Suburethral Sling Research Articles

Midurethral Sling in the Treatment of Mixed Urinary Incontinence: A Literature Review of Functional Outcomes and Associated Factors

Purpose: To review the functional results of the midurethral sling (MUS) in the management of mixed urinary incontinence (MUI) and provide guidance on patient selection and the potential benefits of concomitant treatments.Methods: A literature review from the past 20 years was conducted from the PubMed database using the terms "mixed urinary incontinence," associated to "sling," "midurethral sling," "suburethral sling," "mid-urethral sling," "sub-urethral sling," and "tension-free vaginal tape".Results: The efficacy of the MUS varies considerably depending on the definition of success used. Stress urinary incontinence resolved in 78 to 100% of patients while urge urinary incontinence (UUI) resolved in 57.4 to 82% of patients at short-term follow up. Overall urinary incontinence (UI) resolved in 58% to 85% during this time. A significant proportion of women report a high degree of satisfaction with this treatment. Long-term studies with follow-up period greater than 36 months revealed a deterioration of the functional outcomes, especially for UUI. Older women with predominant UUI or detrusor overactivity on urodynamics may be at risk for poorer outcomes. Among concomitant treatments studied, OnabotulinumtoxinA injection, ospemifene, physiotherapy, percutaneous tibial nerve stimulation and surgical bladder denervation appears to offer benefits in improving UI. However, the evidence is currently insufficient to recommend their routine concomitant use.Conclusion: MUS is an effective treatment for MUI. Further research is needed to better understand the potential benefits of concurrent treatments and to develop models that can predict outcomes and assist physicians in shared decision making about how to approach the management of MUI.

Tissue-engineered sub-urethral sling with muscle-derived cells for urethral sphincter regeneration in an animal model of stress urinary incontinence.

Stress urinary incontinence (SUI) is a widespread condition affecting more than 200 million people worldwide. Common treatments for this condition include retropubic colposuspension, and pelvic sling methods, which use autologous grafts or synthetic materials to support the bladder neck and urethral sphincter. Although these treatments have a cure rate of over 80%, adverse effects and recurrence may still occur. Several studies have focused on the potential of cell therapy. Muscle-derived cells (MDCs) can be easily obtained from small biopsied striated muscular tissues and possess superior multi-lineage differentiation and self-renewal capacity. Based on the unique characteristics of MDCs and previous favorable results in muscle regeneration, we fabricated a chitosan-gelatin hydrogel sling loaded with MDCs in a rat model of SUI. Leak point pressure and histological indices regarding inflammation, muscular atrophy, and collagen density were assessed to compare the effectiveness of cell injection and cell-laden sling. The level of LPP was significantly reduced in the MODEL group versus the control animals. The LPP level was considerably higher in CELL INJECTION, SLING, and CELL/SLING groups compared to the MODEL group but did not reach the significance threshold. The inflammation rate was significantly lower in the CELL/SLING group compared to the SLING group. The CELL/SLING group showed less atrophy compared to the other experimental groups, indicating that the cells may have higher viability on SLING than through injection. This also suggests that in long-term studies, as the degradation rate of hydrogels increases, the function of cells will become more apparent.

