Incontinence Surgery Research Articles

How Do Surgical Interventions for Neurogenic Lower Urinary Tract Dysfunction Impact Quality of Life?

Adult patients with neurogenic lower urinary tract dysfunction (NLUTD) often have urinary symptoms that impact their quality of life (QOL). Our objective is to identify and summarize studies evaluating QOL changes across different NLUTD surgical interventions. A systematic rapid evidence review was carried using EMBASE and MEDLINE. We included adult patients (> 18 years old) with NLUTD who underwent a relevant surgery and had a measurement of QOL. We included pre-post study designs (primary focus) and cross-sectional studies (secondary focus). Studies were reviewed and data extracted by multiple assessors. Standardized data extraction tables were used, and qualitative synthesis was performed. Of the 1074 screened articles 26 were included. There were 3/15 studies that evaluated reconstructive surgery (augmentation and/or catheterisable channel) pre-post intervention (n = 94 patients); there was a 7%-28% relative improvement in bladder related and overall QOL using validated questionnaires, and a large magnitude of improvement in studies using unvalidated questionnaires. There were 3/7 studies that looked at urinary diversion pre-post intervention (n = 153 patients) and showed an approximately 20%-60% improvement in validated questionnaires assessing bladder specific quality of life, and 0%-25% improvement in overall quality of life. Finally, 3/4 studies were pre-post stress incontinence surgeries (n = 67 patients) and they found an improvement in the ICIQ questionnaire scores and study-specific questionnaires. The literature supporting a change in QOL in adult NLUTD patients undergoing surgical interventions is extremely limited due to a lack of pre-post studies, and the frequent use of unvalidated outcome measures.

Mesh-associated pain syndrome: predictors for continence and prolapse mesh removal surgery in a single centre

ObjectiveOver the last two decades one of the main surgical treatment for stress urinary incontinence (SUI) and pelvic organ prolapse (POP) surgery was the insertion of non-absorbable mesh to restore continence and prolapse respectively. Over time complications arose including mesh-associated pain syndrome (MAPS), mesh exposure, mesh, erosion, chronic bladder/vaginal infections, and dyspareunia. Consequently, women chose surgical mesh removal to counter these problems. However, little is known about the demographics, medical co-morbidities, mesh types involved and the timing from mesh insertion to mesh removal. This retrospective study will look at which of these factors may be closely associated with mesh removal surgery.DesignRetrospective evaluation.SettingFemale Pelvic Medicine and Reconstructive Surgery (FPMRS) Clinic at University College London Hospitals NHS Foundation Trust.PopulationAll patients presenting to the FPMRS Clinic between June 2011 to December 2019, requesting mesh removal surgery with a history of MAPS and other mesh complications were included in this study.MethodsPatient demographics including age, ethnicity, obstetric history, and medical co-morbidities; type of mesh/anatomical route used; onset of symptoms; and time from insertion to removal were recorded.Main Outcome MeasuresDetermination of correlation coefficients between patient demographics, patient reported symptoms and mesh removal surgery.ResultsThree hundred and forty-five women with a history of MAPS were included in the study. Women in the 40–60 year old cohort accounted for 54.4% of mesh removal surgery; 54.8% had a BMI under 30 and almost 90% were Caucasian. 96.5% had had children, with over 77% having had a vaginal delivery. 91.9% of patients reported other health conditions including 18.8% with a concomitant history of mental health problems and 15.4% with a history of heart disease. Over 80% of women undergoing mesh removal surgery had a continence mesh (49% retropubic and 32% obturator continence mesh) removed, whereas 20% had an abdominal prolapse and/or vaginal prolapse mesh removed. The average time from mesh insertion to mesh removal was seven years, with the prevalence of mesh removal surgery averaging 85% (range 50–100%) depending on the comorbidity determined.ConclusionsAll women presented to the clinic with a history of MAPS and other comorbidities which may have influenced their decision to pursue mesh removal surgery. There were no specific predictors, other than chronic pain associated with mesh, determining which women underwent surgery, though those with continence mesh were more likely to do so.

