Learning Curve for the Tension-Free Vaginal Tape–Obturator Procedure for Female Stress Urinary Incontinence: A Prospective Single-Surgeon Study

Song, Ruixiang; He, Xing; Chang, Yifan; Zhu, Feng; Zhang, Wei; Cheng, Xiangdong; Song, Qixiang; Hao, Yiru; Huang, M H; Huang, Guangtao; Li, Huizhen

doi:10.1089/end.2019.0571

Cited by 6 publications

(4 citation statements)

References 21 publications

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“…For some physicians, the extrapolated reached level of competence was 20 procedures, for another physician it was 50 procedures. Other studies reporting on the learning curve of MUS surgery for SUI were based on single surgeon outcomes [22–25]. Spelzini et al [23] (2017) and Serati et al [22] (2015) found similar results as this study: complications following sling surgery were not influenced by the number of procedures performed.…”

Section: Discussionsupporting

confidence: 81%

A Clinical Learning Curve Study of Polydimethylsiloxane Urolastic for Stress Urinary Incontinence: Does Safety Improve when Expertise Grow?

Casteleijn¹,

Latul²,

Eekelen³

et al. 2023

Gynecol Obstet Invest

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Objectives: The aim of the study was to characterize the learning curve of bulk injection therapy polydimethylsiloxane Urolastic (PDMS-U) for stress urinary incontinence. Design: Secondary analysis from three clinical studies on efficacy and safety outcomes of PDMS-U was performed. Participants/Materials, Setting, Methods: PDMS-U-certified physicians who performed ≥4 procedures were included. The primary outcome was the number of PDMS-U procedures needed to achieve acceptable failure rates for “complications overall,” “urinary retention,” and “excision,” using the LC-CUSUM method. For the primary outcome, physicians who performed ≥20 procedures were used. For the secondary outcome, logistic and linear regression analysis was used to assess the relationship between number of procedures, complications (complications overall, urinary retention, pain, exposure, excision of PDSM-U), and duration of treatment. Results: In total, 203 PDMS-U procedures were performed by nine physicians. Five physicians were used for the primary outcome. For “complications overall,” “urinary retention,” and “excision,” two physicians reached a level of competence: one at procedure 20 and one at procedure 40. The secondary outcome showed no statistically significant association between procedure number and complications. There was a statistically significant increase in the duration of treatment with more physician experience (mean difference 0.83 min per 10 additional procedures, 95% CI: 0.16–1.48). Limitations: One limitation is that retrospectively collected data might have underreported the number of complications. Secondly, there was variation in the way the technique was applied between physicians. Conclusions: Physicians’ experience in the PDMS-U procedure did not influence safety outcomes. There was large inter-physician variability and most physicians did not reach acceptable failure rates. There was no relationship between PDMS-U complications and the number of performed procedures.

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Section: Discussionsupporting

confidence: 81%

A Clinical Learning Curve Study of Polydimethylsiloxane Urolastic for Stress Urinary Incontinence: Does Safety Improve when Expertise Grow?

Casteleijn¹,

Latul²,

Eekelen³

et al. 2023

Gynecol Obstet Invest

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“…19 Interestingly, learning curves in urogynecology are often based on performances of a single operator, thus limiting the generalization of the data. 20,21 Moreover, often studies assessing the learning curve in cystoscopy are based on training on virtual simulators. 22,23 In our series, data were evaluated for three different residents, making our findings more reproducible.…”

Section: Discussionmentioning

confidence: 99%

Learning Curve of Botulinum Toxin Bladder Injection for the Treatment of Refractory Overactive Bladder

