Midurethral Sling Surgery Research Articles

Comparison of three different midurethral sling operations using urodynamic evaluation

Comparison of three different midurethral sling operations using urodynamic evaluation

Risk Factors for Urinary Tract Infection following Mid Urethral Sling Surgery

Mid urethral sling surgery is common. Postoperative urinary tract infection rates vary in the literature and independent risk factors for urinary tract infection are not well defined. We sought to determine the incidence of and risk factors for urinary tract infection following mid urethral sling surgery. A retrospective cohort of females who underwent sling surgery was captured from the 2006 to 2014 NSQIP® (National Surgical Quality Improvement Program®) database. Exclusion criteria included male gender, nonelective surgery, totally dependent functional status, preoperative infection, prior surgery within 30 days, ASA® (American Society of Anesthesiologists®) Physical Status Classification 4 or greater, concomitant procedure and operative time greater than 60 minutes. The primary outcome was the incidence of urinary tract infection within 30 days of mid urethral sling surgery. Risk factors for urinary tract infection were assessed by examining patient demographic, comorbidity and surgical variables. Logistic regression analyses were performed to estimate the ORs of individual risk factors. Multivariable logistic regression was then performed to adjust for confounding. A total of 9,022 mid urethral sling surgeries were identified. The urinary tract infection incidence was 2.6%. Factors independently associated with an increased infection risk included age greater than 65 years (OR 1.54, 95% CI 1.07-2.22), body mass index greater than 40 kg/m2 (OR 1.89, 95% CI 1.23-2.92) and hospital admission (OR 2.06, 95% CI 1.37-3.11). Mid urethral sling surgery performed by urologists carried a reduced risk of infection compared to the surgery done by gynecologists (OR 0.52, 95% CI 0.40-0.69). The urinary tract infection risk following mid urethral sling surgeryin NSQIP associated hospitals is low. Novel patient and surgical factors for postoperative urinary tract infection have been identified and merit further study.

012 Meta-Analysis of Orgasmic and Overall Sexual Function Post Mid-Urethral Sling Surgery

012 Meta-Analysis of Orgasmic and Overall Sexual Function Post Mid-Urethral Sling Surgery

Current Practices in the Surgical Management of Female Stress Urinary Incontinence: A Survey of Canadian Urologists and Gynecologists

IntroductionWe assessed the practices of urologists and gynecologists who manage stress urinary incontinence surgically to examine the impact of the FDA (U.S. Food and Drug Administration) and/or Health Canada statements on pelvic floor mesh. We also determined how urologists and gynecologists manage recurrent stress urinary incontinence and complications of mesh mid urethral slings. MethodsWe conducted an online survey of urologists and gynecologists who were members of the Canadian Urological Association or Society of Obstetricians and Gynaecologists of Canada. ResultsMid urethral sling was the most common surgery for stress urinary incontinence performed by urologists and gynecologists (100% vs 84%, p=0.0002). The majority of respondents (87%, 119 of 137) were aware of the FDA and/or Health Canada statements and 66% of physicians altered the way they counseled patients before mid urethral sling surgery. An equal proportion of urologists and gynecologists altered their surgical management of stress urinary incontinence due to patient concerns (31% vs 36%) and due to FDA and/or Health Canada statements (16% vs 13%). Repeat mid urethral sling was the most common method of treating recurrent stress urinary incontinence and urologists were more likely than gynecologists to manage complications of mid urethral sling (58% vs 41%, p=0.0286). Chronic pain (33%) and vaginal mesh erosion (26%) were the most common concerns overall. ConclusionsMid urethral sling was reported as the most commonly performed surgery for stress urinary incontinence by urologists and gynecologists after the FDA and Health Canada statements. Both groups altered their surgical practices most commonly due to patient concerns, indicating that negative media attention is impacting the way in which urologists and gynecologists practice when surgically managing stress urinary incontinence in Canada. Variation exists between urologists and gynecologists when it comes to managing complications related to mid urethral sling.

Five years after midurethral sling surgery for stress incontinence: obesity continues to have an impact on outcomes.