Outcomes of transperineal reanastomosis as a salvage treatment for recurrent vesicourethral anastomosis stenosis after radical prostatectomy

Purpose: To evaluate transperineal reanastomosis (TRPA) combined with incontinence surgery as a complex treatment for recurring vesicourethral anastomosis stenosis (VUAS) after radical prostatectomy (RP). Methods: Retrospective analysis of 8 patients who underwent TRPA for recurring VUAS. Detailed preoperative and follow up data were assessed. Results: Mean follow up lasted 47 months (range 17-77) with mean age being 63.4 years (range 61-70). All patients achieved patency and 87.5% (7/8) maintained it to the end of follow up. However, four of them required additional procedures to retain patency. Six underwent incontinence surgery – artificial urinary sphincter (AUS) implantation – after which one cuff erosion occurred. In the end 62.5% (5/8) of patients achieved patent urethra and continence. Conclusions: TRPA combined with incontinence surgery is a reasonable treatment for patients with recurrent VUAS. Nonetheless, this is a set of difficult surgeries that may ultimately end in failure, i.e. the inability to restore urethral patency, urinary incontinence or urinary diversion, hence they should be performed by experienced surgeons.

Outcomes of primary transobturator mid-urethral sling surgery in women of different ages

IntroductionOlder age is associated with greater likelihood of urinary incontinence and unmet care needs. It was hypothesized that age might influence clinical and ultrasound outcomes of transobturator mid-urethral sling (TOS) surgery. The aim of this study was to compare 1-year postoperative clinical and ultrasonographic outcomes of TOS surgery among women of different ages. MethodsA retrospective analysis of a cohort of women who underwent primary and isolated TOS surgery for uncomplicated urodynamic stress incontinence was undertaken. All women underwent pre-operative and 1-year postoperative evaluations including clinical interview, pelvic examination, urodynamic studies and introital four-dimensional ultrasound. To be eligible for surgery, women needed to be independent in their daily life, and to have an acceptable level of surgical risk on pre-operative assessment. The primary outcome was the rate of stress urinary incontinence (SUI) after surgery. The secondary outcomes comprised postoperative adverse events and ultrasound findings. ResultsIn total, 162, 213, 60 and 29 women aged <51, 51–64, 65–74 and ≥75 years, respectively, were included in this study. At 1-year postoperative assessment, older women were more likely to report SUI and bothersome SUI, while the severity of SUI and postoperative adverse events were similar in older women compared with other age groups. Ultrasound revealed that the sling tended to be looser and higher in older women. ConclusionTOS surgery is effective and safe for women of all ages who are independent in their daily life and who have an acceptable level of surgical risk. The sling tended to be looser and higher in older women.

Reply to Editorial Comment on “Management of Complications of Prosthetic Mid-urethral Tape Surgery for Stress Urinary Incontinence in Women”

Reply to Editorial Comment on “Management of Complications of Prosthetic Mid-urethral Tape Surgery for Stress Urinary Incontinence in Women”

Long-term results of artificial urinary sphincter in women: A retrospective monocentric study

BackgroundStress urinary incontinence (SUI) is a public health issue, with major impact on quality of life. An efficient treatment for intrinsic sphincter deficiency (ISD) is the artificial urinary sphincter (AUS). ObjectivesAnalyzing patient survival in terms of revision-free survival, removal-free survival and global survival without reintervention long-term results concerning continence status and complications. DesignWomen with severe ISD and negative Bonney test who were treated with AUS first implantation between 1987 and 2022 were included. ResultsIn our study, 478 patients were treated by AUS first implantation with a mean age of 59.7. The median follow-up time was 13.2years. The median revision-free survival was 19.5years with survival rates at 10, 20 and 30years were 86%, 47% and 32% respectively. Removal-free survival rates at 10, 20 and 30years were 84%, 80% and 60% respectively. Median reintervention-free survival was 17.5years. Survival was negatively affected by neurological etiology of the ISD, history of previous incontinence treatment and intraoperative complications with more early removals in the latter group. The absence of previous incontinence surgery was a protecting factor. Continence status was assessed at 10, 20 and 30years follow-up with a fully continence rate of respectively 83%, 68% and 61%. Intraoperative complication rate was 17.7%, explantation rate was 14% and the revision rate was 23%. ConclusionWomen treated with AUS have an excellent revision-free, removal-free and global survival rate. AUS is a very efficient treatment for women with ISD in terms of continence results with an acceptable intraoperative and long-term complication rate of which patients should be well informed before choosing this treatment for their SUI.

