Failure Rate of Retropubic Midurethral Sling With and Without Concomitant Robotic Sacrocolpopexy

Abstract

Importance:The retropubic midurethral sling (rMUS) and sacrocolpopexy are treatments for stress urinary incontinence (SUI) and pelvic organ prolapse, respectively, which are often performed concomitantly. Objective:The purpose of this study was to identify whether a difference exists in the failure rates of rMUS when placed alone or at the time of robotic sacrocolpopexy (RSC). Study Design:We conducted a single-center retrospective cohort study of patients who underwent rMUS placement between December 2015 and March 2020. The primary outcome was rMUS failure defined as additional treatment for SUI at any point.Results: There were 160 patients who underwent isolated rMUS and 175 patients who underwent rMUS and RSC. Patients who underwent isolated rMUS were more likely to be obese ( P < 0.01). Patients who underwent RSC were older (63.3 ± 9.9 vs 57.7 ± 13.7 years, P < 0.0001) and more likely to be White ( P = 0.02). Follow-up ranged from 0 to 46 months (median, 3 months; interquartile range, 3 months). Failure was observed in 2.3% of rMUS placed alone and 8.6% of rMUS with RSC. Patients who underwent rMUS and RSC had an odds ratio of 3.63 for rMUS failure ( P = 0.03; 95% confidence interval, 1. 16-11.38). Hypertension was associated with 4 times higher rMUS failure (odds ratio, 4.18; P = 0.02; 95% confidence interval, 1.29-13.58). Conclusions:We observed a significantly increased rate of rMUS failure from those placed alone to those placed at the time of RSC. Retropubic midurethral sling at the time of RSC was 4 times more likely to result in additional SUI treatment.

Cost-Utility Analysis of Midurethral Sling Timing Among Women Undergoing Prolapse Surgery

“…Separate models were run to estimate cost-utilities for 6 different scenarios: Separate models were generated based on surgical approach, given the anatomic differences and varying postoperative SUI rates between the 2 types of surgical procedures. 7,15,16 Women were considered to have preexisting SUI if subjective and objective signs of SUI were present, and those without preexisting SUI had no subjective or objective complaints. The International Continence Society definition of occult SUI was used and includes visible urinary leakage with prolapse reduction in women without subjective complaints of SUI.…”

“…Separate models were generated based on surgical approach, given the anatomic differences and varying postoperative SUI rates between the 2 types of surgical procedures 7,15,16 . Women were considered to have preexisting SUI if subjective and objective signs of SUI were present, and those without preexisting SUI had no subjective or objective complaints.…”

“…Randomized controlled data were available for cMUS at the time of vaginal prolapse surgery, with rates of postoperative SUI varying by preoperative incontinence status 5,11,12 . Incidences of postoperative SUI following various MUS strategies for women undergoing MISC were predominantly derived from retrospective data 8,15,16,19,20 . The frequency that women with SUI choose to undergo pelvic floor physical therapy is not well established in the literature and, therefore, expert opinion was used for this parameter 26,27 …”

“…5,11,12 Incidences of postoperative SUI following various MUS strategies for women undergoing MISC were predominantly derived from retrospective data. 8,15,16,19,20 The frequency that women with SUI choose to undergo pelvic floor physical therapy is not well established in the literature and, therefore, expert opinion was used for this parameter. 26,27 Utility estimates were obtained from validity studies of utility measures and previously published cost-utility analyses (Table 2).…”

Comparison of Morbidity and Retreatment After Urethral Bulking or Midurethral Sling at the Time of Pelvic Organ Prolapse Repair

“…3,4 Long-term outcome studies have also demonstrated a high rate of successful treatment, with fewer than 9% of patients undergoing concomitant midurethral sling at the time of POP repair requiring subsequent retreatment for SUI. 5,6…”