The objective was to evaluate the impact of preoperative body mass index ≥30 on objective and subjective cure rates 5years after midurethral sling surgery. Secondary analysis of the 5-year results of a randomized clinical trial evaluating tension-free vaginal tape vs transobturator tape surgery. Women (n = 176) were classified as obese or non-obese based on preoperative height and weight. Women self-reported symptoms and quality of life, and underwent standardized physical examinations and pad-testing. Categorical data were analyzed using Chi-squared or Fisher's exact tests, continuous data by Mann-Whitney U test. Primary outcome was objective cure defined as <1g urine lost on pad-test at 5years post-surgery. Secondary outcomes were subjective cure of incontinence, urinary urge incontinence symptoms, and quality of life scores. Non-obese women had a higher rate of objective cure, 87.4% (n = 83 out of 95) compared with 65.9% (n = 29 out of 44) in the obese group (P = 0.003, risk difference [RD] 21.5%, 95% CI 5.9-37.0%). Subjectively, non-obese women also reported higher rates of cure, 76.7% (n = 89 out of 116) compared with 53.6% (n = 30 out of 56) of obese women (P = 0.002, RD 23.2%, 95% CI 8.0-38.3%). Overall rates of urge incontinence symptoms were similar in the two groups, but rates of bothersome symptoms were higher for obese women (58.9% vs 42.1%, P = 0.039, RD 16.8% 95% CI 1.1-32.6). Fiveyears after surgery, obese women continued to experience lower rates of cure compared with non-obese women.

The Impact of Midurethral Sling Surgery on Sexual Activity and Function in Women With Stress Urinary Incontinence

IntroductionStress urinary incontinence has a negative impact on sexual function. AimTo assess the effect of midurethral sling surgery on sexual activity and function in women with stress urinary incontinence. MethodsThis is a secondary analysis of the Value of Urodynamics Prior to Stress Incontinence Surgery (VUSIS-II) study, which assessed the value of urodynamics in women with (predominantly) stress urinary incontinence. Patients who underwent retropubic or transobturator sling surgery were included in the present study if information was available on sexual activity before and 12 months after surgery. Data were collected from a self-report validated questionnaire combined with non-validated questions. The association between midurethral sling surgery and sexual function (coital incontinence, satisfaction, and dyspareunia) was compared with McNemar χ2 tests for nominal data and paired t-tests for ordinal data. Potentially influential factors were analyzed with univariable and multivariable logistic regression analyses. Main Outcome MeasuresChanges in sexual activity and sexual function after midurethral sling surgery. ResultsInformation on sexual activity was available in 293 of the 578 women (51%) included in the VUSIS-II study. At baseline, 252 of 293 patients (86%) were sexually active vs 244 of 293 (83%) after 12 months. More patients with cured stress urinary incontinence were sexually active postoperatively (213 of 247 [86%] vs 31 of 46 [67%], P < .01). There was a significant decrease in coital incontinence (120 of 236 [51%] preoperatively vs 16 of 236 [7%] postoperatively, P < .01). De novo dyspareunia was present in 21 of 238 women (9%). There was a greater improvement in coital incontinence after placement of the retropubic sling compared with the transobturator sling (odds ratio = 2.04, 95% CI = 1.10–3.80, P = .02). ConclusionThese data show that midurethral sling surgery has an overall positive influence on sexual function in women with stress urinary incontinence. The retropubic sling is more effective than the transobturator sling for improvement of coital incontinence. De novo dyspareunia was present in 1 of 11 women.