Midurethral sling infectious complications: A systematic review

BackgroundThe French Health Authority (Haute Autorité de santé) and French scientific societies (Collège national des gynécologues et obstétriciens français) recommend the use of midurethral slings as the surgical treatment of choice for stress incontinence due to urethral hypermobility and failure of hygienic diet and pelvic rehabilitation. Within a year of implantation, almost 90% of patients no longer experience stress urinary incontinence. Despite their recognized efficacy, retropubic and/or trans-obturator midurethral sling can expose patients to potentially severe infectious complications. MethodsA comprehensive literature review using Pubmed, Medline, Embase and Cochrane: “stress urinary incontinence”, and/or the following keywords “complications”, “infections”, “abscess”, “prosthetic exposures”, “fistula”, “erosion”, “cellulitis”, “fasciitis” in association with the keywords “midurethral slings”, “suburethral sling”, “tension free vaginal tape” and “trans-obturator tape. In the 330 articles, 61 really dealt with infectious complications following the implantation of synthetic midurethral slings in women. ResultsPreoperative urinalysis and intraoperative antibiotic prophylaxis were rarely reported (n=1 and n=11, respectively). We recorded thirty-six cases of abscess, twenty-one cases of cellulitis, sixteen cases of fistula and forty-one cases of prosthetic exposure. In 95.5% of cases, patients were treated with broad-spectrum antibiotics. Total explantation of the prosthesis was performed in 56% of patients at the initial management, with two-stage explantation performed in 23% of cases, partial explantation was carried out in 12% of cases, and the prosthesis was left in place in 9% of cases. No deaths were recorded. ConclusionTo limit the risk of urinary tract infections and potential prosthetic infections, a prophylactic approach should be adopted by performing a preoperative urinalysis and administering intraoperative antibiotic prophylaxis should be discussed. In the event of prosthetic and/or surgical site infection, broad-spectrum probabilistic antibiotic therapy should be initiated as early as possible until targeted antibiotic therapy. Total explantation of the prosthesis appears to be the most appropriate surgical strategy.

The Use of Disposable Supplies: Measuring Suburethral Sling Surgical Waste by Cost and Weight

(Abstracted from Urogynecology 2024;30:132–137) Throughout the past decade, approximately 10% of total greenhouse gas emissions produced nationally in the United States have originated from the US health care system. Additionally, the carbon footprint of the health care system includes around 5 million tons of annual waste production (around 29 lb per hospital bed per day).

Effect of lower urinary tract conditions on surgical outcomes of different suburethral sling procedures for female stress urinary incontinence.

The suburethral sling procedure has been widely used as the first-line treatment for female stress urinary incontinence (SUI). This study retrospectively compared the long-term surgical outcomes and complications between retropubic and transobturator suburethral sling procedures. From 2010 to 2022, a total of 533 women with SUI underwent retropubic pubovaginal sling (PVS) or transobturator tape (TOT) procedures using a synthetic polypropylene mesh with or without concomitant anterior colporrhaphy. All patients underwent preoperative videourodynamic studies, Valsalva leak point pressure (VLPP), and voiding efficiency (VE). The success rate, postoperative complications, overactive bladder symptoms, transvaginal urethrolysis, and repeat procedures were compared among different surgical procedures. Among the patients, PVS was performed in 251 (47.1%) patients and with colporrhaphy in 58 (10.9%), TOT in 174 (32.6%) and with colporrhaphy in 50 (9.4%). The success rate was 87.4% in the PVS group and 75.4% in the TOT group, with or without colporrhaphy (p = 0.001). Urethrolysis was performed in 4.7% of the patients, and repeat suburethral sling procedures were performed in 8.3%. The overall success rate was significantly lower in TOT group, either with high or low VLPP, or with high or low VE. The rate of persistent OAB was significantly higher in TOT group regardless of VLPP or VE, whereas patients with VE < 90% at baseline had a significantly higher rate of postoperative dysuria. TOT procedures had an inferior long-term success rate than PVS procedures for female SUI. Additionally, no differences in the success rate were observed between patients with different bladder functions, high or low VLPP, and high or low VE.

Evaluation and repair of a complex recurrent urethral diverticulum with calculus formation involving a sub-urethral incontinence sling: a case report

Evaluation and repair of a complex recurrent urethral diverticulum with calculus formation involving a sub-urethral incontinence sling: a case report

An assessment of the relationship between urethral hypermobility as measured by ultrasound and the symptoms of stress urinary incontinence in primiparous women 9-18 months postpartum.

