Underwent Sling Placement Research Articles

Impact of Sling at Time of Prolapse Surgery on Overactive Bladder.

Prolapse surgery and sling surgery both lead to improvement in overactive bladder. However, less is known regarding how slings performed concurrently with less is know about how overactive bladder symptoms change in patients having prolapse surgery with a sling compared to prolapse surgery without a sling. The primary aim was to compare change in postoperative overactive bladder symptoms in patients with preoperative overactive bladder who underwent sling placement versus no sling with prolapse surgery. This was a secondary analysis of a cohort study evaluating overactive bladder in patients undergoing prolapse surgery. Sling procedures were performed concomitantly for treatment or prevention of stress incontinence. Baseline and 3-month follow-up urinary symptoms were assessed with the Overactive Bladder Questionnaire Short Form (OAB-q SF) and Urinary Distress Inventory-6 (UDI-6). Of patients with overactive bladder, 26 (40.0%) underwent midurethral sling (MUS) placement and 39 (60.0%) no sling. Preoperative OAB-q SF bother (score [SD], 46.8 [20.2] vs 40.2 [22.1]; P = 0.23) was similar between groups, but UDI-6 scores (59.2 [28.8] vs 43.8 [29.1]; P = 0.04) were higher in the sling group. At 3 months, the change (improvement) in OABq-SF bother (-16.9 [24.1] vs -22.4 [23.0]; P = 0.36), OABq-SF health-related quality of life (22.8 [28.6] vs 22.9 [23.9]; P = 0.99), and UDI-6 (-38.8 [32.9] vs -34.0 [27.8]; P = 0.53) were similar in the MUS and no MUS groups. Patients with prolapse and overactive bladder undergoing prolapse surgery with a sling had similar improvements in OAB-q SF bother scores compared with those who did not have a sling.

(374) Reviewing the Long-Term Effectiveness of Artificial Urinary Sphincter and Urethral Sling Insertion for Post-Prostatectomy Male Stress Urinary Incontinence

Abstract Introduction Stress urinary incontinence is the second-most common complication male patients face post-prostatectomy. Artificial urinary sphincters (AUS) and urethral slings are two effective surgical treatments recommended for patients with incontinence who have failed conservative therapy. Slings are often preferred in cases of mild to moderate SUI, whereas AUS is preferred in severe cases. Although prior studies have shown the AUS to be superior in restoring continence, few have compared them in a diverse patient population. We aim to determine the effectiveness of both devices both in the short-term and long-term postoperative setting. Objective To review the 1 and 3 year effectiveness of both AUS and urethral slings in post-prostatectomy patients, measured as the change in median pads per day. Methods This was a single-institution retrospective chart review study of 124 patients who received either an AUS or sling between the years 2015-2022. Patients were divided into one of two groups depending on if they underwent surgery for a urethral sling or AUS. Demographic, intra-operative, and post-operative characteristics were collected. Median pads used per day was the primary measure of outcome. A two-sample t-test, chi-square, or Mann-Whitney U test was used to compare baseline characteristics based on distribution normality. Wilcoxon signed-rank tests were used to compare 1 and 3 year pad usage to baseline. Results A total of 116 patients were included, of which 72 (62.1%) underwent sling placement while 44 (37.9) received an AUS. Patients receiving an AUS were older (67.2 [7.5] vs 64.0 [7.1], p=0.024), had a higher rate of prior radiation therapy (29.5% vs 11.1, p=0.012), and used more pads per day preoperatively (3 [2-5] vs 2 [1-3], p<0.001). Patients with an AUS showed statistically significant lower usage of pads per day at 1 year (1 [0-2]; p<0.001) and 3 years (2 [1-3]; p<0.017). The sling cohort showed a significant difference at 1 year (1 [0-1]; p<0.001) but not at 3-years (1 [0-2], p=0.123). Conclusions Post-prostatectomy insertion of an AUS results in a significant improvement to continence at 1 and 3 years, while the urethral sling is only significantly effective at 1 year. Disclosure No

Cost Value Analysis of Single Incision Midurethral Sling Insertion in the In Office Vs. Hospital Setting