Characterization of Lower Urinary Tract Symptoms Before and After Midurethral Sling Revision

Study ObjectiveTo characterize outcomes in women undergoing surgical revision of a midurethral sling and characterize factors associated with satisfaction of revision. DesignRetrospective cohort study (Canadian Task Force classification II-3). SettingA urogynecology clinic at a large academic referral center. PatientsWomen undergoing surgical revision of synthetic mesh midurethral sling (index surgery). InterventionsChart review was performed to obtain baseline clinicodemographic information, operative notes, urodynamic parameters, and symptom-specific distress and impact questionnaire data. Eligible women were then sent follow-up questionnaires that assessed reasons for index surgery, presence of dyspareunia, symptom-specific distress and impact, and satisfaction after mesh midurethral sling surgery. Measurements and Main ResultsOf 144 eligible women, 69 (47.9%) responded, 15 (10.4%) declined participation or were deceased, and 59 (41.6%) did not respond. The mean time from index surgery was 22.2 ± 14.0 months. Women with transobturator slings were more frequently revised for vaginal exposure (p = .003), whereas women with retropubic slings were more frequently revised for voiding dysfunction (p < .0001). Sixty-four percent of women were satisfied with surgery. Satisfied women had more improvement in pain (p = .04), dyspareunia (p < .001), and Patient Global Impression of Improvement questionnaire scores (p < .0001). Multivariable analysis showed that satisfaction decreased with increasing years in age (adjusted odds ratio = 0.95; 95% confidence interval, 0.90–0.99). ConclusionWomen who were satisfied with sling revision were younger and more likely to have resolution of pain and dyspareunia and improved Patient Global Impression of Improvement scores. This information may help to inform patients regarding expectations with regard to sling revision.

Results of collagen sling placement following the partial removal of a synthetic midurethral sling

ObjectiveTo assess results of placement of the Pelvilace collagen sling following partial removal of a primary synthetic sling because of late complications. MethodsA retrospective study was undertaken of patients with late complications after midurethral sling surgery who underwent placement of a Pelvilace sling at a center in the Netherlands between January 2006 and January 2011. A postoperative questionnaire was used to evaluate the continence status and continence-related quality of life. Patients scoring 0 in the Urogenital Distress Inventory stress symptoms section were considered cured. The subjective improvement or deterioration in symptoms was scored using the Patient Global Impression of Improvement (PGI-I). ResultsThe questionnaire was completed and returned by 32 (84%) of 38 patients after a mean follow-up of 54.3 months. Nine (28%) patients were deemed cured. Among 29 patients who had not undergone a third surgery, the PGI-I showed a postoperative improvement in 14 (48%). The other 15 patients rated their postoperative situation as little improved, unchanged, or deteriorated. Further subanalysis showed clear differences in postoperative results between the different types of late complications (erosion and/or displacement). ConclusionThe concomitant placement of a collagen sling following partial removal of a primary polypropylene sling shows reasonable results for specific complications.

Sling mobilization in the management of urinary retention after mid‐urethral sling surgery

To compare intermittent catheterization, sling mobilization, and sling transection for treatment of urinary retention after mid-urethral sling surgery. Data registered in the Norwegian Female Incontinence Registry from 1998 to 2013 were analyzed in this cohort study to compare subjective and objective outcomes after intermittent catheterization, sling mobilization, and sling transection as management of postoperative urinary retention after mid urethral sling surgery. Subjective outcomes were degree of symptom bother and the percentage of women stating "very satisfied" at the postoperative follow-up. The objective outcome was leakage at a cough-jump pad stress test. Intervention due to urinary retention was performed in 585 of 18,772 women (3.1%). Women who had their sling mobilized or had intermittent catheterization, scored better on all postoperative outcomes than those who had their sling transected (P < 0.001). Sling transection was more often needed after intermittent catheterization than after mobilization (P = 0.023). No outcome differences were found between intermittent catheterization only and sling mobilization only. Intention to treat analysis showed that women who underwent sling mobilization as the primary procedure significantly more often had a negative stress test (P = 0.033) and were more often "very satisfied" with the treatment (P = 0.006) than those who were primarily catheterized. Sling mobilization is a more successful treatment than intermittent catheterization or transection for urinary retention after mid-urethral sling surgery. Clinical trial registration was not applicable because this study is based on an analysis of anonymous data from The Norwegian Female Incontinence Registry. Neurourol. Urodynam. 36:1091-1096, 2017. © 2016 Wiley Periodicals, Inc.