UroARC: A novel surgical risk calculator for older adults undergoing pelvic organ prolapse and stress urinary incontinence surgery.

Surgeries for pelvic organ prolapse (POP) and stress urinary incontinence (SUI) are commonly performed in older adults, many of whom are also frail. A surgical risk calculator for older adults undergoing POP/SUI surgeries that incorporates frailty, a factor known to increase the risk of surgical complications, would be helpful for preoperative counseling but currently does not exist. Medicare Carrier, Outpatient, and MedPAR files were examined for beneficiaries undergoing POP and SUI surgery between 2014 and 2016. A total of 15 POP/SUI categories were examined. The Claims-Based Frailty Index (CFI), a validated measure of frailty in Medicare data, and Charlson Comorbidity Index were deconstructed into their individual variables, and individual variables were entered into stepwise logistic regression models to determine which variables were most highly predictive of 30-day complications and 1-year mortality. To verify the prognostic accuracy for each model for surgical complications of interest, calibration curves and tests of model fit, including C-statistic, Brier scores, and Spiegelhalter p values, were determined. In total, 108 479 beneficiaries were included. Among these, 4.7% had CFI scores consistent with mild to severe frailty (CFI≥0.25). A total of 13 prognostic variable categories were found to be most highly predictive of postoperative complications. Calibration curves for each outcome of interest showed models were well-fit. Most models demonstrated high c-statistic values (≥0.7) and high Spiegelhalter p values (≥0.9), indicating good model calibration and excellent discrimination, and low Brier scores (<0.02), indicating high model accuracy. Urologic surgery for older Adults Risk Calculator serves as a novel surgical risk calculator that is readily accessible to both patients and clinicians that specifically factors in components of frailty. Furthermore, this calculator accounts for the heterogeneity of an aging population and can assist in individualized surgical decision-making for these common procedures.

High-intensity focused ultrasound (HIFU) for the treatment of female urinary incontinence: A retrospective analysis.

This study aims to demonstrate the effectiveness of high-intensity focused ultrasound, a noninvasive treatment, for managing urinary incontinence (UI) in women. This is a single-center, retrospective study involving 28 women. Patients, aged between 32 and 65, were included. Patients with insulin-dependent diabetes, neurological disease, active urinary tract infection, undiagnosed vaginal bleeding, who had incontinence surgery, and receiving estrogen therapy were excluded from the study. Incontinence severity was evaluated with the International Incontinence Consultation Questionnaire Short Form (ICIQ-SF). Patients were evaluated before treatment and 6 months after treatment using the ICIQ-SF and the Pelvic Organ Prolapse/Urinary Incontinence Sexual Function Assessment short form. In the analysis of numerical variables independent or paired t test or linear mixed effects models were used. Least square means were used in post hoc comparisons. Mean age of the patients was 45.50 ± 7.59 years. There were 18 (64%) stress urinary incontinence (SUI) and 10 (36%) mixed urinary incontinence (MUI). Six months after treatment, mean ICIQ-SF and Pelvic Organ Prolapse/Urinary Incontinence Short Form Questionnaire scores showed a significant positive change. After the procedure, UI completely disappeared in 43% of the patients. The rate of severe UI decreased from 39% to 8%, and very severe UI decreased from 8% to 0%. Incontinence severity was significantly different in the MUI and SUI groups before and after the procedure. After the procedure, UI completely disappeared in 67% of the patients in the SUI group, while it remained at a mild level in 33%. The decrease in ICIQ-SF score in the SUI group was significantly higher than that in the MUI group. There were no severe adverse events, in 4 patients there was mild vaginal discharge which resolved in 1 week. This study showed that high-intensity focused ultrasound treatment, can be effective and safe even in a single session. Selection and recall biases are potential biases in retrospective studies. Lacking a control group is another limitation. Although advances in technology are very important for medical treatments, their effectiveness and safety need to be proven. Future research in this area with a larger sample size and a prospective design will offer further evidence supporting effectiveness of this treatment model.