<h3>Study Objective</h3> Patient outcomes between Mid-urethral slings in office setting vs hospital setting based on average total patient encounter time, total procedure time, total patient cost. The secondary outcomes were adverse events, unexpected outcomes, and urgent evaluation. <h3>Design</h3> Retrospective, double-arm study, 1 physician implanted a mid-urethral single-incision sling with the clinical diagnosis for urethral hypermobility or stress urinary incontinence. <h3>Setting</h3> Office setting and hospital-based setting. <h3>Patients or Participants</h3> 78 women underwent sling placement in an office setting and 47 patients underwent sling placement in a hospital-based setting. <h3>Interventions</h3> Patients were evaluated at 2 and 6 weeks after surgery. A validated Surgical Satisfaction Questionnaire (SSQ-8) was collected at the 6-week post-operative visit. Patients that did not complete the SSQ-8 were contacted by phone. All women with the diagnosis of urethral hypermobility or stress urinary incontinence. <h3>Measurements and Main Results</h3> Between January 2016 until August 2020 a total of 125 women underwent a single incision mid urethral sling procedure. Hospital-based setting: The average SSQ-8 score totaled 39.17 out of 40. The average total patient encounter time was 344.702 minutes. The average total time in the OR was 50.06 minutes. 5 total patients reported one adverse event, 13 patients reported 6 unexpected outcomes. No patients were seen for emergent evaluation. Office-based setting: The average SSQ-8 score totaled 39.48 out of 40. The average total patient encounter time was 53.76 minutes. The average total time in the OR was 22.05 minutes. 5 total patients reported one adverse event, 25 patients reported 27 unexpected outcomes. 1 patient was seen for emergent evaluation. No statistically significant differences in patient satisfaction. <h3>Conclusion</h3> The findings have shown considerable favor office-based setting in comparison to the hospital setting. There is a significant difference in the financial cost and the total patient encounter time. The office-based setting would be the more advantageous option for patients. The office-based setting is cost-effective, less time-consuming, and is safe.

The Impact of Frailty on Outcomes of Sling Surgery with and without Prolapse Repair.

Frailty has emerged as a significant predictor of morbidity in urological surgery, but its impact on outcomes of sling surgery for stress incontinence remains unclear. The purpose of this study is to describe the prevalence of frailty among women undergoing sling surgery and determine the association of frailty with 30-day postoperative outcomes. We analyzed data from the American College of Surgeons National Surgical Quality Improvement Project (NSQIP®) in 2013-2016 to identify patients undergoing sling placement using Current Procedural Terminology, 10th edition, code 57288. Patients were categorized into 2 groups based on whether they underwent isolated sling placement or had a sling with concomitant prolapse surgery. Frailty was assessed using the 5-factor Modified Frailty Index (mFI-5) developed for use with the NSQIP data set. Patients were considered frail if 2 or more factors from the mFI-5 were present. Outcomes and complications within 30 days were captured from the NSQIP data and logistic regression models used to adjust for age, race/ethnicity, body mass index and frailty. We identified 25,887 women who underwent sling placement, 15,087 of whom underwent isolated sling placement (Group 1) and 10,800 of whom underwent sling with concomitant prolapse repair surgery (Group 2). Frailty was present in 9.3% of patients in Group 1 and 10.2% of patients in Group 2 (p=0.0122). Among those who underwent isolated sling placement, frailty was associated with increased length of hospital stay (OR 1.2, 95% CI 1.1-1.4, p=0.0008) and 30-day hospital readmission (OR 1.7, 95% CI 1.1-2.5, p=0.0093). Older patients undergoing isolated sling placement were more likely to have longer operation time (OR 1.2, 95% CI 1.1-1.3, p <0.0001) and hospital length of stay (OR 1.3, 95% CI 1.2-1.4, p <0.0001). Frailty was also associated with increased 30-day hospital readmission in patients who underwent sling with concomitant prolapse repair (OR 1.8, 95% CI 1.3-2.6, p=0.0003), while age was not (OR 0.9, 95% CI 0.7-1.1, p=0.29). We found that frailty was present in relatively few patients undergoing sling surgery. Adverse postoperative outcomes and complications were low overall. Increased age and frailty were both associated with longer length of stay. Frailty, but not age, was significantly associated with increased likelihood of hospital readmission within 30 days following surgery. Our findings provide insight into the preoperative characteristics of women undergoing sling surgery in a large national sample, suggesting the need for preoperative identification of the frail patient.

