1
|
CADISH LA, FORD CB, Wu JM, Anger JT. Mortality and Reoperation Following Midurethral Sling Versus Urethral Bulking in Older Women. Urology 2022; 165:144-149. [PMID: 35460678 PMCID: PMC9940270 DOI: 10.1016/j.urology.2022.03.033] [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: 12/02/2021] [Revised: 03/22/2022] [Accepted: 03/31/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To examine differences in mortality, retreatment rates, and comorbidities that may be risk factors for retreatment among Medicare beneficiaries (age 65+) undergoing midurethral sling vs urethral bulking. MATERIALS AND METHODS This was a retrospective cohort study using the 5% limited data set from the Center for Medicare and Medicaid Services between 2010 and 2018. Beneficiaries age 65 or older who underwent sling or bulking without concomitant surgery from 2011 to 2014 were included and followed until reoperation or retreatment, loss of Medicare, death, or December 31, 2018. Repeat procedures for ongoing stress incontinence or complication were included. Associations between index treatment and need for a secondary procedure were evaluated using Cox proportional hazards models. RESULTS Median follow-up time was 5.7 years for 1,700 patients undergoing sling and 5.2 years for 875 patients undergoing bulking. Within 5 years, 10.2% of sling patients and 23.2% of bulking patients had died. When controlling for age, race, and comorbidities, bulking patients were 1.73 times more likely than sling patients to die during the study period. Bulking patients were significantly more likely to have 12 of the 16 of the medical comorbidities evaluated. By 5 years, 6.7% of sling patients had been retreated for stress urinary incontinence (SUI) compared with 24.6% of bulking patients. Apart from hypertension, none of the comorbidities evaluated was associated with a difference in the risk of a subsequent surgical procedure. Members of racial and ethnic minority groups were less likely to be retreated. CONCLUSION Older adults undergoing bulking are notably sicker and have shorter life expectancy as compared with those undergoing sling, suggesting these factors heavily guide patient selection. Comorbidities do not predispose patients to reoperation or retreatment.
Collapse
Affiliation(s)
- Lauren A. CADISH
- Urogynecology, Department of Obstetrics and Gynecology, Providence Saint John’s Health Center, Santa Monica, CA
| | - Cassie B. FORD
- Department of Population Health Science, Duke University School of Medicine, Durham, NC
| | - Jennifer M. Wu
- Section of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynecology, University of North Carolina Chapel Hill, Chapel Hill, NC
| | | |
Collapse
|
2
|
Sahin MO, Sen V, Irer B, Yildiz G. The effects of menopause on the quality of life and long-term outcomes of transobturator tape treatment in women with stres urinary incontinence. Int Braz J Urol 2020; 46:716-724. [PMID: 32539254 PMCID: PMC7822352 DOI: 10.1590/s1677-5538.ibju.2019.0331] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 10/13/2019] [Indexed: 01/22/2023] Open
Abstract
Purpose: We aimed to investigate the effects of menopause on long-term outcomes of transobturator tape (TOT) surgery. Materials and Methods: Patients who underwent TOT surgery were evaluated under two groups as postmenopausal and premenopausal. The International Consultation on Incontinence short-form questionnaire (ICIQ-SF), Incontinence Impact Questionnaire (IIQ-7) and Urogenital Distress Inventory-Short Form (UDI-6) questionnaires were completed by the patients at the 1st and 5th-year follow-up sessions. Patients with a postoperative UDI-6 and IIQ-7 score of <10 were considered as cured, those with lower postoperative scores compared to the preoperative period were regarded as improved, and the cases that had higher postoperative scores than preoperative values were interpreted as TOT failure. The TOT success rates were compared between the results obtained from UDI-6 and IIQ-7. Results: A