017 Meta-Analysis of Orgasmic and Overall Sexual Function Post Mid-Urethral Sling Surgery

017 Meta-Analysis of Orgasmic and Overall Sexual Function Post Mid-Urethral Sling Surgery

The effect of major depression on quality of life after surgery for stress urinary incontinence: a secondary analysis of the Trial of Midurethral Slings

Depression has been associated with symptom amplification, functional impairment, and lower incontinence-specific quality of life in women with urinary incontinence. Although depression has been shown to impact both subjective and objective outcomes after many different surgeries, there are limited data on the effects of major depression on postoperative outcomes after antiincontinence surgery. The purpose of this study was to determine whether major depression affects urinary incontinence severity and quality of life after midurethral sling surgery. This was a secondary analysis of the Trial of Midurethral Slings. Participants were assigned randomly either to a retropubic or transobturator sling for stress urinary incontinence. Each was classified as having major depression or not by the validated depression screening Patient Health Questionnaire-9. Pre- and postoperative urinary incontinence severity (which was assessed by the International Consultation on Incontinence Questionnaire), urinary incontinence-specific quality of life (which was assessed by the Incontinence Impact Questionnaire and the Urinary Distress Inventory), and sexual function (which was assessed by the Prolapse/Urinary Incontinence Sexual Questionnaire) was compared between groups at baseline and at 12 months. Five hundred twenty-six patients were included: 79 patients (15%) had major depression before surgery; 447 patients (85%) did not. Baseline incontinence severity was higher in women with major depression than in those without (International Consultation on Incontinence Questionnaire, 14.7 ± 4.1 vs 12.9 ± 4.0; P < .001). Similarly, baseline quality of life and sexual function were worse in depressed women than in nondepressed women (Incontinence Impact Questionnaire, 235.6 ± 95.8 vs 134.8 ± 89.8; P < .001; Urinary Distress Inventory, 162.7 ± 46 vs 128.6 ± 41.3; P < .001; and Prolapse/Urinary Incontinence Sexual Questionnaire-12, 27.2 ± 7.3 vs 33.9 ± 6.4; P < .001). After adjustment for differences between groups, baseline major depression did not negatively affect 12-month incontinence severity or quality of life. However, at 12 months after surgery, despite significant improvement in sexual function scores in depressed women, the 12-month scores were still significantly worse in the major depression group (Prolapse/Urinary Incontinence Sexual Questionnaire-12, 34.1 ± 7.1 vs 37.7 ± 6.1; P<.001); multivariable analysis showed independent association of baseline major depression with 12-month sexual function. At 12 months, 83% of those women (66/79) with baseline major depression were no longer depressed. Women with major depression who are planning surgery for stress urinary incontinence have worse quality of life than nondepressed women. However, women with major depression improve significantly more than those without major depression such that, at 12months postoperatively, incontinence severity and quality of life are notdifferent between groups. Sexual function is worse before and after theoperation for depressed women.

Preoperative Urodynamic Parameters (Valsalva Leak Point Pressure and Maximum Urethral Closure Pressure), Urinary Collagen and Plasma Vitamin D Levels as Predictors of Mid Urethral Sling Surgery Outcome

To determine the best predictor of the mid urethral sling outcome we calculated the AUC of ROC curves of preoperative parameters, including Valsalva leak point pressure, maximum urethral closure pressure, urinary NTx (N-telopeptide of crosslinked type I collagen) and plasma vitamin D values (D2, D3 and D2 plus D3). This was an ancillary study of TOMUS (Trial of Mid-urethral Slings) and the ValUE (Value of Urodynamics Evaluation) trial in which subjects underwent mid urethral sling surgery for stress urinary incontinence. Valsalva leak point pressure and maximum urethral closure pressure were measured in 427 subjects, whereas NTx, vitamin D2, vitamin D3 and vitamin D2 plus D3 levels were obtained from 150, 116, 115 and 116 subjects respectively. Outcome success was defined using identical outcome (subjective and objective) variables for all subjects. ROC curves with corresponding AUC values were compared. TOMUS and ValUE subjects were significantly different in age, body mass index, UDI (Urogenital Distress Inventory) scores. TOMUS subjects had alower surgical success rate compared to ValUE subjects (66.3% vs 76.0%, p=0.03). The AUC values of Valsalva leak point pressure, maximum urethral closure pressure, NTx, and vitamins D2, D3 and D2 plus D3 were 0.542, 0.561, 0.702, 0.627, 0.645 and 0.640, respectively. The AUC of NTx was significantly higher than the AUCs of Valsalva leak point pressure and maximum urethral closure pressure (p = 0.02 and 0.03, respectively). Urinary NTx was the best predictor of the mid urethral sling outcome. This test is not only noninvasive, it is also modifiable. Finding ideal modifiable risk factors prior to mid urethral sling surgery should be subject to future investigations.

