Female Pelvic Medicine and Reconstructive Surgery最新文献

{"title":"Cost-effectiveness Analysis of Early Sling Loosening Versus Delayed Sling Lysis in the Management of Voiding Dysfunction After Midurethral Sling Placement","authors":"D. Vargas Maldonado, K. Wymer, J. Gebhart, A. Madsen, J. Occhino, E. Trabuco, B. Linder","doi":"10.1097/SPV.0000000000001165","DOIUrl":"https://doi.org/10.1097/SPV.0000000000001165","url":null,"abstract":"Objective The aim of this study was to perform a cost-effectiveness analysis comparing the management for ongoing voiding dysfunction after midurethral sling placement, including early sling loosening and delayed sling lysis. Methods A Markov model was created to compare the cost-effectiveness of early sling loosening (2 weeks) versus delayed sling lysis (6 weeks) for the management of persisting voiding dysfunction/retention after midurethral sling placement. A literature review provided rates of resolution of voiding dysfunction with conservative management, complications, recurrent stress urinary incontinence, or ongoing retention, as well as quality-adjusted life years (QALYs). Costs were based on 2020 Medicare reimbursement rates. Incremental cost-effectiveness ratios were compared using a willingness-to-pay threshold of $100,000/QALY. One-way and probabilistic sensitivity analyses were performed. Results At 1 year, early sling loosening resulted in increased costs ($3,575 vs $1,836) and higher QALYs (0.948 vs 0.925) compared with delayed sling lysis. This translated to early sling loosening being the most cost-effective strategy, with an incremental cost-effectiveness ratio of $74,382/QALY. The model was sensitive to multiple variables on our 1-way sensitivity analysis. For example, delayed sling lysis became cost-effective if the rate of voiding dysfunction resolution with conservative management was greater than or equal to 57% or recurrent stress urinary incontinence after early loosening was greater than or equal to 9.6%. At a willingness-to-pay threshold of 100,000/QALY, early sling loosening was cost-effective in 82% of microsimulations in probabilistic sensitivity analysis. Conclusions Early sling loosening represents a more cost-effective management method in resolving ongoing voiding dysfunction after sling placement. These findings may favor early clinical management in patients with voiding dysfunction after midurethral sling placement.","PeriodicalId":48831,"journal":{"name":"Female Pelvic Medicine and Reconstructive Surgery","volume":"28 1","pages":"e103 - e107"},"PeriodicalIF":1.6,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46686830","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How Involved Do Patients Want to Be in the Medical Decision-Making at the Initial Urogynecology Clinic Visit?","authors":"L. Westbay, W. Adams, H. Barnes, M. Gevelinger, Daryl McKee, C. Fitzgerald, M. Acevedo-alvarez, E. Mueller, T. Pham","doi":"10.1097/SPV.0000000000001157","DOIUrl":"https://doi.org/10.1097/SPV.0000000000001157","url":null,"abstract":"Objective The aim of this study was to compare patients' preferred role in medical decision-making before the initial urogynecology visit to their perceived role after the visit. Methods This prospective cohort study enrolled women presenting for their initial urogynecology visit. Before and after the visit, patients completed the Control Preference Scale (CPS), which categorizes the role that patients want to have in medical decision-making: active, collaborative, or passive. Patients also completed the Pelvic Floor Distress Inventory, CollaboRATE, Patient Global Impression of Improvement, patient satisfaction, and Short Test of Functional Health Literacy in Adults questionnaires. Univariable and multivariable generalized estimating equations were used. Results Women (n = 100) with a mean age of 59.1 years (SD = 15.5) participated in the study. Based on CPS before the visit, 50% of the women preferred active involvement, whereas 45% preferred collaborative and 5% preferred passive involvement. After the visit, these rates change to 40%, 48%, and 11%, respectively. On univariable analysis, women were 1.56 times more likely to report a collaborative or passive CPS response after the visit (P = 0.02). This remained true on multivariable analysis (odds ratio, 1.57; P = 0.04). Patients' CPS