The aim of the study was to estimate the relationship between bladder neck hypermobility as assessed by ultrasound and the occurrence of stress urinary incontinence as measured with the UDI-6 questionnaire in primiparous women 9-18 months postpartum. The study included 100 women 9-18 months after their first delivery, 19% of whom (study group) presented with urethral hypermobility. Ultrasound was used to determine the position and mobility of the bladder neck in order to assess the urethral hypermobility. A vector of ≥15 mm was defined as urethral hypermobility. Symptoms of stress urinary incontinence were assessed using question 3 of the UDI-6 questionnaire, in which the presence of symptoms was defined as a response rated from 1 to 4. We demonstrated a statistically significant relationship between urethral hypermobility and the symptoms of stress urinary incontinence with a statistical significance level of p <0.002. Stress urinary incontinence is a common disorder in women, the pathophysiology of which is not fully understood. It has adverse effects on the quality of life, perception of one's own body and sexual function. Impairment of urethral fixation may play an important role in the pathophysiology of this common form of urinary incontinence. The study showed that urethral hypermobility, as assessed by ultrasound, contributes to stress urinary incontinence, as measured with the UDI-6 score. Although stress urinary incontinence is a multifactorial disorder influenced by anatomical changes and congenital anatomical features, it is easily diagnosed. Suburethral slings are an effective surgical technique; however, the incidence of postoperative voiding dysfunction or recurrent stress urinary incontinence is 10-20%. Therefore, an assessment of anatomical changes in stress urinary incontinence may help individualize the surgical strategy.

Comparison of perioperative adverse events following suburethral sling placement using synthetic mesh, autologous rectus fascia, and autologous fascia lata in a national surgical registry.

To assess and compare 30-day perioperative adverse events following suburethral sling surgery using synthetic mesh, autologous rectus fascia, and autologous fascia lata in women. This was a retrospective cohort study of patients who underwent fascial or synthetic sling placement for stress urinary incontinence between 2008 and 2021 using the American College of Surgeons' National Surgical Quality Improvement Program database. Current Procedural Terminology codes were used to identify patients undergoing each type of sling procedure. Multivariable regression analysis with stepwise regression was used to assess the odds of composite adverse events (e.g., urinary tract infection, surgical site infection, pulmonary embolism, and other reportable events) between cohorts. Of the 41 533 female patients who underwent isolated suburethral sling placement without concurrent procedures, 41 292 (99.4%) received a synthetic mesh sling, and 241 (0.6%) received an autologous facial sling. In the fascial sling cohort, 160 (66.4%) underwent rectus fascia harvest and 81 (33.6%) underwent fascia lata harvest. Sling surgeries involving autologous fascia were associated with increased odds of adverse events compared to those involving synthetic mesh, even after adjusting for confounders (adjusted odds ratio [aOR]: 3.63, 95% confidence interval [CI]: 2.56-5.15). Compared to fascial slings from rectus fascia, slings from fascia lata were associated with increased odds of composite adverse events (aOR: 2.11, 95% CI: 1.03-4.04). However, with the exclusion of urinary tract infections, the adverse event rate was similar between slings using the two fascial harvest techniques (aOR: 1.93, 95% CI: 0.81-4.63). In this retrospective database study, suburethral sling surgeries using autologous fascia were independently associated with a 3.6-fold increase in odds of 30-day perioperative adverse events compared to sling surgeries using synthetic mesh.

Surgical Procedures for the Treatment of Stress Urinary Incontinence (SUI) in the Light of the Updated FDA-Warning and its Effects on Practice Patterns in Germany between 2010 and 2021.

Changes in surgical practice patterns to cure stress urinary incontinence (SUI) became evident after FDA warnings regarding vaginal mesh were issued. The primary aim was to describe nationwide numbers of suburethral alloplastic slings (SAS) inserted in 2010, 2015, 2018 and 2021 in Germany. Secondary, numbers were related to SUI specific non-alloplastic alternatives and bulking agents. Additionally, age distribution and overall inpatient surgeries in women were subject to analysis. Descriptive study utilizing data gathered from the German Federal Statistical Office ( www.destatis.de ). Included were the following procedures of inpatient surgery: A. SAS; B. non-allplastic slings; C. open/laparoscopic colposuspension; D. Bulking agents; overall changes and changes in age distribution (groups of 5-years intervals) are described. Overall, n=3599466 female inpatient procedures were analyzed. There was a considerable decrease of SAS surgeries of 28.49% between 2010 (n=23464) and 2015 (n=16778), and a decrease of 12.42% between 2015 and 2018 (n=14695) and an additional decrease of 40.66% between 2018 and 2021 (n=8720). Over time a 55.03% continuous decrease in non-alloplastic slings was observed (n=725 in 2010 to n=326 in 2021). Open and laparoscopic colposuspension numbers went down with a rate of 58.23% (n=4415 in 2010, n=1844 in 2021). Between 2010 and 2018, only bulking agent procedures increased with a rate of 5.89% from n=1425 to n=1509. There was a considerable decrease in inpatient surgical procedures using SAS. Alternatives not only failed to compensate, but experienced also a major decline.

