson M and International Urogynecology Journal were the authors and journals with the highest output, respectively. The United States, France and the United Kingdom are among the top three countries/organizations in relevant publications in worldwide. 584 key words in the literature are divided into 8 clusters, which are mainly related to prolapse type, risk factors, surgical methods, imaging, quality of life and bioengineering. Using clinical research and tissue engineering technology to reduce mesh complications is the current hot spot in this field. Conclusion: Reasonable application of mesh and avoiding mesh complications are still the most concerned topics in POP research. Although clinical research, surgical improvement, biological mesh and bioengineering technology have shown promising results, it is still urgent to carry out clinical transformation application research.
Collapse
Affiliation(s)
- Quan Zhou
- Department of Gynecology and Obstetrics, The People’s Hospital of China Three Gorges University/The First People’s Hospital of Yichang, Yichang, China
- Department of Gynecology and Obstetrics, The 900th Hospital of Joint Logistic Support Force, Fuzhou, Fujian, China
- *Correspondence: Quan Zhou, ; Yan-Feng Song,
| | - Man Lu
- Department of Gynecology and Obstetrics, The People’s Hospital of China Three Gorges University/The First People’s Hospital of Yichang, Yichang, China
| | - Guo-Sheng Li
- Department of Gynecology and Obstetrics, The People’s Hospital of China Three Gorges University/The First People’s Hospital of Yichang, Yichang, China
| | - Gan-Lu Peng
- Department of Gynecology and Obstetrics, The People’s Hospital of China Three Gorges University/The First People’s Hospital of Yichang, Yichang, China
| | - Yan-Feng Song
- Department of Gynecology and Obstetrics, The 900th Hospital of Joint Logistic Support Force, Fuzhou, Fujian, China
| |
Collapse
|
7
|
Artsen AM, Sassani JC, Moalli PA, Bradley MS. Complications Reported to the Food and Drug Administration: A Cross-sectional Comparison of Urogynecologic Meshes. Female Pelvic Med Reconstr Surg 2022; 28:452-460. [PMID: 35536679 PMCID: PMC9246837 DOI: 10.1097/spv.0000000000001193] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
IMPORTANCE The U.S. Food and Drug Administration uses the Manufacturer and User Facility Device Experience database to evaluate the safety of urogynecologic meshes; however, reports on individual meshes have not been characterized. OBJECTIVE The aim of the study was to compare complications among available urogynecologic meshes reported to the Manufacturer and User Facility Device Experience database. STUDY DESIGN This study is a cross-sectional analysis of medical device reports (MDRs) of urogynecologic mesh from January 2004 to March 2019, using the Reed Tech Navigator (LexisNexis), which codes MDRs. The percentage of reports containing specific complaints (not an adverse event rate) were compared with χ 2 tests with Dunn-Sidak correction. Correlations with time on market, mesh weight, stiffness, and porosity were determined. RESULTS The 34,485 reports examined included 6 transvaginal meshes, 4 sacrocolpopexy meshes, and 10 midurethral slings. Most reported events were pain, erosion, and infection. For transvaginal prolapse, less than 10% of Uphold Lite (Boston Scientific) reports contained pain or erosion versus greater than 90% of Prolift/Prolift+M (Ethicon, P < 0.001). For sacrocolpopexy mesh, greater than 90% of Gynemesh (Ethicon; Prolift in vaginal form) reports included erosion and pain versus less than 60% for Artisyn (Ethicon), Restorelle (Colpoplast), and Upsylon (Boston Scientific, P < 0.0001). For slings, Gynecare TVT Obturator had the highest proportion of erosion and pain complaints. Heavier sling meshes had more reports. When Ascend (Caldera Medical), an outlier with only 5 reports, was excluded, transvaginal mesh stiffness correlated strongly with number of reports. For transvaginal meshes, number of reports correlated with time on market (ρ = 0.8, P = 0.04). CONCLUSIONS Individual meshes have different properties with different complication profiles, which should inform mesh development and use. Gynemesh MDRs included pain and erosion more frequently than others. Comprehensive registries are needed.
Collapse
Affiliation(s)
- Amanda M Artsen
- From the Division of Urogynecology, University of Pittsburgh Medical Center, Pittsburgh, PA
| | | | | | | |
Collapse
|
8
|
Manufacturer and User Facility Device Experience Reporting of Events Related to Transvaginal Mesh: Understanding the Data. Female Pelvic Med Reconstr Surg 2022; 28:332-335. [PMID: 35421039 DOI: 10.1097/spv.0000000000001177] [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
OBJECTIVE The aim of this study was to examine potential bias in reports to the Manufacturer and User Facility Device Experience (MAUDE) database involving vaginal mesh by identifying the party submitting the report, the nature of the complaints, and whether the reports were edited. METHODS All reports submitted to the MAUDE database involving synthetic transvaginal mesh from January 2000 through December 2017 (40,266 safety reports) were identified. A random 2% sample (900) of these reports was reviewed in depth to determine the specific relevant details, including reporter type (patient, manufacturer, lawyer) and details of the complaint/injury. RESULTS Of the 40,226 reports to MAUDE identified, 28,473 (70.7%) were sling reports, and 11,793 (29.3%) described mesh products augmenting pelvic organ prolapse repair. Of the 900 reports reviewed in depth, 46%, 41%, 10%, and 2% of entries were reported by the manufacturer, attorney, health care provider, and patients, respectively. In the 4 years after submission, 18.6% of reports were modified at least once. CONCLUSIONS The MAUDE database allows physicians, manufacturers, and patients to immediately report adverse events experienced due to medical devices. While this database is an important means to identify potential danger to patients, any individual can file a report and, thus, it should not be the sole source of evidence to consider when assessing device safety. Further, the MAUDE database provides no information into the total number of cases performed without complication.