Should maximal urethral closure pressure be performed before midurethral sling surgery for stress incontinence? A time to revisit.

Maximum urethral closure pressure (MUCP) provides an objective assessment of urethral integrity, but its role in predicting outcome after midurethral sling (MUS) placement is debatable and current practice in the UK is variable. The study was carried out to determine if lower preoperative MUCP is associated with poor outcome following MUS. The study was a retrospective review of the British Society of Urogynaecology (BSUG) database and urodynamics (UDS) data. Patients who reported outcome as "no improvement", "worse" or "much worse" on the Patient Global Impression of Improvement (PGII) scale were identified as having a poor outcome. Patients who reported "a little improvement", "improved" and "very much improved" on the PGII were thought to have a good outcome. The preoperative demographics, UDS findings and quality of life (International Consultation of Incontinence questionnaires [ICIQ-SF]) data of the two groups were compared. A total of 236 women were identified for the study. Of these, 24 women (10.2%) had a poor outcome. Of the remaining women reporting a good outcome, 50 cases were randomly selected. All urodynamic parameters, including mean functional urethral length (FUL), bladder capacity, and Qmax, were similar, except for mean MUCP 37.05 cm H2O, which was significantly lower in group 1 (poor outcome 37.05cm H2O) compared with a mean MUCP of 50.6 cm H2O in group 2 (good outcome; p = 0.005). We conclude that failure following MUS is associated with preoperatively lower MUCP, which can be used as a predictor of failure.

Effect of Midurethral Sling Surgery on Vaginal Sensation.

Previous studies have reported changes in the sensory functioning of the vagina in women with pelvic floor disorder. To evaluate vaginal and clitoral sensation before and after surgery with trans-obturator tape (TVT-O, Ethicon Johnson & Johnson). Quantitative sensory thresholds for warm, cold, and vibratory sensations were measured at the vagina and clitoris 1 day before and 12 ± 4 months after surgery. Differences in thresholds to warm, cold, and vibratory sensations at a predetermined anatomic area of the genital region. Twenty-two women were admitted for midurethral sling surgery, and four were lost to follow-up. For the remaining 18 (mean age= 52 years, range= 37-65), we found a significant sensory decrease at the clitoral region to cold, warm, and vibratory stimuli after surgery. In contrast, in the anterior vaginal wall, there was a significant decrease only to warm stimuli after surgery. TVT-O can cause sensory loss in the clitoral and anterior vaginal wall region that can be measured and quantified. The effect of such sensory loss on sexual function and quality of sexual life needs further investigation.

