Measuring outcomes in urogynecological surgery: “perspective is everything”

Parker-Autry, Candace; Barber, Matthew D.; Kenton, Kimberly; Richter, Holly E.

doi:10.1007/s00192-012-1908-7

Cited by 26 publications

(15 citation statements)

References 52 publications

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“…Recent studies on how best to assess postoperative outcomes agree on the importance of including the risk of retreatment in a composite outcome assessment. 20,21 Of note, our study only focused on surgery for recurrent SUI or POP. We did not assess subsequent procedures due to mesh complications, and counseling patients regarding these potential risks is also important.…”

Section: Discussionmentioning

confidence: 99%

Cumulative Incidence of a Subsequent Surgery After Stress Urinary Incontinence and Pelvic Organ Prolapse Procedure

Dieter

Pate

et al. 2017

Obstetrics &Amp; Gynecology

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Objective To assess the 5-year risk and timing of repeat stress urinary incontinence and pelvic organ prolapse procedures. Methods We conducted a retrospective cohort study, using a nationwide database, the 2007–2014 Marketscan Commercial Claims and Encounters and Medicare Supplemental Databases (Truven Health Analytics), which contain de-identified health care claims data from approximately 150 employer-based insurance plans across the United States. We included women aged 18–84 years and used CPT codes to identify surgeries for stress urinary incontinence (SUI) and pelvic organ prolapse (POP). We identified index procedures for SUI or POP after at least three years of continuous enrollment without a prior procedure. We defined three groups of women based on the index procedure: 1) SUI surgery only, 2) POP surgery only, 2) Both SUI+POP surgery. We assessed the occurrence of a subsequent SUI or POP procedure over time for women < 65 years and ≥ 65 years with a median follow-up time of 2 years (IQR 1,4). Results We identified a total of 138,003 index procedures: SUI only n=48,196, POP only n=49,120, and both SUI+POP n=40,687. The overall cumulative incidence of a subsequent SUI or POP surgery within 5 years after any index procedure was 7.8% (95%CI: 7.6, 8.1) for women < 65 and 9.9% (95%CI: 9.4, 10.4) for women ≥ 65 years. The cumulative incidence was lower if the initial surgery was SUI only and higher if an initial POP procedure was performed, whether POP only or SUI+POP. Conclusions The 5-year risk of undergoing a repeat SUI or POP surgery was < 10%, with higher risks for women ≥ 65 years and for those who underwent an initial POP surgery.

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Section: Discussionmentioning

confidence: 99%

Cumulative Incidence of a Subsequent Surgery After Stress Urinary Incontinence and Pelvic Organ Prolapse Procedure

Dieter

Pate

et al. 2017

Obstetrics &Amp; Gynecology

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“…Bothersome symptoms and disease-specific quality of life were measured with the UDI and the Incontinence Impact Questionnaire (IIQ). 11,13 The Patient Global Impression of Severity (PGI-S) and the Patient Global Impression of Improvement (PGI-I) were used to measure overall severity of POP and/or UI and outcome of treatment. 14 Generic health status was measured with the Rand-36 and EQ-5D.…”

Section: Methodsmentioning

confidence: 99%

Transvaginal prolapse repair with or without the addition of a midurethral sling in women with genital prolapse and stress urinary incontinence: a randomised trial

