PD33-04 NATIONWIDE SURVEY ON PERIOPERATIVE MANAGEMENT AND SURGICAL SITE INFECTION OF PATIENTS WHO UNDERWENT TRANSVAGINAL MESH FOR TREATMENT OF PELVIC ORGAN PROLAPSE

Abstract

METHODS: We analyzed data from 2 multicenter SUI surgical trials of women with stress predominant mixed urinary incontinence conducted by the UITN: SISTEr (Burch v. autologous fascial sling) and TOMUS (retropubic v. transobturator midurethral sling). The primary outcome was improvement of 70% from baseline in symptoms measured by irritative subscale of the Urinary Distress Inventory (UDI-I) and MESA Urge Index. Differences in procedure outcomes were compared within the trial. Regression models used 12 and 60 month data. RESULTS: At 12 months, most women (60-76%) reported OAB symptom improvement (Figure 1). Symptom improvement was similar between TOMUS sling groups at 1 year(70.3% RMUS vs 72.9% TMUS, p1⁄40.70) and 5 years. More women reported symptom improvement in the Burch group compared to the sling (71% vs 59.6%, p1⁄40.01) at 1 year; this difference was sustained at 5 years. Similar, significant improvements from baseline urgency incontinence were observed for each group in SISTEr and TOMUS without significant group differences. The % of women with symptom improvement declined significantly in each group, though at 5 years, 49%-67% continued to report improvement. Predictors of symptom change in TOMUS included concomitant surgery (decreased odds of improvement at 12 months) and greater baseline symptom severity (increased odds of improvement). Variables not predictive of symptom change included pre-operative anticholinergics, urodynamic detrusor overactivity, bladder volumes at first desire, strong desire or maximum cystometric capacity. Greater symptom improvement at 12 months occurred in SISTEr participants who were menopausal(on HRT), who were not obese, and with greater baseline OAB symptoms; conversely, increasing parity reduced the odds of symptom improvement. CONCLUSIONS: Most women with stress predominant mixed urinary incontinence experienced significant improvement in OAB wet and dry symptoms after SUI surgery although initial improvement diminishes over time. Urodynamic parameters are not prognostic of change in baseline OAB symptoms.