The role of perioperative medications in urinary retention following midurethral sling

Postoperative urinary retention (PUR) is a known complication of midurethral sling (MUS) placement. The use of certain perioperative medications may influence the risk of this complication. This study aimed to investigate the association of perioperative medications with urinary retention after MUS. This was a retrospective study of women undergoing MUS placement for stress urinary incontinence by a fellowship-trained urologic surgeon between 2015 and 2018, under approval by the Institutional Review Board. Both retropubic and transobturator approaches were included. All patients underwent an active void trial following surgery. Intraoperative medications given by the anesthesia team were retrospectively noted. The Fisher's exact test was used to compare the association of PUR with categorical variables. A total of 82 patients were included, 17 (21%) of whom failed postoperative void trial due to urinary retention. Of 25 patients receiving perioperative scopolamine, 40% failed the postoperative void trial, compared to 12% of patients not receiving scopolamine (p = .048). Groups were then stratified based on scopolamine use due to the observed independent association with PUR. Subgroup analysis revealed a stronger association of postoperative retention with scopolamine in patients undergoing concomitant prolapse surgery. Notably, retention rate and scopolamine use were similar whether patients underwent sling placement alone or in combination with prolapse surgery. Rate of retention was also higher for retropubic versus transobturator slings (36% vs. 9%; p = .005). Perioperative scopolamine may be associated with an increased risk of postoperative urinary retention following MUS, especially in the setting of a concomitant prolapse surgery.

Postoperative Opioid Prescribing Patterns in Women Undergoing Mid-Urethral Sling Placement [37F

INTRODUCTION: Mid-urethral slings are currently the most common surgery performed for stress urinary incontinence, however, no benchmarks exist to inform providers on appropriate opioid prescribing for this procedure. METHODS: Using MarketScan Commercial Claims and Encounters Database from Truven Health Analytics, we extracted all outpatient claims from 2005 through 2016 that identified women ≥ 18 years who underwent sling placement for stress incontinence using CPT codes. From this cohort, we determined whether the procedure was isolated or done concomitantly with other procedures. Patients were classified as having filled a prescription for an opioid perioperatively if a claim for a schedule II, III or tramadol prescription was filled 28 days before or after the procedure. Oral morphine milligram equivalents (MME) were calculated for each prescription. RESULTS: A total of 153,631 women were identified using the above-mentioned criteria. Of these, 79,069 (51.5%) underwent an isolated sling procedure while 74,562 (48.5%) underwent combined procedures. 84% of the patients in our cohort had 1 or more prescriptions in the perioperative time period. The median cumulative MME prescribed for patients preoperatively with isolated and multiple procedures were 200 and 225, respectively. Postoperatively, the median cumulative MME for isolated and multiple procedures were 150 and 225, respectively. Nearly half of patients who filled an opioid prescription preoperatively filled another postoperatively. CONCLUSION: Among women undergoing isolated mid-urethral sling placement, the median cumulative MME are now described. Further research optimizing prescribing practices is needed.

PD06-09 THE POSTOPERATIVE PHENOTYPE OF RESOLVED, REFRACTORY AND DE-NOVO URGENCY URINARY INCONTINENCE FOLLOWING SLING PLACEMENT AT TIME OF PELVIC ORGAN PROLAPSE REPAIR WITH A MEDIAN FOLLOW-UP OF 1 YEAR