total of 109 patients were included in the study (53 postmenopausal and 56 premenopausal). We contacted with 90 (48 premenopausal and 42 postmenopausal) women at 1st year control and 80 (44 premenopausal and 36 postmenopausal) women at 5th year control. There was a significant improvement in all of three questionnaires between the preoperative and post-operative 1st year control (ICIQ-SF: 15.5±2.5 vs. 1.8±4.3, p <0.001; IIQ-7: 68.9±9.8 vs. 2.75±15.2, p <0.001; UDI-6: 27.1±11.1 vs. 6.0±14.6, p <0.001) and the preoperative and post-operative 5th year control (ICIQ-SF: 15.5±2.5 vs. 3.1±5.3, p <0.001; IIQ-7: 68.9±9.8 vs. 9.6±26.7, p <0.001; UDI-6: 27.1±11.1 vs. 5.1±10.0, p <0.001). When we compared the premenopausal and postmenopausal patients in terms of recurrent urinary tract infection (UTI); 5 (12%) patients had recurrent UTI in postmenopausal group but no patients had recurrent UTI in premenopausal group at 1st year follow-up (p=0.039) and similarly the same 5 (13.9%) patients in follow-up had recurrent UTI in postmenopausal group but no patients had recurrent UTI in premenopausal group at 5th year follow-up (p=0.045). There were no significant differences between the premenopausal and postmenopausal patients in terms of TOT success rates at 1st and 5th year control, evaluated with UDI-6 (1st year: p=0.198 and 5th year: p=0.687) and IIQ-7 (1st year: p=0.489 and 5th year: p=0.608) questionnaires. Conclusions: Transobturator tape surgery is an effective and reliable method according to the long-term outcomes reported in this paper. In the current study, we determined that the TOT success rates were not affected by the presence of menopause.
Collapse
Affiliation(s)
| | - Volkan Sen
- Department of Urology, Manisa State Hospital, Manisa, Turkey
| | - Bora Irer
- Department of Urology, Izmir Metropolitan Municipality Esrefpasa Hospital, Izmir, Turkey
| | - Guner Yildiz
- Department of Urology, Dr. Suat Seren Chest Diseases and Surgery Training and Research Hospital, Izmir, Turkey
| |
Collapse
|
3
|
Paz-Levy D, Weintraub AY, Reuven Y, Yohay Z, Idan I, Elharar D, Yohay D. Prevalence and risk factors for urinary tract infection following stress urinary incontinence surgery with two midurethral sling procedures. Int J Gynaecol Obstet 2018; 143:333-338. [PMID: 30229894 DOI: 10.1002/ijgo.12680] [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: 02/18/2018] [Revised: 07/21/2018] [Accepted: 09/17/2018] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To compare prevalence and risk factors for urinary tract infection (UTI) following midurethral sling surgery with either the GYNECARE ABBREVO Continence System (Ethicon, Somerville, NJ, USA) or a standard transobturator. METHODS A retrospective cohort study was conducted among women who underwent midurethral sling surgery to treat stress urinary incontinence at a single tertiary hospital in Israel between January 1, 2014, and August 11, 2015. Data were retrieved from medical records. The diagnosis of UTI was based on a positive urine culture result. RESULTS Of 178 patients included, 30 (16.9%) underwent the ABBREVO procedure and 148 (83.1%) underwent the standard transobturator procedure. The mean ± SD BMI at the time of surgery was 28.1 ± 4.5 for the standard transobturator procedures and 30.7 ± 15.2 for the ABBREVO procedures. Women who underwent the ABBREVO procedure had an increased duration of hospitalization (P=0.004), and higher rates of concomitant anterior colporrhaphy procedures (P=0.009) and concomitant hysterectomy (P=0.009). Only 38 (21.3%) women developed UTIs within 12 months of surgery (seven in the ABBREVO procedure group and 31 in the standard transobturator procedure group). No statistically significant between-group differences were found for the risk of UTI or for urinary tract adverse events, such as recurrent UTI and the need for rehospitalization. CONCLUSIONS The two procedures were comparable in terms of prevalence and risk factors for UTI during the postoperative period.