Urgency Incontinence before and after Revision of a Synthetic Mid Urethral Sling

We evaluate urgency urinary incontinence outcomes for patients who underwent revision of a presumed obstructing synthetic mid urethral sling and examine risk factors for persistent or de novo symptoms after surgery. From February 1, 2005 to June 1, 2013, 107 women underwent sling revision for new or worsening lower urinary tract symptoms after synthetic mid urethral sling surgery. Patients were grouped based on urgency urinary incontinence symptoms and characteristics associated with persistent or de novo symptoms after revision were examined using logistic regression models. Median followup was 29 months (IQR 12-54) and time to revision was 21 months (IQR 5-48). Patients presenting for sling revision with urgency incontinence (68) were more likely to experience a more than 6-month delay to revision vs those presenting with obstructive voiding symptoms (39) (OR 3.25, 95% CI 1.33-7.92, p <0.01). After revision urgency incontinence persisted in 76.5% (52 of 68) and was associated with a pre-revision need for anticholinergic medication (OR 5.58, 95% CI 1.44-21.39, p=0.01) and smoking (OR 5.21, 95% CI1.21-22.49, p=0.03). De novo urgency incontinence developed in 43.6% (17 of 39) of patients and was associated with de novo stress incontinence (OR 15.9, 95% CI 3.2-78.3, p <0.01). Women with post-revision urgency incontinence (denovo or persistent) had higher Urogenital Distress Inventory-6 scores than patients with no or resolution of urgency incontinence. Patients presenting with new or worsening urgency urinary incontinence after sling placement were more likely to undergo delayed revision compared to those presenting with obstructive voiding symptoms. There is a high rate of bothersome persistent and de novo urgency incontinence after sling revision. Patient expectations should be managed accordingly before sling revision.

Risk factors for failure of repeat midurethral sling surgery for recurrent or persistent stress urinary incontinence.

To study the outcomes following repeat midurethral sling (MUS) surgery in patients with persistent or recurrent stress urinary incontinence after failure of primary MUS surgery and risk factors for surgical failure. The medical records of 24 patients who underwent repeat MUS surgery at a single tertiary center from January 2004 to February 2014 were reviewed. The types of MUS used for the repeat surgey were transobturator, retropubic and single incision slings. Objective cure was defined as no demonstrable involuntary leakage of urine during increased abdominal pressure in the absence of a detrusor contraction observed during filling cystometry, and subjective cure was defined as a negative response to Urogenital Distress Inventory six (UDI-6) question 3 during follow-up between 6months and 1year postoperatively. The change in the inclination angle between the urethra and pubic axis was measured with introital ultrasonography and the cotton swab test performed. The objective and subjective cure rates were 79.2% and 75%, respectively. There were no differences in demographics between the patients with failure of surgery and those with successful surgery. Significant independent risk factors for failure of repeat MUS surgery were a change in cotton swab angle at restand straining of <30° (OR 4.6, 95% CI 2.5-7.9°), a change in inclination angle of <30° (OR 4.6, 95% CI 2.5-7.9°), intrinsic sphincter deficiency (OR 3.4, 95% CI 1.8-6.1) and a mean urethral closure pressure of <60 cmH2O (OR 2.9, 95% CI 1.5-4.5). In one patient the bladder was perforated. Repeat MUS surgery is safe and has a good short-term success rate, both objectively and subjectively, with independent risk factors for failure related to bladder neck hypomobility and poor urethral function.

Clitoral Pain Following Retropubic Midurethral Sling Placement.

IntroductionAlthough uncommon, postprocedural pain with associated sexual dysfunction may be seen in patients after retropubic midurethral sling placement for treatment of stress urinary incontinence.AimsTo describe a report of a woman who developed localized severe, persistent periclitoral pain after placement of a retropubic midurethral sling.MethodsA healthy 41‐year‐old underwent an uncomplicated retropubic midurethral sling procedure. She developed persistent postoperative clitoral pain with worsening associated with arousal, impairing sexual function. Symptoms resolved with time and a course of steroid medication.Main Outcome MeasuresTo report a case of clitoral pain following midurethral sling surgery, and to provide a discussion about clitoral innervation, possible pain etiologies, and management options.ResultsWe report a case of clitoral pain associated with sexual dysfunction and provide a review of clitoral innervation as well as potential mechanisms of nerve injury associated with a retropubic sling procedure.ConclusionClitoral pain symptoms following placement of a retropubic midurethral sling should be evaluated and promptly addressed, given the potential negative impact on the patient's sexual function. Christofferson M, Barnard J, and Montoya TI. Clitoral pain following retropubic midurethral sling placement. Sex Med 2015;3:346–348.