Barba¹,

Lazar²,

Cola³

et al. 2022

IJWH

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Intradetrusor botulinum toxin injections is an established second-line treatment for patients with refractory overactive bladder syndrome (OAB). We aimed to evaluate the learning curve of intradetrusor injections with botulinum toxin for the treatment of refractory OAB. Patients and Methods: This retrospective study analyzed all women with idiopathic and refractory OAB who underwent botulinum toxin bladder injections performed by residents with no previous experience with operative cystoscopy under consultant supervision. Baseline International Consultation on Incontinence Questionnaire-Short Form questionnaire (ICIQ-SF) and Euroqol (EQ-5D) questionnaires were collected. Procedural data (operative time, number of valid injections, complications, subjective easiness, perceived tolerability) and patients' outcomes (Patients Global Impression of Improvement (PGI-I), ΔICIQ-SF, ΔEQ-5D, need for self intermittent catheterization, duration of efficacy) were considered as markers to evaluate learning curves for each resident. Results: Twenty-seven patients underwent intravesical injection of botulinum toxin performed by residents. Only a grade 1 Clavien-Dindo complication occurred, and none of the patients had urinary retention. PGI-I was very satisfactory, scoring 1.4 ± 0.9. Both ICIQ-SF and EQ-5D 2-2 were statistically improved (p < 0.00001 and p = 0.04, respectively). The mean duration of efficacy resulted to be 8.0±4.3 months. A positive effect of the learning curve was observed only for operative time, subjective easiness, and perceived tolerability. Conclusion: Intradetrusor botulinum toxin injection for the treatment of refractory OAB is characterized by high efficacy and very low complications even at the very beginning of the learning curve when performed under proper mentorship.

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“…However, these reports have led to an unjustified decrease in the use of urodynamics even for more complex indications. For instance, a recent Dutch survey revealed that almost half of urologists and gynecologists do not carry out urodynamics in complex cases, such as stress incontinence associated with large postvoid residual, poor flow, or doubts regarding the reason for incontinence [ 15 ]. This widespread reduction in the use of urodynamics poses some criticism with respect to residents’ training, in particular, in terms of underexposure to this diagnostic tool.…”

Section: Discussionmentioning

confidence: 99%

The Learning Curve of Urodynamics for the Evaluation of Lower Urinary Tract Symptoms

et al. 2022

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Background and Objectives: Urodynamics is considered the gold standard for lower urinary tract functional assessment. However, it requires very specific skills and training, which are currently difficult to master due to its reduced use. Moreover, no studies or data are available to define the workload and the learning curve of this diagnostic tool. As a consequence, we aimed to evaluate the learning curve of residents with no previous experience to correctly perform and interpret urodynamics, and properly address and manage patients with pelvic floor disorders based on urodynamics findings. Materials and Methods: This prospective study analyzed a series of proficiency parameters in residents performing urodynamics under consultant supervision, including the following: duration of procedure, perceived difficulty, need for consultant intervention, accuracy of interpretation, and therapeutic proposal. The number of procedures performed was then divided into groups of five to evaluate the progressive grade of autonomy (technical and full management autonomy) reached by each resident. Results: In total, 69 patients underwent urodynamics performed by three residents, with every resident performing at least 20 exams. Duration of procedure, perceived difficulty, need for consultant intervention, accuracy of interpretation, and the appropriateness of the hypothetical proposal of management/treatment based on their interpretation of clinical data and urodynamic findings was shown to be directly related to the number of exams performed. Technical autonomy in the execution of uroflowmetry was reached in the group performing 6–10 procedures, while technical autonomy in the execution of cystomanometry with pressure/flow study was obtained in the group of 16–20 procedures. The latter corresponded also to the gain of full autonomy which also included an optimal therapeutic proposal. Conclusion: We found that there is a tangible learning curve for urodynamics in terms of several proficiency parameters. A workload of 5 uroflowmetries and 15 cystomanometries with pressure/flow studies may be adequate to complete the learning curve.

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Learning Curve for the Tension-Free Vaginal Tape–Obturator Procedure for Female Stress Urinary Incontinence: A Prospective Single-Surgeon Study

Cited by 6 publications

References 21 publications

A Clinical Learning Curve Study of Polydimethylsiloxane Urolastic for Stress Urinary Incontinence: Does Safety Improve when Expertise Grow?

A Clinical Learning Curve Study of Polydimethylsiloxane Urolastic for Stress Urinary Incontinence: Does Safety Improve when Expertise Grow?

Learning Curve of Botulinum Toxin Bladder Injection for the Treatment of Refractory Overactive Bladder

The Learning Curve of Urodynamics for the Evaluation of Lower Urinary Tract Symptoms

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