Current Treatment of Stress Urinary Incontinence by Bulking Agents and Laser Therapy-An Update.

Stress urinary incontinence (SUI) affects around 20% of women. In addition to the established suburethral sling insertion, two less invasive approaches are of interest today: urethral bulking agents and vaginal laser therapy. This review discusses articles through December 2023 identified by a PubMed literature search using the keywords "incontinence" and "bulking" or "laser". Although the two approaches are less effective than sling insertions, there are specific conditions in which one or the other technique is more advantageous. Injecting bulking agents into the urethra only takes some minutes and works without general anesthesia. The method is particularly suited for elderly, frail, or obese patients with multiple comorbidities, but is also applicable for all patients and in combination with other therapies. Generally, the safety profile is good but differs between bulking materials. Two laser types-the Erbium:YAG laser with SMOOTH-mode and the fractional ablative CO2 laser-deliver heat into the tissue to induce tissue tightening and regeneration. Intravaginal laser therapy improves mild to moderate SUI, while studies describe how intraurethral laser therapy is also beneficial for severe SUI. Young women between childbirths, as well as postmenopausal women, may benefit from laser therapy. The method is safe, can be performed on an outpatient basis, and does not require any artificial material.

Analysis of British Columbia practice patterns in the management of female stress urinary incontinence with emphasis on mesh use.

Female stress urinary incontinence (SUI) is common and has a profound impact on quality of life. Suburethral slings are the most common treatment for SUI in this population. These can be placed with synthetic mesh or autologous fascia. Mesh-related complications after midurethral sling procedures are documented in the literature but the risk of complications and reoperation is lower than the use of transvaginal mesh for pelvic organ prolapse repair. In this study, we sought to evaluate local practice patterns of management of female SUI with specific emphasis on mesh use. A survey created by an expert panel was disseminated to respective provincial societies. Sixty-eight percent of respondents offer midurethral slings in their practice but only 60.6% of these respondents would offer surgical removal of the sling if there were complications, such as mesh erosion or pain. A large portion (39.4%) of respondents are performing transobturator slings as compared to retropubic midurethral slings (36.3%) and only 8.5% have removed the leg component associated with the transobturator sling in their practice. Furthermore, compared to most respondents offering midurethral slings (64.8%), only a minority of surgeons offer alternatives: 23.9% of respondents offer periurethral bulking agent injections, 15.5% offer pubovaginal slings, and 12.7% offer retropubic urethropexies. Our study supports that surgeons should continue to review surgical risks and alternative treatment options as part of the surgical consent process. As such, surgeons should be able to offer a variety of surgical approaches to manage female SUI.

Безопасность субуретральной петлевой пластики трансобтураторным доступом у пациенток младше 45 лет