The Effect of Patient Position during Mid-Urethral Sling Operations on the Postoperative Outcomes of Sling Success: A Randomized Clinical Study

Aims: To determine and compare the effectiveness, peri- and postoperative outcomes of mid-urethral sling (MUS) operations for urinary incontinence, using 2 different patient positions during surgery. Methods: In this study, 146 patients underwent MUS surgery in a urogynecology clinic. Of them, 72 patients underwent the intraoperative surgical procedure of reverse trendelenburg patient positioning for tape adjustment (group 1) and the remaining 74 patients had the routine surgical procedure of MUS surgery (group 2). The primary outcome was the evaluation of postoperative urine leaks, using the stress test, and secondary outcomes were quality of life, using the International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF, Turkish version) and complication rates. Results: There were no significant differences in demographic variables between the 2 groups. The overall cure rates for incontinence in the lithotomy position was 97.22 and 85.13% for groups 1 and 2, respectively, in which group 1 had a statistically significant decrease in urine leak postoperatively (p < 0.05; OR 3.08, 95% CI 2.78-22.14). The postoperative ICQ-SF scores showed no significant difference between the 2 groups (p = 0.19). Conclusion: Applying a 45-degree reverse trendelenburg position for tape adjusting during MUS operation results in a greater objective cure rate compared with the typical dorsolithotomy position; however, there was no difference in the subjective outcome.

Risk of postoperative urinary tract infections following midurethral sling operations in women undergoing hysterectomy.

Urinary tract infections (UTIs) are the most common complication following hysterectomy and mid-urethral sling procedures (MUS). As a MUS is often placed at the time of hysterectomy, we sought to determine if the addition of an MUS procedure significantly increases the risk of UTI in the first 30 days following hysterectomy. This retrospective cohort study utilizes the National Surgical Quality Improvement Program (NSQIP) data bank for the years 2006-2012. The database collects data on all enrolled patients preoperatively and in the first 30 days postoperatively. The database was searched using procedural codes for various types of hysterectomies and MUS procedures. We assessed the incidence of postoperative UTIs following hysterectomy (HYST) only, MUS only, and hysterectomy combined with MUS (HYST + MUS). Adjusted logistic regression analyses were performed to evaluate the effects of individual risk factors and models of interaction. The NSQIP cohort included 3,757 in the HYST + MUS group, 9,851 in the MUS-only group, and 57,398 in the HYST-only group. The rates of postoperative UTI, which was the most common postoperative morbidity, were 5.3, 3.4, and 2.5 % respectively. Multivariate logistic regression analysis showed a persistent significant increase in rates of UTI (p < 0.001) between the MUS + HYST group and the HYST-only group. This significance was not maintained between the MUS-only group and the MUS + HYST group. Data from the NSQIP databank indicate that performing an MUS in combination with hysterectomy nearly doubles the risk of postoperative UTI over a hysterectomy alone.

Influence of anterior vaginal mesh with concomitant mid-urethral sling surgery on stress urinary incontinence: clinical and sonographic outcome.

To clinically and sonographically evaluate the influence of anterior vaginal mesh (AVM) surgery with concomitant mid-urethral sling surgery (MUS) for stress urinary incontinence (SUI). Women with severe symptomatic pelvic organ prolapse (POP) stage III or IV with concomitant SUI were divided into two groups: Group I had transobturator tape (TOT) and AVM surgery and Group II underwent TOT without AVM surgery. Clinical outcome was assessed pre-operatively and 1year post-operatively, while ultrasound evaluations were performed after one year. Objective cure was defined as no urinary leakage demonstrable on provocative filling cystometry. Subjective SUI cure was a negative response to Urogenital Distress Inventory Six (UDI-6) (question 3). A total of 97 women were recruited, 57 in Group I and 40 in Group II. Three women had symptomatic prolapse in Group I and 5 in Group II. There were no differences in the ultrasound and clinical outcomes between women who had mid-urethral slings with and without AVM. Successful SUI outcome was reported in 85 women. Urethral kinking was demonstrable in 50% of successful cases, but none with failed outcomes. Subanalysis among those with successful SUI outcome (n=85) and failure (n=12) revealed the tape, bladder neck and mesh mobility was significantly higher (P<0.001) among those with SUI success. Among women who had MUS, there were no differences in the ultrasound and clinical outcome between those who had AVM or otherwise.