Ploeg

Rengerink

Steen

et al. 2015

BJOG

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Objective To compare transvaginal prolapse repair combined with midurethral sling (MUS) versus prolapse repair only.Design Multi-centre randomised trial.Setting Fourteen teaching hospitals in the Netherlands.Population Women with symptomatic stage two or greater pelvic organ prolapse (POP), and subjective or objective stress urinary incontinence (SUI) without prolapse reduction.Methods Women were randomly assigned to undergo vaginal prolapse repair with or without MUS. Analysis was according to intention to treat.Main outcome measures The primary outcome at 12 months' follow-up was the absence of urinary incontinence (UI) assessed with the Urogenital Distress Inventory and treatment for SUI or overactive bladder. Secondary outcomes included complications.Results One hundred and thirty-four women were analysed at 12 months' follow-up (63 in MUS and 71 in control group). More women in the MUS group reported the absence of UI and SUI; respectively 62% versus 30% UI (relative risk [RR] 2.09; 95% confidence interval [CI] 1.39-3.15) and 78% versus 39% SUI (RR 1.97; 95% CI 1.44-2.71). Fewer women underwent treatment for postoperative SUI in the MUS group (10% versus 37%; RR 0.26; 95% CI 0.11-0.59). In the control group, 12 women (17%) underwent MUS after prolapse surgery versus none in the MUS group. Severe complications were more common in the MUS group, but the difference was not statistically significant (16% versus 6%; RR 2.82; 95% CI 0.93-8.54).Conclusions Women with prolapse and co-existing SUI are less likely to have SUI after transvaginal prolapse repair with MUS compared with prolapse repair only. However, only 17% of the women undergoing POP surgery needed additional MUS. A wellinformed decision balancing risks and benefits of both strategies should be tailored to individual women.Keywords Midurethral sling, pelvic organ prolapse, randomised, stress urinary incontinence.Tweetable abstract Combination of prolapse repair with midurethral sling reduces the risk of postoperative stress incontinence.Please cite this paper as: van der Ploeg JM, Oude Rengerink K, van der Steen A, van Leeuwen JHS, Stekelenburg J, Bongers MY, Weemhoff M, Mol BW, van der Vaart CH, Roovers J-PWR, on behalf of the Dutch Urogynaecology Consortium*. Transvaginal prolapse repair with or without the addition of a midurethral sling in women with genital prolapse and stress urinary incontinence: a randomised trial. BJOG 2015;122:1022-1030.*The complete list of authors and collaborators from the Dutch Urogynaecology Consortium are listed in Supporting Information Appendix S1.Trial registration: The Netherlands National Trial Register NTR1197 (www.trialregister.nl).

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“…Reporting pelvic floor research study outcomes based on multiple objective and subjective measures has been recommended [21]. This is vital to accurately assess the true effect of an intervention.…”

Section: Discussionmentioning

confidence: 99%

Safety and Efficacy of Retropubic or Transobturator Midurethral Slings in a Randomized Cohort of Turkish Women

Tarcan¹,

Mangır²,

Şahan³

et al. 2014

Urol Int

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Objective: The aim of this study was to evaluate the safety and efficacy of retropubic (RP) or transobturator (TO) midurethral slings (MUS) in a prospective randomized cohort of Turkish women. Patients and Methods: A total of 54 women with urodynamic stress urinary incontinence (SUI) were randomized to undergo either RP or TO MUS between August 2006 and February 2013 in a tertiary referral center by a single surgeon. All patients had history, physical examination, urodynamic evaluation and quality of life assessments. The validated Turkish versions of the SEAPI, ICIQ-SF and OAB-V8 questionnaires were used. The Advantage® RP and the Obtryx® TO MUS Systems were used for all RP and TO procedures. Results: Twenty-seven patients were randomized to each group. The median follow-up was 48.5 ± 21.8 months. The median hospital stay was 24.0 ± 4.8 h and median operative time was 35.0 ± 19.9 min. The overall objective and subjective cure rates were 92.6 and 79.6%, respectively. The quality of life of all patients significantly increased after the operation compared to their preoperative status. Patients with a poorer subjective cure rate were those with mixed urinary incontinence, whose preoperative SEAPI and OAB-V8 scores were significantly higher. Conclusion: MUS surgery is highly effective and could safely be performed in a cohort of Turkish women with SUI in subspecialty centers by experienced surgeons. There is no significant difference between RP or TO applications in terms of safety and efficacy. Further studies with long-term follow-up data are required.

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Measuring outcomes in urogynecological surgery: “perspective is everything”

Cited by 26 publications

References 52 publications

Cumulative Incidence of a Subsequent Surgery After Stress Urinary Incontinence and Pelvic Organ Prolapse Procedure

Cumulative Incidence of a Subsequent Surgery After Stress Urinary Incontinence and Pelvic Organ Prolapse Procedure

Transvaginal prolapse repair with or without the addition of a midurethral sling in women with genital prolapse and stress urinary incontinence: a randomised trial

Safety and Efficacy of Retropubic or Transobturator Midurethral Slings in a Randomized Cohort of Turkish Women

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