Outcome of post-prostatectomy stress urinary incontinence surgery in men with preoperative idiopathic detrusor overactivity.

Urodynamic evidence of storage dysfunction such as detrusor overactivity (DO) and/or poor compliance are present in up to 30-40% of patients after Radical Prostatectomy (RP). However, the current optimal management of men with DO on preoperative urodynamics prior to male stress urinary incontinence (SUI) surgery is not known. We performed a systematic search of the literature including articles on patients undergoing SUI surgery after prostatectomy with preoperative DO between January 2003 and May 2023 to ensure contemporaneous data was obtained. We identified 11 eligible publications with a total of 792 patients. On Urodynamics, 29% (n = 229) patients had DO prior to SUI surgery. Overall 69% patients had a successful outcome after SUI surgery while 26% (132/499) failed while 34% (32/95) patients who had proven DO preoperatively failed SUI surgery. The difference was not statistically significant. Considering the sub-group analysis, the failure rate with preoperative DO was significantly higher in the sling group (43%) than in the AUS group (18%). The review was limited by the outcome heterogeneity, variability in study inclusion criteria, reporting and analysis and the quality of the available studies. Within the limitations of the data, this review did not show a statistically significant higher failure rate of male incontinence surgery in patients with DO. Hence, patients with DO on preoperative urodynamics who are eligible for male SUI surgery should not be denied surgery but should be counselled appropriately of the risks and potential need for subsequent treatment, to manage expectations.

234 - Hysterectomy for Uterine Fibroids and Anti-urinary Incontinence Surgery: A Nationwide Cohort Study

234 - Hysterectomy for Uterine Fibroids and Anti-urinary Incontinence Surgery: A Nationwide Cohort Study

Comparison of Surgical Outcomes of Autologous Mid-Urethral Fascia Slings and Retropubic Mid-Urethral Slings for Women Undergoing a Primary Surgery for Stress Urinary Incontinence: A Systematic Review and Meta-Analysis.

Current guidelines on surgical treatment of stress urinary incontinence (SUI) recommend an informed decision making process between the physicians and patients reviewing all available surgical options with and without mesh. However, there is a lack of synthesized clinical evidence on some of the comparisons that can feed into patient counseling processes. The aim of this study was to review the available studies comparing clinical outcomes of an autologous fascial sling (AFS) and a retropubic (RP) synthetic sling for women undergoing a primary surgery for SUI. We conducted a literature search from 1990 to 2024 following international guidelines. We have included studies reporting on comparative outcomes of AFS and RP synthetic sling surgeries as a primary procedure. Three randomized studies were included with follow-up durations ranging from 24 months to 10 years. The mean percentage change in symptom scores ranged from 27.7% to 44.9%, with no significant difference between the two sling types. There was no difference between groups with regard to objective cure rates, subjective cure rates and length of hospital stay between AFS and RP slings. AFS surgeries had longer operative times. There were concerns about bias, particularly related to allocation, blinding, and missing outcome data. Overall, both types of slings had similar cure rates but AFSs were associated with longer operative times. The study highlights the need for more research on the comparative effectiveness of AFS and synthetic slings for SUI surgery to guide decision-making for SUI surgical treatments.