Introduction. Symptoms of stress urinary incontinence develop with age in every third woman. To date, suburethral sling surgery is the «gold standard» treatment for stress urinary incontinence. Sling operation is possible by various approaches, each of them has its own advantages and disadvantages. It is believed that transobturator access is combined with the risks of damage of the obturator vessels, tendons of the adductor muscles of the thigh, branches of the genital and anterior labial nerves. In connection with the above, most authors do not recommend the transobturator access for younger patients. The purpose of the study. To evaluate the efficacy and safety of suburethral sling surgery by transobturator access in patients under 45 years of age suffering from stress and mixed forms of urinary incontinence. Materials and methods. A single-center, retrospective observational study was conducted. The anamnestic data of the patients, efficacy (according to the examination in the chair, questionnaires ICIQ-SF, IIQ-7) and safety (the presence of erosions of the synthetic prosthesis, dyspareunia and chronic pain by examination, survey and questionnaires VAS, ODI) were evaluated. The analysis of the obtained data was carried out using the Microsoft Excel data array processing program. Results. After applying the inclusion and exclusion criteria, 61 patients participated in the study. The subjective effectiveness of the operation was 98.3%, the objective effectiveness was 95%. No erosion of the synthetic prosthetic device was observed in any patient. Chronic pain persisting for more than 1 month was noted in 1 patient (1.7%). Complaints of dyspareunia were also noted in only 1 patient (1.7%). Conclusion. The obtained results indicate the high efficiency and safety of transobturator access, and allow us to conclude that the use of transobturator access as a technique for primary implantation of a suburethral sling in young patients is justified.

The Evaluation of the Effect of Suburethral Transobturator Sling on the Urethra Using Ultrasound Examination

Abstract Background Despite the use of suburethral tapes for many years, the mechanism of their action and the reasons for their failures have not been thoroughly understood. Objectives The aim of this study was to analyze the impact of the TOT tape on changes in urethral mobility depending on its location. Additionally, the urethral funneling was evaluated. Material and methods 57 patients with SUI symptoms had TOT implanted. Ultrasound examinations were performed before and 3–6 months after surgery, among others, urethral length, suburethral tape location, bladder neck mobility, and urethral funneling were evaluated. Results 77.2% of patients were cured, while 22.8% were not cured. After tape insertion, a reduction in bladder neck mobility parameters was observed in the group of patients with preoperative hypermobile urethras, regardless of the therapeutic outcome. The average distance of the tape from the hypoechoic area of the urethra was smaller in cured patients, while the relative tape position did not differ significantly between cured and not cured women. Before surgery, all patients had a long urethral funneling. Postoperatively, all non‑cured patients had a long funneling, while in cured patients, no long urethral funneling was observed. Conclusions The TOT suburethral tape reduced urethral mobility to a similar extent in cured and not cured women. The effect on UM was noticeable in patients with preoperative hypermobile urethrae. The obtained TOT tape locations did not affect the degree of UM reduction. Patients in whom the TOT tape was located closer to the hypoechoic zone of the urethra had a greater chance of effective elimination of SUI symptoms. It was confirmed that the assessment of the urethral funneling during PFS ‑TV may be useful for confirming SUI and for assessing the effects of SUI treatment after suburethral tape implantation.

Evaluating Patient Preferences and Clinical Outcomes in Stress Urinary Incontinence Treatment: A Short-Term Follow-Up Study of the Transobturator Tape Procedure and Pubourethral Ligament Plication (a Minimally Invasive Technique).

This study aims to provide an in-depth analysis of patient preferences and clinical outcomes associated with two surgical techniques for treating stress urinary incontinence (SUI): the transobturator suburethral sling (TOT) procedure and the pubourethral ligament plication (PUL) procedure. We evaluated the rates of postoperative complications, the duration of each procedure, hemoglobin loss, and days of hospitalization. This prospective study included 80 patients who underwent surgery for SUI: 40 patients for the TOT procedure and 40 patients for the PUL procedure. Clinical data on patient characteristics, treatment efficacy, and post-surgical outcomes were analyzed to assess patient preferences and real-world clinical effectiveness. Regarding patient preferences, those who underwent TOT surgery were more likely to be older, had a higher average number of pregnancies, and were more often postmenopausal, in contrast to those who underwent PUL surgery (p < 0.001 for each comparison). TOT patients had a hospital stay on average of 1.02 days, while PUL patients benefited from ambulatory stays only. In addition, the TOT group had a significantly longer average operating time (16.80 min) compared to the PUL group (9.90 min, p < 0.001). The study revealed notable outcomes in both groups, with high cure rates for both TOT (N1 = 33, 82.5%) and PUL (N2 = 28, 70%) procedures. Specifically, 76.25% of the patients (61 out of 80) were cured after the procedures. Chronic pelvic pain was present in 3.75% of all patients and was notably only observed in the TOT group, with 3 (7.5%) cases being noted. Similarly, vaginal erosion was experienced by 5% of all patients, with 10% of patients in the TOT group and none in the PUL group being affected. Dyspareunia occurred in 2.5% of all patients, with there being two (5%) cases in the TOT group and none in the PUL group. This study highlights that while the PUL procedure achieves cure rates comparable to TOT, it offers a less invasive option with shorter operating times and no hospitalization required. These findings suggest that PUL could be a viable alternative for stress urinary incontinence (SUI) treatment, especially in contexts where avoiding mesh use is preferred. This adds significant value to patient-centered care in SUI management, offering tailored treatment options based on patient characteristics, preferences, and risk profiles.

