One hundred cases of sui treatment that failed: a prospective observational study on the behavior of patients after surgical failure

Abstract

ARTICLE INFO ______________________________________________________________ ______________________Objectives: Determine what happens to patients after unsuccessful SUI operations and to explore the reasons why these patients change doctors. Materials and Methods:One hundred consecutive failed patients treated for SUI were interviewed about the exams requested after persistence of the incontinence as well as the reasons they abandoned their primary doctors through a structured questionnaire.Results: Among the patients with cases of anterior colporrhaphy, bladder suspensions or slings, 34.3%, 13.7% and 8.3%, respectively, were not offered any further type of investigative procedures to clarify the failure. Urodynamic evaluations were recommended in 75% of failed slings, and 66.6% of the patients proceeded with these tests. In contrast, only 31% of patients with bladder suspensions and 40% of patients with anterior colporrhaphy were recommended for urodynamic investigations, and only 44.4% and 28.5% of them, respectively, proceeded with the option. Patients´ delusions were reinforced by the doctors' attitude toward the investigations. Vacuous justifications and the lack of intention to seek improvement were the driving forces causing the patients to change doctors. Conclusion: Unsuccessful patients are evaluated in a non-protocol form. Difficulty in clarifying the reasons for surgical failure and the disruption of the doctor-patient relationship are the main reasons why patients abandon them.

The Burden of Reoperations and Timeline of Problems in 1,530 Cases of Mesh-Related Complications

“…Moreover, patients treated for pelvic floor problems and SUI seem to constitute a unique population characterized by poor follow-up and unrecognized recurrent rates differing from oncological or transplanted patients [3,21]. It is becoming common sense that conservative management for mesh-related complications does not provide appropriate management, except in some asymptomatic cases [22].…”

“…Attrition bias (lost of follow-up), recall bias (patients with negative results are more prone to report it), and reporting bias (under- or overreporting in injured patients due to stigmatization) are significant forces influencing long-term follow-ups and proper clinical identification by the operating surgeon. Moreover, failed procedures often lead patients to seek other experts, second opinions, and advanced medical resources [3, 4], further confounding the real incidence of mesh-related problems.…”

“…Attrition bias (lost of follow-up), recall bias (patients with negative results are more prone to report it), and reporting bias (under-or overreporting in injured patients due to stigmatization) are significant forces influencing long-term follow-ups and proper clinical identification by the operating surgeon. Moreover, failed procedures often lead patients to seek other experts, second opinions, and advanced medical resources [3,4], further confounding the real incidence of mesh-related problems. These factors were not explored in the context of the mesh-related problems but certainly contribute to the observed concentration of injured patients in tertiary referral centers then well positioned to better understand long-term mesh-related problems.…”