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Incontinence: Evaluation (Urodynamic Testing) (PD06)1 Apr 2020PD06-09 THE POSTOPERATIVE PHENOTYPE OF RESOLVED, REFRACTORY AND DE-NOVO URGENCY URINARY INCONTINENCE FOLLOWING SLING PLACEMENT AT TIME OF PELVIC ORGAN PROLAPSE REPAIR WITH A MEDIAN FOLLOW-UP OF 1 YEAR Xinyuan Zhang*, Robyn K. Shaffer, and Amy D. Dobberfuhl Xinyuan Zhang*Xinyuan Zhang* More articles by this author , Robyn K. ShafferRobyn K. Shaffer More articles by this author , and Amy D. DobberfuhlAmy D. Dobberfuhl More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000833.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: To improve counseling in women at risk of refractory and/or de-novo urgency urinary incontinence following sling placement at time of prolapse repair, we created a two-by-two subjective outcome model to characterize changes in storage dysfunction following surgery. METHODS: We identified 139 women who underwent urodynamics (UDS) followed by prolapse repair with or without sling placement. Inclusion criteria included POP-Q stage 2+ cystocele and at least 7 days of follow-up. Our primary outcome was the presence of refractory and/or de-novo urgency urinary incontinence (UUI) following surgery. Data were analyzed using t-test, Chi-square and Fisher’s exact test. RESULTS: 139 women (age 62.6 ± SD 11.4 years old, BMI 27.0 ± SD 5.34) had pre-operative UDS which revealed a mean: [email protected] 20.5 ± SD 13.7 cmH2O, Qmax 17.7 ± SD 10.0 mL/s, capacity 528.7 ± SD 218.2 mL, PVR 117.1 ± SD 182.3 mL. Women underwent anterior only (n=64), apical only (n=19) or anterior/apical (n=56) prolapse repair for overall POP-Q stage 2 (n=55), 3 (n=77) or 4 (n=7) prolapse. A majority underwent sling placement (n=82; [email protected] 17.5 ± SD 11.0 cmH2O, Qmax 19.3 ± SD 10.0 mL/s, capacity 531.3 ± SD 221.3, PVR 88.2 ± SD 163.4 mL), versus the remaining who did not undergo sling placement [n=57; [email protected] 24.9 ± SD 16.0 cmH2O (p = 0.002), Qmax 15.3 ± SD 9.6 mL/s (p = 0.018), capacity 525.1 ± SD 215.7 mL (p = 0.870), PVR 158.7 ± SD 200.7 mL (p = 0.018)]. Following surgery (median 369 days), sling failure, defined as recurrence of objective stress urinary incontinence symptoms, at 3, 6, 12 were 8%, 10%, and 13% respectively. In those women who underwent sling placement, following surgery they developed de-novo (13/82, 15.9%), resolved (15/82, 18.3%), and refractory (31/82, 37.8%) UUI at a similar rate compared to those women who did not undergo sling placement [de-novo (6/57, 10.5%, p=0.293), resolved (15/57, 26.3%, p=0.232), and refractory (14/57, 24.6%, p=0.067) UUI]. CONCLUSIONS: Rates of de-novo, resolved and refractory urgency urinary incontinence following prolapse repair did not differ regardless of concurrent sling placement at time of prolapse surgery. Source of Funding: NIH 1L30DK115056-01 © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e157-e157 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Xinyuan Zhang* More articles by this author Robyn K. Shaffer More articles by this author Amy D. Dobberfuhl More articles by this author Expand All Advertisement PDF downloadLoading ...

Impact of preoperative urodynamics on women undergoing pelvic organ prolapse surgery.

Preoperative urodynamic studies (UDS) are frequently performed before pelvic organ prolapse (POP) surgery to assess urethral and bladder function. The primary goal of this study is to examine how preoperative UDS are utilized and what value these studies have in patient treatment and/or counseling. We retrospectively reviewed patients who underwent prolapse surgery and had preoperative UDS between June 2010 and February 2015. Indications for UDS were classified into four categories: (1) occult stress urinary incontinence only, (2) overactive bladder symptoms, (3) mixed or insensible urinary incontinence, and (4) voiding symptoms and/or elevated post-void residual. We identified changes in management or counseling that were directly attributable to UDS results prior to surgery. Three hundred ninety-two patients underwent urodynamic testing for indications 2-4 above, and 316 met the inclusion criteria. Fifty-seven percent (180/316) had OAB symptoms (34.4% wet, 65.6% dry), 40.2% (127/316) had mixed incontinence, and 17.1% (54/316) had voiding symptoms and/or elevated PVR. A total of 3.5% (11/316) patients had alteration in their management or counseling based on the results of the UDS; 29.4% (50/170) of the women evaluated for occult SUI alone or with other symptoms demonstrated it and 41 underwent sling placement. UDS did not have a significant impact on preoperative management or counseling in POP surgery if demonstration of occult SUI was not the indication for preoperative study in women committed to POP surgery. Major alterations in treatment were rare and occurred mostly in women with stress incontinence that also had concomitant voiding symptoms and/or elevated PVR.