Second Suburethral Sling Implantation for the Recurrent Urinary Incontinence after Radical Prostatectomy when First Sling Surgery was Non-Effective: Case Report

Stress urinary incontinence is a complication after radical prostatectomy. The suburethral sling implantation operation is often performed for mild to moderate male urinary incontinence after radical prostatectomy. There are non-adjustable suburethral slings that are effective up to 73.7% and adjustable slings that are effective up to 92%. We present a case report of a 62-year-old man who underwent radical prostatectomy due to prostate cancer in 2018 and experienced moderate degree urinary incontinence. After non-effective conservative treatment in 2020-02-27, the suburethral transobturator sling implantation was performed in another hospital, but it did not yield effective results. After further examinations in 2023-03-25, an adjustable ATOMS system suburethral male sling implantation was performed and it was effective. 2023-05-03 ATOMS system was adjusted and after this there was no urinary incontinence. ATOMS system is an effective surgical method for the treatment of male recurrent urinary incontinence or for cases where the initial sling implantation has failed.

EP34.18: Postoperative ultrasound of suburethral slings: a preliminary study

EP34.18: Postoperative ultrasound of suburethral slings: a preliminary study

Efficacy of single and repeated transurethral bladder neck incisions for female voiding dysfunction.

This study aimed to assess the efficacy of single and repeat transurethral bladder neck incision (TUI-BN) for female voiding dysfunction caused by bladder outlet obstruction (BNO). Further, the predictive factors associated with better treatment outcomes were identified. Women with voiding difficulty due to BNO who underwent TUI-BN were included in this research. All patients underwent videourodynamics study at baseline and after TUI-BN. Successful outcome was defined as a voiding efficiency of ≥ 66.7% and a global response assessment score of ≥ 2 after treatment. Repeat TUI-BN was considered for patients with insufficient improvement. The outcomes of repeat surgery, surgical complications, and predictive factors of successful outcomes were evaluated. In total 158 cases, the success rates were 61.4% and 45.2% after the first and second TUI-BN, respectively, with an overall cumulative rate of 70.3%. The success rates were comparable between patients with detrusor underactivity (DU) and those without (54.9% vs. 68.4%). The absence of a previous history of suburethral sling and a high baseline corrected maximum flow rate were a significant predictor of favorable outcomes. The cumulative rate of regaining self-voiding function was 95.1%. The incidence rates of vesico-vaginal fistula and de novo stress urinary incontinence requiring surgery were 1.2% and 2.5%, respectively. Regardless of the presence of DU, TUI-BN is effective against female voiding dysfunction caused by BNO. Repeat procedures are beneficial and can improve self-voiding function. A high corrected maximum flow rate and the absence of a previous history of suburethral sling can contribute to greater success rates.

Low detrusor contractility has a less favorable outcome of anti-incontinence surgery for women with stress urinary incontinence.

