The impact of midurethral sling surgery on the development of urinary tract infections

Berger, A; Tan-Kim, Jasmine; Menefee, Shawn A.

doi:10.1007/s00192-021-04779-x

Cited by 8 publications

(5 citation statements)

References 20 publications

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“…Postoperative UTI is a factor of treatment failure due to improper healing. It is also associated with the development of de novo urinary urge and recurrent stress incontinence, with the risk of reoperation being required for the purpose of mesh revision/removal [ 17 ].…”

Section: Discussionmentioning

confidence: 99%

Postoperative Prevention of Urinary Tract Infections in Patients after Urogynecological Surgeries—Nonantibiotic Herbal (Canephron) versus Antibiotic Prophylaxis (Fosfomycin Trometamol): A Parallel-Group, Randomized, Noninferiority Experimental Trial

et al. 2022

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Introduction and hypothesis: Urinary tract infections (UTIs) are one of the most common complications of urogynecological surgeries. The risk of UTIs is increased by the catheterization of the bladder, intraoperative cystoscopy, and urine retention after the procedure. Due to increasing antibiotic resistance, there is a need to search for new methods of postoperative UTI prevention. Canephron is a mixture of century herbs, lovage roots, and rosemary leaves with diuretic, spasmolytic, anti-inflammatory, antibacterial, and nephroprotective properties. The aim of this study is to demonstrate the noninferiority of Canephron versus antibiotic prophylaxis with fosfomycin trometamol (FT), based on the collective results of postoperative urine culture analyses. Methods: One hundred and twenty-five female patients were randomized into two groups before undergoing urogynecological surgeries, including a control group (n = 67), which received one dose of 3g of FT the day after the procedure, and a study group (n = 58), which received Canephron three times a day for 14 days, starting the day after the procedure. All the patients were assessed using the Acute Cystitis Symptom Score (ACSS). Results: UTIs were observed in 6.4% of the patients. There was no statistically significant difference between the use of FT and Canephron in terms of UTIs (Chi^2 N-1 = 0.8837; p = ns). Additional factors, such as menopausal status and the type of procedure performed, increased the risk of developing a UTI. Factors such as the body mass index (BMI), sexual activity, and parity had no correlation. Conclusions: Canephron is noninferior to FT in the prevention of postoperative UTIs. The use of such a phytotherapeutic drug may help to decrease antibiotic consumption, which is closely connected to the growing trend of antibiotic resistance.

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Section: Discussionmentioning

confidence: 99%

Postoperative Prevention of Urinary Tract Infections in Patients after Urogynecological Surgeries—Nonantibiotic Herbal (Canephron) versus Antibiotic Prophylaxis (Fosfomycin Trometamol): A Parallel-Group, Randomized, Noninferiority Experimental Trial

et al. 2022

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“…In the long-term, subjective cure rates ranged from 43-92% in the transobturator group, and from 51-88% in the retropubic group. 69,[79][80][81] Overall morbidity was low in both groups, with complications including vascular/visceral injury, bladder/ urethral perforation, postoperative voiding dysfunction, urgency and urgency urinary incontinence, vaginal mesh exposure, suprapubic or groin pain, and need for further treatment. The risks of prosthesis complications specific to the use of mesh, such as exposure (vaginal, urethral, bladder) and mesh-related pain, should be explicitly discussed with the patient prior to its surgical consideration.…”

Section: What Is the Role Of Mus In Managing The Index Patient With F...mentioning

confidence: 92%

“…New-onset, repeated UTIs occur in 2-7% of women after a MUS, and older age and post-MUS urinary retention are significant risk factors. 79 If a patient had recurrent UTIs prior to SUI surgery and the same pattern continues, then logically revising the sling is unlikely to help. A few things must be addressed if the recurrent UTIs are new:…”

Section: Should You Remove/revise a Sling In A Woman With Repeated Ut...mentioning