Collapse
Affiliation(s)
- Dorit Paz-Levy
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Adi Y Weintraub
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Yonatan Reuven
- Division of Community Health, Siaal Research Center for Family Medicine and Primary Care, Faculty of Health Science, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Zehava Yohay
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Inbal Idan
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Debi Elharar
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - David Yohay
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| |
Collapse
|
4
|
Editorial Commentary. UROLOGY PRACTICE 2018. [DOI: 10.1016/j.urpr.2017.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
|
5
|
Weintraub AY, Reuven Y, Paz-Levy D, Yohay Z, Idan I, Elharar D, Glinter H, Tzur T, Yohay D. Prevalence and risk factors for urinary tract infection up to one year following midurethral sling incontinence surgery. Eur J Obstet Gynecol Reprod Biol 2018; 222:146-150. [PMID: 29408746 DOI: 10.1016/j.ejogrb.2018.01.028] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Revised: 12/22/2017] [Accepted: 01/24/2018] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To investigate the prevalence and risk factors of urinary tract infection (UTI) one year following sub-midurethral sling (SMUS) incontinence surgery in a university affiliated medical center in southern Israel. METHODS A retrospective cohort study was conducted to identify and characterize patients who suffered UTI within a year following SMUS surgery. The study population comprised of all patients who underwent a SMUS surgery between the years 2014 and 2015. Demographic and clinical data were retrieved from the patients' medical records, and a comparison between patients with and without a positive urine culture was performed. RESULTS During the study period, there were 178 SMUS surgeries. Urine culture positive UTI was noted in 21% (38 patients) within the first year following surgery. The mean age and BMI of patients complicated with UTI was 64.8 and 29.1, respectively. The most common pathogen found in urine culture was E. coli that accounted for 55% of all UTIs. When comparing patients with and without UTI, no significant difference was noted in the pre- and intra-operative characteristics. However, duration of hospitalization and readmissions in the first year following surgery, were significantly associated with the risk of UTI (p < 0.026 and p < 0.003, respectively). CONCLUSIONS Approximately one in every five women undergoing a SMUS operation in our population will suffer from UTI within a year from surgery. A significant association was found between the duration of hospitalization and readmissions in the first postoperative year and suffering from UTI.
Collapse
Affiliation(s)
- Adi Y Weintraub
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheba, Israel.
| | - Yonatan Reuven
- Siaal Research Center for Family Medicine and Primary Care, Division of Community Health, Faculty of Health Science, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Dorit Paz-Levy
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheba, Israel
| | - Zehava Yohay
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheba, Israel
| | - Inbal Idan
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheba, Israel
| | - Debi Elharar
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheba, Israel
| | - Hannah Glinter
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheba, Israel
| | - Tamar Tzur
- Department of Obstetrics and Gynecology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - David Yohay
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheba, Israel
| |
Collapse
|
6
|
Howard DL, McGlynn A, Greer JA. Military Surgeon Volume and Stress Incontinence Surgery Complications: A Retrospective Cohort Study. J Minim Invasive Gynecol 2018; 25:855-860. [PMID: 29337213 DOI: 10.1016/j.jmig.2018.01.001] [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: 10/25/2017] [Revised: 12/28/2017] [Accepted: 01/02/2018] [Indexed: 11/30/2022]
Abstract
STUDY OBJECTIVE To compare 12-month postoperative complication rates in women who underwent sling procedures by high-volume versus low-volume surgeons at US military treatment facilities (MTFs). DESIGN Retrospective cohort study (Canadian Task Force classification II-2). SETTING US MTFs. PATIENTS Female military beneficiaries enrolled in TRICARE. INTERVENTIONS Sling surgery for stress urinary incontinence between January 1, 2011 and December 31, 2012. MEASUREMENTS AND MAIN RESULTS The primary exposure was surgeon volume (high vs low). Surgeon volume was categorized as high or low based on the number of slings performed in the previous 2 years at US MTFs (January 1, 2009 to December 31, 2010). The primary outcome was a composite variable indicating at least 1 postoperative complication within 12 months. We used International Classification of Diseases, 9th revision and Current Procedural Terminology codes to identify postoperative complications that occurred in the 12 months after the index sling procedure. During the study period 348 gynecologic and urologic surgeons performed 1632 slings. The average patient age was 47.2 years. Based on our data distribution we classified surgeons as high volume (>12 slings/2 years) or low volume (<4 slings/2 years). High-volume surgeons operated on patients who were older, more likely to have comorbidities, and more likely to receive concomitant prolapse surgery. Using a cluster analysis the overall likelihood of at least 1 postoperative complication in 12 months for high-volume versus low-volume surgeons was 48.4% versus 42.2% (adjusted odds ratio, 1.24; 95% confidence interval, .99-1.54; p = .06). There were no differences between high- and low-volume surgeons in the rate of almost all other postoperative complications. CONCLUSION No significant differences in 12-month complication rates after sling surgery, stratified by surgeon volume, were seen in a setting of overall low-volume military surgeons.