Comparing the vaginal wall sling with autologous rectus fascia and polypropylene sling: Short term outcomes and patient satisfaction

Objectives: Many women are affected by stress urinary incontinence (SUI). Due to investigations of the safety of synthetic mesh slings, there has been renewed interest in autologous slings. The aim of this study is to evaluate whether different sling material affects outcomes and patient satisfaction.Methods: A retrospective review was performed of patients who underwent sling placement between May 2011 and April 2017 for SUI or stress-predominant mixed urinary incontinence. Patients were divided based on the sling material used: vaginal wall sling (VWS), rectus fascia sling (RFS), and soft polypropylene sling (SPS). Outcomes were compared using a Likert scale, the validated SEAPI score system, Incontinence Impact Questionnaire 7 (IIQ-7), and Incontinence Symptom Severity Index (ISSI).Results: There were 228 patients that underwent sling placement with 94 receiving VWS, 62 RFS, and 72 SPS. Mean follow-up was 14 months. There was no statistical difference in postoperative pad usage or satisfaction score between the groups. All three groups had a statistically significant postoperative improvement in subjective SEAPI scores and daily pad use. The VWS and RFS groups had significant improvement in their ISSI. The VWS group also had postoperative improvement in IIQ-7 score. Complication rates were rare and similar between all three groups.Conclusions: Patient satisfaction and outcomes were overall similar between all three sling materials. Based on our outcomes, we continue to use the VWS as a treatment option for patients with SUI and redundant vaginal wall tissue that are opposed to synthetic mesh slings.

Improving Male Sling Selectivity and Outcomes—A Potential Role for Physical Demonstration of Stress Urinary Incontinence Severity?

IntroductionWe reviewed our 9-year experience with AdVance™ Male Sling System cases to determine clinical features associated with treatment success and to refine procedure selectivity. We hypothesized that preoperative physical demonstration of stress urinary incontinence by the standing cough test improves patient selection for male sling surgery. MethodsRetrospective review of primary AdVance sling surgeries between 2008 and 2016 was performed. Patients without standing cough test results were excluded from study. Success was defined as 1 pad per day or less postoperatively and no further intervention. Standing cough test was performed during preoperative consultation and objectively graded using the MSIGS (Male Stress Incontinence Grading Scale). ResultsOf the 203 male patients who underwent sling placement 80 (39%) experienced treatment failure during a median followup of 63.5 months. From 2008 to 2016 the proportion of AdVance slings performed as a surgical treatment modality for stress urinary incontinence decreased from 66% to 13%. Increasing selectivity correlated with greater treatment success. Success was greater among men using 2 pads per day or less preoperatively (77% vs 36%, p <0.0001), having physical findings of mild stress urinary incontinence (MSIGS grade 0-2 on standing cough test, 67% vs 26%, p <0.0001) and without a history of radiation (64% vs 41%, p=0.02). In combination, men without prior radiation with mild stress urinary incontinence and favorable standing cough test were “ideal patients” with an 81% success rate. Incremental increases in pad per day use (OR 1.8 per pad, p <0.0001) and MSIGS grade (OR 1.7 per grade, p=0.005) were independently associated with treatment failure. ConclusionsIncreasing selectivity has improved sling outcomes for men with stress urinary incontinence. Ideal sling candidates have not received radiation therapy, and have history and physical findings suggestive of mild stress urinary incontinence.

V2-01 TRANSVAGINAL SLING EXCISION: TIPS AND TRICKS

You have accessJournal of UrologyFemale Voiding Dysfunction1 Apr 2016V2-01 TRANSVAGINAL SLING EXCISION: TIPS AND TRICKS Marisa Clifton and Howard Goldman Marisa CliftonMarisa Clifton More articles by this author and Howard GoldmanHoward Goldman More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.2655AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Synthetic midurethral sling placement is the most common procedure performed for women with symptomatic stress urinary incontinence. Postoperative complications are well documented in the literature. The estimated rate of sling revision for urethral obstruction is approximately 2.3% and for mesh extrusion is 1.8%. However, this may be an underestimate of the true incidence. Herein, we present three separate cases of mesh excision and provide tips to improve surgical outcomes in these patients METHODS Three separate cases of mesh excision were recorded. Techniques utilized in sling excision were discussed in this video RESULTS Our first patient underwent transobturator sling in 2010 for symptomatic stress incontinence. Postoperatively, she developed voiding dysfunction and was evaluated for urinary hesitancy and weak stream. Her office cystoscopy was negative for mesh perforation and urodynamic study showed evidence of outlet obstruction. She elected to proceed with excision of a portion of the sling. Our second case is of a patient who underwent a sling for mixed urinary incontinence. Postoperatively, her urgency incontinence worsened significantly and she complained of significant dyspareunia. Her physical examination demonstrated pain where her sling was palpable at the midurethra. Cystoscopy was negative for mesh perforation, however, urodynamics showed evidence of bladder outlet obstruction. Our third patient underwent sling placement for stress incontinence in 2006. Approximately 2 months before presentation, her husband felt mesh during sexual intercourse. During physical examination, mesh was palpable at the right sulcus. The patient wished to have this portion of the sling removed. CONCLUSIONS In summary, plan incisions based on where mesh can be identified. If the location of the obstructing mesh is not apparent, use a cystoscope sheath or dilator to help with identification. If it is difficult to identify mesh during the dissection, a knife may help identify mesh from surrounding tissues. When performing sling excision for extrusion, ensure an adequate length of mesh is removed to prevent recurrence. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e180 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Marisa Clifton More articles by this author Howard Goldman More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Indications and risk factors for midurethral sling revision.