confidence: 99%

2024 Canadian Urological Association guideline: Female stress urinary incontinence

Carlson,

Andrews,

Bascom

et al. 2024

CUAJ

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prior to publication, this guideline underwent review by the cua guidelines steering committee and expert reviewers. INTRODUCTION & PURPOSEFemale stress urinary incontinence (FSUI) is a common condition that affects approximately 10-20% of the population. 1 It is associated with negative impacts on quality of life (QoL), socialization, and exercise; it has a significant financial impact, and is associated with depression and anxiety. 2 In 2012, the last Canadian Urological Association (CUA) guideline addressing adult urinary incontinence was published; it covered male and female nonneurogenic stress and urgency incontinence. 3 Given the considerable changes in the management of FSUI, and the very distinct considerations and surgical procedures for this group, an individual guideline providing a more detailed overview of this topic was requested by the CUA Guidelines Steering Committee.The specific population this guideline is intended to cover is women over 18 years of age with stress urinary incontinence. This CUA guideline is intended to be used by healthcare providers treating patients with FSUI. The guideline objective is to cover topics important to the evaluation, counselling, non-surgical and surgical treatment of FSUI, and the management of complications of FSUI surgery.Given the significant variation in patients with FSUI, in some sections we focus on the evaluation and management of the "index patient" (similar to other guidelines). 4,5 Other sections are dedicated to specific nonindex patients with FSUI. We recognize that guidelines cannot address the management of all FSUI scenarios. METHODOLOGYWe decided to use a question-and-answer format to provide brief, accessible, and practical answers to common questions addressing the evaluation and management of FSUI. The guideline panel was created to provide representation from a mix of community and academic urologists and allied health professionals from across Canada, in keeping with the CUA guideline rules. Disagreements during the guideline process were resolved by consensus-building. Conflicts of interests for the authors are included at the end of the guideline. The views or interests of the CUA did not influence the final set of recommendations.The guideline panel was led by Dr. Kevin Carlson and Dr. Blayne Welk. The group first met virtually in December 2021. Objectives to guide the development of this document were agreed upon: 1) to be comprehensive without replicating existing evidence reviews; 2) to provide evidence-based and expert-based opinions on relevant topics within FSUI; and 3) to address the unique needs of Canadian urologists where appropriate.All guideline members were asked to submit relevant topics that could be addressed in a questionand-answer format, and the final list of questions was agreed upon by the panel. Further feedback was received from CUA members at the 2022 CUA annual meeting. Individual sections were assigned to members, with another panel member acting as primary reviewer. Members reviewed publications relevant to ...

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“…Thirtyday outcomes included 30-day complications, both overall and for UTI separately, as UTI is a well-known complication of sling surgery. 6,11,12 Additionally, since UTI is a more minor complication, it was assessed independent of more serious complications. One-year outcomes included 1-year mortality and the need for repeat procedures (for both urinary incontinence and for outlet obstruction) at 1 year.…”

Section: Outcome Measuresmentioning

confidence: 99%

Frailty Is Associated with an Increased Risk of Complications and Need for Repeat Procedures after Sling Surgery in Older Adults

et al. 2022

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Purpose:Sling surgery is the gold standard treatment for stress urinary incontinence in women. While data support the use of sling surgery in younger and middle-aged women, outcomes in older, frail women are largely unknown.Materials and Methods:Data were examined for all Medicare beneficiaries ≥65 years old who underwent sling surgery with or without concomitant prolapse repair from 2014 to 2016. Beneficiaries were stratified using the Claims-Based Frailty Index (CFI) into 4 categories: not frail (CFI <0.15), prefrail (0.15 ≤CFI <0.25), mildly frail (0.25 ≤CFI <0.35) and moderately to severely frail (CFI ≥0.35). Outcomes included rates and relative risk of 30-day complications, 1-year mortality and repeat procedures for persistent incontinence or obstructed voiding at 1 year.Results:A total of 54,112 women underwent sling surgery during the study period, 5.2% of whom were mildly to moderately to severely frail. Compared to the not frail group, moderately to severely frail beneficiaries demonstrated an increased adjusted relative risk (aRR) of 30-day complications (56.5%; aRR 2.5, 95% CI: 2.2–2.9) and 1-year mortality (10.5%; aRR 6.7, 95% CI: 4.0–11.2). Additionally, there were higher rates of repeat procedures in mildly to severely frail beneficiaries (6.6%; aRR 1.4, 95% CI: 1.2–1.6) compared to beneficiaries who were not frail.Conclusions:As frailty increased, there was an increased relative risk of 30-day complications, 1-year mortality and need for repeat procedures for persistent incontinence or obstructed voiding at 1 year. While there were fewer sling surgeries in performed frail women, the observed increase in complication rates was significant. Frailty should be strongly considered before pursuing sling surgery in older women.

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The impact of midurethral sling surgery on the development of urinary tract infections

Cited by 8 publications

References 20 publications

Postoperative Prevention of Urinary Tract Infections in Patients after Urogynecological Surgeries—Nonantibiotic Herbal (Canephron) versus Antibiotic Prophylaxis (Fosfomycin Trometamol): A Parallel-Group, Randomized, Noninferiority Experimental Trial

Postoperative Prevention of Urinary Tract Infections in Patients after Urogynecological Surgeries—Nonantibiotic Herbal (Canephron) versus Antibiotic Prophylaxis (Fosfomycin Trometamol): A Parallel-Group, Randomized, Noninferiority Experimental Trial

2024 Canadian Urological Association guideline: Female stress urinary incontinence

Frailty Is Associated with an Increased Risk of Complications and Need for Repeat Procedures after Sling Surgery in Older Adults

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