Management of Complications of Prosthetic Mid-urethral Tape Surgery for Stress Urinary Incontinence in Women

OBJECTIVESto propose guidelines for the management of complications of prosthetic mid-urethral tape surgery for stress urinary incontinence in women. METHODSThese guidelines are based on an exhaustive literature review on retropubic and trans-obturator mid-urethral tape complications. The expert panel rated the level of evidence of each study, summarized literature for the treatment of each complication, and proposed guidelines. RESULTSManagement of these complications is complex and the first treatment is crucial to offer the best functional result to the patient. We propose a standardized approach and guidelines for the management of complications to help physicians to early identify a surgical complication, offer adequate treatment for each complication and provide clear and appropriate information to patients. We detailed management of intraoperative complications: bladder, urethral, vaginal, visceral and vascular injury; short term post-operative complications: bleeding/hematoma, voiding dysfunction, pain, infection; and long-term post-operative complications: chronic voiding dysfunction, de novo overactive bladder syndrome, chronic pain, dyspareunia, vaginal, bladder and urethral tape erosion. CONCLUSIONThese guidelines may help physicians to improve management of prosthetic mid-urethral sling complications that may occur following stress urinary incontinence surgery.

Martius Labial Fat Pad Use in the Treatment of Complications Associated With Prior Surgery for Urinary Incontinence or Pelvic Organ Prolapse

ObjectiveTo evaluate the outcomes of Martius Labial Fat Pad (MLFP) in the treatment of complications related to surgery for urinary incontinence (UI) and/or pelvic organ prolapse (POP) and to assess the influence of mesh presence. MethodsFollowing institutional review board approval (n° STU 2023 1280), a review of all women who underwent a MLFP procedure at our tertiary center after UI and/or POP repair was performed by an independent investigator. The primary outcome was the rate of post-operative complications classified according to the Clavien-Dindo classification. Secondary outcomes were based on indications and functional results. A subgroup analysis was performed according to the type of prior repair: mesh or native tissue repair. ResultsFrom 2006-2022, 26 patients underwent a MLFP procedure, with a median follow-up duration of 30 (12-67.5) months. Bladder outlet obstruction and fistulae were the two most frequent indications. Post-operative complications occurred in 15 patients (58%): grade I in 6 (43%), grade 2 in 3 (21%), grade 3b in 4 (29%) and grade 4b in 1 (7%). Four of the grade ≥ 3 complications occurred in the mesh group. Median operative time was longer in the mesh group: 200 minutes (177.5-229.5) versus 146 minutes (128-190) (p=0.03) and the success rate was lower: 61% versus 85% (p=0.06). Overall, surgery was successful in 19 patients (73.8%). ConclusionMFLP is a reliable flap in specialized indications after UI and/or POP repair procedures with a higher risk of major complications and a lower success rate in women previously operated with mesh.

Experiences and Outcomes of the Society of Genitourinary Reconstructive Surgeons Fellowship Training: Growth in Fellowships Mirrors the Evolution of the Discipline

ObjectiveTo describe experiences and outcomes of the Society of Genitourinary Reconstructive Surgeons (GURS) fellowship match. In 2012, GURS developed a centralized fellowship match which has grown from 13 to 30 programs. MethodsGURS match statistics and case logs were reviewed from 2013-2024. Additionally, a 37 question survey evaluating satisfaction, procedural competency, fellowship experience, and employment opportunities were sent to graduates. Linear regression was performed to examine trends over time. ResultsOver the study period, program match success remained stable (94.7%;p=0.50) while applicant success (63.3%) increased over time (p=0.04). North American and female applicants experienced higher match success (72.8% and 73.6%) compared to their international (35.5%;p<0.0001) and male counterparts (60.0%;p=0.02). On case log analysis, mean surgical volumes per year increased in urethral reconstruction (mean=88.1;p=0.02), male sexual health (n=32.7;p=0.03), genital reconstruction (mean=16.4;p<0.01) and abdominal reconstruction (mean=24.5;p=0.03). Male incontinence surgeries remained stable (mean=30.5;p=0.21) while female reconstruction declined (mean=23.2;p=0.01). With a survey response rate of 54.5% (97/178), training satisfaction was 95.9% which did not differ by gender (p=0.54) or year of training (p=0.22). 97.9% felt competent to enter unsupervised reconstructive practice, 94.8% reported an understanding of the relevant literature and 96.9% were satisfied with their job as a reconstructive urologist. 49.5% identified a different case mix in practice compared to fellowship, most commonly related to abdominal (44.9%) or genital reconstruction (16.3%). ConclusionGURS fellowships have grown organically over the last decade and mirror the growth and evolution of the discipline with sustained high-levels of graduate satisfaction, surgical experience, competence, scholarly inquiry and employment.