To determine the indications and risk factors for needing midurethral sling revision in a cohort of women undergoing midurethral sling placement. This was a case-control study of all women undergoing midurethral sling placement for stress urinary incontinence (SUI) between January 2003 and December 2013. Cases were patients who underwent midurethral sling placement followed by sling revision (incision, partial or complete excision). Controls were patients who underwent sling placement only. Once all subjects had been identified, the electronic medical record was queried for demographic and perioperative and postoperative data. Of 3,307 women who underwent sling placement, 89 (2.7%, 95% CI 1.9 - 3.4) underwent sling revision for one or more of the following indications: urinary retention (43.8%), voiding dysfunction (42.7%), recurrent urinary tract infection (20.2%), mesh erosion (21.3%), vaginal pain/dyspareunia (7.9%), and groin pain (3.4%). The median time from the index to the revision surgery was 7.8 months (2.3 - 17.9 months), but was significantly shorter in patients with urinary retention. The type of sling placed (retropubic or transobturator) was not associated with indication for revision. Patients who underwent revision surgery were more likely to have had previous SUI surgery (adjusted odds ratio 4.4, 95% CI 1.7 - 6.5) and to have undergone concomitant vaginal apical suspension (adjusted odds ratio 2.4, 95% CI 1.4 - 4.5). The rate of sling revision after midurethral sling placement was 2.7%. Urinary retention and voiding dysfunction were the most common indications. Patients with a history of previous SUI surgery and concomitant apical suspension at the time of sling placement may be at higher risk of requiring revision surgery.

Autologous retro-pubic urethral sling: a novel, quick, intra-operative technique to improve continence after robotic-assisted radical prostatectomy.

After radical prostatectomy, many men may suffer from urinary incontinence, which can have detrimental effects on quality of life. We describe a novel technique using an autologous retro-pubic urethral sling placed at the time of robotic-assisted laparoscopic prostatectomy (RALP) and evaluate its impact on post-operative urinary continence. During 2011, 153 men who underwent sling placement at the time of RALP at a high-volume academic institution were compared to 78 men who did not undergo sling placement. The primary outcomes were time to one and no pads per day. The association between these outcomes and placement of a sling was assessed using Cox proportional hazards regression. Median follow-up was 26weeks in those who had slings and 32.5weeks in those who did not. Clinical and pathological characteristics were similar between the groups, with the exception that sling patients were older (p<0.01) and underwent less nerve sparing (p<0.01). Multivariate analysis showed that sling placement did not appear to have an effect on time to one (p=0.24) or no pads per day (p=0.20). Although the association between sling placement and early return of urinary continence did not reach statistical significance, there was a selection bias against the sling, since it was placed in men who were expected to have more difficulty regaining their continence. A randomized trial is needed to assess the true benefit of sling placement on urinary continence.

1871 CORRELATION OF PRE-OPERATIVE ABDOMINAL LEAK POINT PRESSURE WITH POST-OPERATIVE STRESS URINARY INCONTINENCE AFTER CYSTOCELE REPAIR AND SLING