Collapse
Affiliation(s)
- David L Howard
- 633rd Medical Group, Joint Base Langley-Eustis, Hampton, VA.
| | | | - Joy A Greer
- Women's Health Department, Division of Urogynecology, Naval Medical Center, Portsmouth, VA
| |
Collapse
|
7
|
Howard DL, McGlynn A, Greer JA. Complications of Sling Surgery for Stress Urinary Incontinence Among Female Military Beneficiaries. J Womens Health (Larchmt) 2018; 27:830-835. [PMID: 29320304 DOI: 10.1089/jwh.2017.6503] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Prior studies of complications after sling surgery excluded the large number of women in military treatment facilities (MTFs). OBJECTIVE To characterize the postoperative complication rates after sling surgery for Stress urinary incontinence (SUI) within MTFs in the United States. MATERIALS AND METHODS Retrospective cohort study of women aged 18 and older, with SUI, and who underwent either an outpatient or inpatient mid-urethral sling placement for SUI in any MTF in the United States between January 1, 2011 and December 31, 2012. RESULTS During the study period, 348 surgeons performed 1632 slings. The average patient age was 47.2 years, and 22.4% of the patients had a concomitant pelvic organ prolapse procedure. Overall, 45.5% of subjects had at least one postoperative complication. Of the specific complications, urologic infectious complications were the most frequent, occurring in 25.2% of patients. Overall, only 0.9% of patients underwent a repeat incontinence procedure. In multivariate analyses, concomitant pelvic organ procedure was associated with an increased risk of bladder outlet obstruction and noninfectious urologic complications. Those with a Charlson comorbidity index score of 1 or more were more likely to have an infectious complication and a new diagnosis of pelvic pain. Women older than the median age were less likely than those below to experience treatment failure and a new diagnosis of pelvic pain. CONCLUSIONS The population of women with SUI undergoing sling surgery at MTFs is a young population with postoperative complication rates lower than previously reported. However, the absolute overall complication rate is still high, specifically related to urinary tract infections, suggesting that significant opportunities exist for quality improvement.
Collapse
Affiliation(s)
- David L Howard
- 1 MAJ USAF MC, 633rd Medical Group, Joint Base Langley-Eustis, Obstetrics and Gynecology, Hampton, Virginia
| | - Andrea McGlynn
- 2 Department of Clinical Investigation, Naval Medical Center , Portsmouth, Virginia
| | - Joy A Greer
- 3 CDR MC USN, Division of Urogynecology, Department of Women's Health, Naval Medical Center Portsmouth , Portsmouth, Virginia
| |
Collapse
|
8
|
Blaivas JG, Purohit RS, Benedon MS, Mekel G, Stern M, Billah M, Olugbade K, Bendavid R, Iakovlev V. Safety considerations for synthetic sling surgery. Nat Rev Urol 2015; 12:481-509. [DOI: 10.1038/nrurol.2015.183] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
|