Outcome of Post-prostatectomy Incontinence Surgery in Men With Preoperative Idiopathic Detrusor Overactivity

Outcome of Post-prostatectomy Incontinence Surgery in Men With Preoperative Idiopathic Detrusor Overactivity

Efficacy and Complications of Mitrofanoff Continent Urinary Diversion in Adults with Complex Urethral Strictures: A Single-Center Experience.

The management of complicated and irreparable urethral strictures can be challenging, and continent urinary diversion has emerged as a viable option. This study aims to investigate the complications associated with continent urinary diversion using the Mitrofanoff principle in patients with complex urethral strictures that cannot be corrected through urethroplasty surgery. A total of 22 patients were included in this study, who underwent continent urinary diversion surgery using the Mitrofanoff technique. The patients were monitored for post-surgical complications over an average follow-up period of 28.36±14.26 months. Surgical failure was defined as the inability to completely and regularly empty urine from the new urinary tract. Half of the patients experienced surgical complications, with only one case resulting in surgery failure. The most common complication observed was stoma stenosis. Two patients reported slight urinary leakage from the stoma site. Notably, all patients except one, regained control over their urine after the procedure. Early therapeutic interventions were classified according to the Clavien-Dindo grading system, showed that none of the patients experienced severe complications (grade 4 or 5). The study examines the outcomes of continent urinary diversion using the Mitrofanoff technique in adults with complex urethral strictures, providing realistic expectations of complications. Overall, the study shows that this approach is a viable option with a high success rate and manageable complication for individuals with complex urethral strictures that cannot be corrected through urethroplasty surgery.

Single Incision Sling Surgery for Female Stress Urinary Incontinence: A Retrospective Cohort Single-Institution Study.

Background: Stress urinary incontinence (SUI) affects around 35% of adult women and has a significant impact on quality of life. A single incision sling (SIS), such as Altis®, was introduced to improve original slings and avoid complications. The present study aimed to evaluate the SIS Altis® subjective and objective cure rates of women with SUI, mixed urinary incontinence (MUI), recurrent SUI, and SUI with concomitant prolapse and report its complications from one single medical center. Methodology: A retrospective cohort, unsponsored study was conducted at the Jordan University Hospital. All women patients were treated with the SIS Altis® procedure, and prolapse procedures were also completed as necessary. The chi square analysis for the cure rates was conducted between the subgroups. Results: From June 2016 to June 2019, 111 women patients with a mean age of 48.0 ± 11.3 years underwent a SIS Altis® procedure. The overall outcome resulted in 81% and 85% of patients being subjectively and objectively cured. The subjectively cured MUI patients were significantly fewer than SUI patients (70% versus 86%, p < 0.05), and patients with recurrent SUI had significantly lower rates (56% for subjective and objective cure rates; p < 0.01 and 0.001). Of the 44 patients who underwent SIS Altis® and concomitant vaginal repair surgery, no significant differences in subjective and objective cure rates were observed. Only 2.7% of women had mild pain, 2.7% had vaginal tape erosion, and 9% had to be re-operated on. Conclusions: The Altis® procedure is effective in women who suffer from SUI for a 19-month follow-up period. However, recurrent SUI patients had lower subjective and objective cure rates than primary SUI patients. Further research is needed with a larger sample size in a prospective study design to determine the effectiveness of single SIS in patients with recurrent SUI.

Virtual Compared With In-Office Postoperative Visits After Urogynecologic Surgery: A Randomized Controlled Trial.