You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Female Urology II1 Apr 20121871 CORRELATION OF PRE-OPERATIVE ABDOMINAL LEAK POINT PRESSURE WITH POST-OPERATIVE STRESS URINARY INCONTINENCE AFTER CYSTOCELE REPAIR AND SLING Sam Kuykendall, Sharron Mee, Gary Leach, and Maggie Vuturo Sam KuykendallSam Kuykendall Los Angeles, CA More articles by this author , Sharron MeeSharron Mee Los Angeles, CA More articles by this author , Gary LeachGary Leach Los Angeles, CA More articles by this author , and Maggie VuturoMaggie Vuturo Los Angeles, CA More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.2025AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES It is unknown if the severity of stress urinary incontinence (SUI) on pre-operative urodynamic studies correlates with a patient's likelihood of persistent SUI after cystocele repair with sling. No previous studies have evaluated the correlation of pre-operative abdominal leak point pressures (ALPP) with incidence and severity of SUI after cystocele repair with sling placement. METHODS A retrospective review was performed examining 420 patients who underwent cystocele repair with simultaneous suburethral sling. All patients had both pre-operative urodynamic studies (UDS) and follow-up with a validated incontinence questionnaire. UDS were performed in all patients with and without reduction of the cystocele. All patients underwent sling placement regardless of pre-operative UDS findings. Sling types included transobturator sling, single incision sling and cadaveric fascial sling. Presence and severity of patient SUI was self-reported in a validated questionnaire post-operatively. RESULTS Of 424 patients analyzed who underwent cystocele repair and sling, 185 demonstrated SUI on pre-operative urodynamic studies. The remaining 239 patients did not show SUI during pre-operative UDS. There was no detectable difference in the proportion of patients with or without post-operative SUI in any of the three groups with pre-op SUI based on pre-operative ALPP (p=0.67 for LO v MID or HI v MID; p=1.0 for LO v HI). We estimated the 95% confidence interval for the difference to be ± 18% (LO v MID or HI v MID) and + 22% (LO v HI). There was no statistically significant difference between the three groups when compared to the 239 patients who were dry pre-operatively as well. Additionally, ALPP did not correlate with post-operative SUI based on sling type. CONCLUSIONS Despite suburethral sling placement at the time of cystocele repair, some patients experience post-operative SUI which is usually reported as mild. There is no evidence for a direct correlation between ALPP on pre-operative urodynamics and the likelihood of continued SUI after cystocele repair with sling placement. Incidence and Severity of Self-Reported SUI after Cystocele Repair Based on Pre-op ALPP Preop ALPP <50 (75 pts) Preop ALPP 50-80 (70 pts) Preop ALPP >80 (40 pts) PreOp ALPP of infinity (DRY) (239 pts) No Post-op SUI 46(61%) 42(60%) 32(80%) 218(91%) Mild SUI 19(25%) 19(27%) 6(15%) 14(6%) Moderate SUI 7(9%) 8(11%) 1(3%) 6(3%) Severe SUI 3(4%) 1(1%) 1(3%) 1(<1%) © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e756-e757 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Sam Kuykendall Los Angeles, CA More articles by this author Sharron Mee Los Angeles, CA More articles by this author Gary Leach Los Angeles, CA More articles by this author Maggie Vuturo Los Angeles, CA More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Long-term clinical and urodynamic evaluation of the polytetrafluoroethylene suburethral sling for treatment of genuine stress incontinence

To assess long-term clinical and urodynamic outcomes of suburethral sling procedures using polytetrafluoroethylene grafts. Between January 1986 and May 1991, 108 women underwent suburethral sling placement to treat genuine stress incontinence. At least 1 year after surgery, 62 women participated in a telephone interview about surgical outcome and completed a follow-up urodynamic evaluation. Seventy-three percent of patients reported stress incontinence cure and 61% were objectively cured. Neither low urethral closure pressure nor a history of multiple prior anti-incontinence procedures, singly or in combination, adversely affected outcome. Postoperative maximum urethral closure pressure and functional urethral length were significantly greater in patients who were cured of their incontinence than in those whose surgery failed. Patients who were cured had higher amplitude detrusor contractions during micturition and greater post-void residual urine than those who were not cured. Thirty-three percent of patients with urodynamically stable bladders preoperatively developed detrusor instability after surgery. Detrusor instability remitted after surgery in half of the patients who had this condition preoperatively. Postoperative wound complications developed in 40% of patients who underwent sling placement, and 22% of the grafts were eventually removed. Polytetrafluoroethylene suburethral sling placement is an effective treatment for stress incontinence and low urethral pressure. Urodynamic data suggest that urethral obstruction is responsible for surgical cure. Patients should be warned of the high complication rate for this suburethral sling procedure and that graft removal may be necessary.