Few studies exist comparing the effect of different lower urinary tract dysfunctions (LUTDs) on anti-incontinence surgery. This study investigates the long-term therapeutic outcome of a suburethral sling procedure among women with stress urinary incontinence (SUI) and different LUTDs. This study retrospectively reviewed 401 women treated with a suburethral sling for SUI. Following baseline videourodynamic findings, the patients were divided into pure SUI or SUI with concomitant LUTD (mixed detrusor overactivity and SUI, low detrusor contractility and SUI, and presence of bladder outlet obstruction and SUI) groups. The primary endpoint was the SUI-free-specific survival rate. A successful outcome was defined as the absence of any SUI event. The secondary endpoints included postoperative complications, surgical revision rate, and changes in videourodynamic parameters. At a mean follow-up of 5.1 (standard deviation: 5.4, range 0.1-24.1) years, the median cumulative duration of SUI-free survival was 15.4years and 15.9years in the pure SUI and SUI and concomitant LUTD subgroup, respectively, without significant difference between the groups. No between-group difference in postoperative complications was also noted. The cumulative incidences of the overall reoperation rate were 15.3%, 11.6%, 30.9%, and 7.3% in the pure SUI, detrusor overactivity, low detrusor contractility, and bladder outlet obstruction subgroups, respectively, with a significant difference between the groups (p = 0.006). Women who underwent suburethral sling surgery for SUI treatment had comparable long-term success rates regardless of baseline LUTD. However, those with low detrusor contractility may experience less favorable results in terms of higher reoperation rates.

The Use of Disposable Supplies: Measuring Suburethral Sling Surgical Waste by Cost and Weight.

The health care industry is a leading contributor to solid waste in the United States, and two thirds of a hospital's regulated medical waste is produced from surgery. The primary objective was to assess the utilization of single-use disposable supplies during suburethral sling cases. We observed suburethral sling plus cystoscopy procedures at an academic medical center. Cases with concomitant procedures were excluded. Our primary outcome was the quantity of wasted supplies, defined as disposable supplies that were opened at the start of the procedure and were unused. Secondarily, we quantified those supplies in both weight and United States dollars. In a subset of cases, we obtained the weight of the total amount of trash generated from the procedure. A total of 20 cases were observed. Most frequently wasted items included an emesis basin, large ring basin, and rectangle plastic tray. Redundant supplies wasted included a 1-L sterile water bottle and, on average, 2.73 (SD, 2.34) blue towels. The sum of the weight of the wasted items among cases was 1.33 lb, associated with $9.50. The average total amount of trash produced from 11 cases was 14.13 lb (SD, 2.27). Removal of the most frequently wasted items would achieve a 9.4% reduction in solid waste produced by the case. A large waste burden per surgical case was produced by a minor procedure. Removal of frequently wasted items, a reduced number of towels, and smaller cystoscopy fluid bags are simple strategies that would decrease overall waste production.

Short-, mid-, and long-term outcomes of suburethral slings with concomitant pelvic organ prolapse surgeries

BACKGROUND: This retrospective cohort study assessed the outcomes of combined surgeries for pelvic organ prolapse (POP) and stress urinary incontinence (SUI) in 31 patients with a follow-up of 7 years. OBJECTIVE: The study aimed to determine the success and recurrence rates of POP and SUI while comparing the outcomes, analyzing the predictors for recurrence, and reporting on complications. MATERIALS AND METHODS: Demographic and clinical profiles were analyzed descriptively using frequency and percentages. Objective SUI cure rate was assessed via office cystometry with a cough stress test, while POP was evaluated using the POP-Q system. Subjective cure rates for both conditions were determined using a symptom severity checklist based on the King's Health Questionnaire. Chi-square tests assessed associations between objective outcome parameters and time elapsed since surgery, and other outcome predictors, with significance set at p &lt; 0.05. RESULTS: The results showed a high objective cure rate of 96% for SUI and subjective cure rates of 96% for both SUI and POP. Long-term symptoms included urine frequency and retention, while mesh erosion occurred in one patient. The objective cure rate for POP was 67.7%, with recurrence in the anterior compartment at the midterm and in various compartments at long term. Vault fixation suggests efficacy in reducing apical prolapse recurrence. The preoperative age was identified as a significant risk factor for POP recurrence. CONCLUSION: This study supports the durability and efficacy of combined surgeries for SUI and POP, with high patient satisfaction.