To compare patient satisfaction, health care resource utilization, and adverse events among patients receiving a virtual video compared with in-office postoperative visit after urogynecologic surgery. We hypothesized that virtual video visits would be noninferior to in-office visits. This was a randomized noninferiority clinical trial of patients undergoing surgery for pelvic organ prolapse and urinary incontinence at a single academic tertiary referral center. Participants were randomized to receive either a virtual video postoperative visit or a standard in-office postoperative visit. The primary outcome was patient satisfaction measured by the validated PSQ-18 (Patient Satisfaction Questionnaire-18) (noninferiority margin 5 points) at the 6-week postoperative visit. Secondary outcomes included PSQ-18 domain scores (noninferiority margin 0.5 points) and composite health care resource utilization and adverse events after the 6-week postoperative visit up to 12 weeks after surgery (noninferiority margin 10%). A sample size of 100 participants (50 per group) would allow 80% power to assess a 5-point noninferiority margin on the total PSQ-18 with an SD of 10 and α=0.05. From January 2023 to September 2023, 265 patients were screened for eligibility, and 104 were randomized. A total of 100 participants (50 per arm) completed the study and were included in the analysis. The mean±SD age of all participants was 57.0±13.2 years. The mean±SD PSQ-18 total score was 75.18±8.15 in the virtual group and 75.14±8.7 in the in-office group. The mean PSQ-18 total score was 0.04 points higher (ie, greater degree of satisfaction) in the virtual group, with a 95% CI of -2.75 to 2.83, which met the criterion for noninferiority. Between-group differences for all PSQ-18 domain scores likewise met criterion for noninferiority. Composite health care resource utilization was 14.0% lower in the virtual group than in the in-office group (20.0% vs 34.0%, 95% CI, -28.0% to 1.0%). For composite adverse events, the between-group difference was 2.0% (2.0% in virtual group vs 0.0% in in-office group, 95% CI,-3.0% to 8.0%). Virtual video postoperative visits were noninferior to in-office visits with regard to patient satisfaction, health care resource utilization, and adverse events and can be offered as an alternative to in-office visits for postoperative follow-up after urogynecologic surgery. ClinicalTrials.gov, NCT05641077.

The future of male stress urinary incontinence surgery

The future of male stress urinary incontinence surgery

Evaluation of a Patient-Centered Perioperative Curriculum: A Pilot Study

Objectives: To evaluate a standardized patient perioperative education curriculum for women undergoing pelvic reconstructive surgery. Materials and Methods: We performed a feasibility study to examine the practicality of a group-based, perioperative patient-centered educational curriculum (PPEC). Adult (≥ 18 years) English-speaking women undergoing surgery for pelvic organ prolapse (POP) and/or stress urinary incontinence (SUI) at a single center from February 2020 to March 2020 were approached to complete a PPEC session instead of receiving usual perioperative counseling. In-person PPEC sessions were facilitated by one Registered Nurse and attended by 2-4 patients and their support people 2 weeks before surgery. Patients undergoing SUI and POP surgeries were combined in each session. Recruitment was halted prematurely due to the COVID-19 pandemic. The content of the PPEC incorporated information about health optimization, details regarding the day of surgery, and instructions for postoperative care including pain, urinary and bowel management. A questionnaire assessing six aspects of patient preparedness was completed prior to (pre) and immediately following (post) course completion. Each question was self-rated on a scale of preparedness from 0 (not at all) to 10 (proficient). The primary outcome was change in self-assessed patient preparedness for pelvic reconstructive surgery. Median and interquartile range of pre- and post-course scores for each question are reported and the Wilcoxon matched pairs signed rank test was used to test significance of differences. Results: A total of 16 patients were included in this pilot study. Patient preparedness was significantly improved among all domains for patients who completed the PPEC session. Prior to PPEC, patients self-reported they were most prepared in how to be healthy for surgery. The greatest difference in pre- to post-PPEC preparedness self-reported scores was in what to expect during hospital admission. Conclusion: Our novel approach to perioperative counseling through a standardized educational curriculum offered to mixed groups of patients undergoing SUI and/or POP surgery was associated with significant improvements in patient preparedness for surgery.