Collapse
|
9
|
Pace N, Artsen A, Baranski L, Palcsey S, Durst R, Meyn L, Moalli PA. Symptomatic improvement after mesh removal: a prospective longitudinal study of women with urogynaecological mesh complications. BJOG 2021; 128:2034-2043. [PMID: 34047446 PMCID: PMC8497415 DOI: 10.1111/1471-0528.16778] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To compare clinical characteristics and outcomes in patients undergoing excision of polypropylene urogynaecological mesh for pain, mesh exposure or both. DESIGN Prospective, longitudinal cohort. SETTING Academic tertiary referral centre. POPULATION Women undergoing complete vaginal mesh excision for mesh exposure and/or pain. METHODS Clinical and patient-reported outcomes assessing pain (visual analog scale, VAS), bother (Pelvic Floor Distress Inventory, PFDI) and functional impact (Pelvic Functional Impact Questionnaire, PFIQ) were collected at baseline, 6, 12 and 24 months after complete mesh excision. Outcomes were compared by mesh type (sling, prolapse [transvaginal or sacrocolpopexy mesh], both) and complication (pain, exposure, both). MAIN OUTCOME MEASURES 'Much better' or 'Very much better' on Patient Global Impression of Improvement (PGI-I) up to 2 years after removal. RESULTS Of 173 women, 48 underwent removal for pain, 27 for exposure and 98 for exposure plus pain. 'Moderate to severe' baseline symptoms were reported by 75%; the most prevalent and severe symptom was dyspareunia. Patients with pain alone were most bothered (PFDI median 234.2, interquartile range 83, P = 0.02) and had the highest functional impact (PFIQ median 181, interquartile range 138, P < 0.001). After excision, only 33.3% of women with pain alone reported 'improved' symptoms (PGI-I), versus 73.9% with exposure, 58.3% with exposure plus pain (P = 0.03) with no differences in PGI-I by mesh type. VAS scores decreased in all groups, but PFDI and PFIQ did not improve in pain patients. CONCLUSIONS In women experiencing a pain complication after urogynaecological mesh insertion, mesh removal often does not improve symptoms. TWEETABLE ABSTRACT Only 33% of women with pain complications have improved symptoms after urogynaecological mesh removal.
Collapse
Affiliation(s)
- N Pace
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - A Artsen
- Department of Obstetrics, Gynecology & Reproductive Sciences, Women's Center for Bladder & Pelvic Health, UPMC Magee-Womens Hospital, Pittsburgh, PA, USA
- Magee-Womens Research Institute, Pittsburgh, PA, USA
| | - L Baranski
- Department of Obstetrics, Gynecology & Reproductive Sciences, Women's Center for Bladder & Pelvic Health, UPMC Magee-Womens Hospital, Pittsburgh, PA, USA
| | - S Palcsey
- Magee-Womens Research Institute, Pittsburgh, PA, USA
| | - R Durst
- Department of Obstetrics, Gynecology & Reproductive Sciences, Women's Center for Bladder & Pelvic Health, UPMC Magee-Womens Hospital, Pittsburgh, PA, USA
| | - L Meyn
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - P A Moalli
- Department of Obstetrics, Gynecology & Reproductive Sciences, Women's Center for Bladder & Pelvic Health, UPMC Magee-Womens Hospital, Pittsburgh, PA, USA
- Magee-Womens Research Institute, Pittsburgh, PA, USA
| |
Collapse
|
10
|
Rates of Sling Procedures and Revisions-A National Surgical Quality Improvement Program Database Study. Female Pelvic Med Reconstr Surg 2020; 27:e559-e562. [PMID: 33315624 DOI: 10.1097/spv.0000000000000995] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of this study was to describe trends in sling procedures and revisions, including fascial slings and midurethral slings (MUS) using a large, national database with respect to the 2011 U.S. Food and Drug Administration (FDA) mesh-related safety communication. METHODS This was a cross-sectional cohort study using data from the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database from 2010 to 2018, evaluating the prevalence of sling revision and fascial slings and their trends over time. Patients who underwent MUS, fascial slings, and sling revisions were identified by Current Procedural Terminology codes. Sling revisions and fascial slings were evaluated as a proportion of the total number of MUS performed per year. Three distinct periods were evaluated in relation to the 2011 FDA communication: 2010 to 2012, 2012 to 2015, and 2015 to 2018. Observed trends were assessed with Pearson correlation coefficients with a P value less than 0.05 considered significant. RESULTS During the study period, 32,657 slings were captured: 32,389 MUS and 268 fascial slings. The rate of sling revisions was low (0.4% in 2010 to 1.2% in 2015). Between 2012 and 2015, the rate of sling revision increased significantly (R = 1, P = 0.002); following 2015, the rate of sling revisions decreased significantly over time (R = -0.96, P = 0.04). The rate of fascial slings between 2012 and 2015 increased significantly (R = 0.95, P = 0.047); however, the rate plateaued starting in 2015 (R = -0.49, -P = 0.51). CONCLUSIONS Our data suggest that MUS remain the preferred procedure for treatment of stress urinary incontinence despite the recent FDA communications with MUS representing 99% of sling procedures during the study period.
Collapse
|