responses were not associated with their responses on CollaboRATE, Patient Global Impression of Improvement, patient satisfaction, or Short Test of Functional Health Literacy in Adults. Eighty-eight percent of women reported a fully collaborative visit based on CollaboRATE, and 87% reported being “completely satisfied” with the visit. Conclusions Despite a change in women's reported involvement in decision-making after their first urogynecology visit compared with their preferences before the visit, most women perceived collaboration during their visit and were completely satisfied.","PeriodicalId":48831,"journal":{"name":"Female Pelvic Medicine and Reconstructive Surgery","volume":"28 1","pages":"153 - 159"},"PeriodicalIF":1.6,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42290008","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Vaginal Hysterectomy Performed Under General Versus Neuraxial Regional Anesthesia: Comparison of Patient Characteristics and 30-Day Outcomes Using Propensity Score–Matched Cohorts","authors":"C. X. Hong, Edward K. Kim, Alessandra I Cardi, H. Harvie","doi":"10.1097/SPV.0000000000001163","DOIUrl":"https://doi.org/10.1097/SPV.0000000000001163","url":null,"abstract":"Objectives Compared with surgery under general anesthesia (GA), surgery under neuraxial regional anesthesia (RA) has been associated with economic and clinical benefits in certain populations. Our aim was to compare preoperative and postoperative characteristics and 30-day outcomes, including intraoperative complications, for patients undergoing benign vaginal hysterectomy under GA versus RA. Methods This is a retrospective cohort study of patients who underwent vaginal hysterectomy for benign indications between 2015 and 2019 using the American College of Surgeons National Surgical Quality Improvement Program database. Patients were identified using Current Procedural Terminology codes and stratified into GA and RA groups. Propensity score matching was performed to account for selection bias between anesthesia groups. Results Of 18,030 vaginal hysterectomies performed during this study period, 17,472 (96.9%) were performed under GA and 558 (3.1%) under RA. The RA group was older, more likely to be White, and more likely to have a history of chronic obstructive pulmonary disease and chronic steroid use (P < 0.01 for all); they were less likely to be discharged the same day (8.6% vs 12.2%, P = 0.01). In the matched cohort, there were similar proportions of major, minor, and composite complications between RA and GA groups (major: odds ratio [OR], 0.95; 95% confidence interval [CI], 0.51–1.78; minor: OR, 1.18; 95% CI, 0.74–1.88; composite: OR, 1.10; 95% CI, 0.75–1.64). Similar proportions of same-day discharge were observed (OR, 0.72; 95% CI, 0.47–1.10). Conclusions Although RA comprises only 3% of the anesthetic modalities used for benign vaginal hysterectomies, it is associated with a similar incidence of postoperative complications compared with general anesthesia.","PeriodicalId":48831,"journal":{"name":"Female Pelvic Medicine and Reconstructive Surgery","volume":"28 1","pages":"e98 - e102"},"PeriodicalIF":1.6,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44754090","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Can Women Accurately Predict Their Voided Volumes?","authors":"Siri Drangsholt, Stephanie Sansone, Megan Donnelly, Bilal Chughtai","doi":"10.1097/SPV.0000000000001148","DOIUrl":"10.1097/SPV.0000000000001148","url":null,"abstract":"<p><strong>Importance: </strong>Voiding diaries can be onerous, we sought to investigate if some women can predict their voided volumes.</p><p><strong>Objectives: </strong>The objective of this study is to determine the accuracy of estimated voided volumes and characteristics most predictive of accuracy.</p><p><strong>Study design: </strong>We prospectively collected data on 101 women undergoing urodynamics for lower urinary tract symptoms and/or prolapse at a tertiary care facility. Data collection included postvoid residual volume, urodynamic diagnosis, flow time and rate, and a 1-time measurement of voided volume into a blinded uroflow. Linear and logistic regression analyses were performed to examine predictors of estimated voided volume (mL).</p><p><strong>Results: </strong>Mean age was 58.2 years (standard deviation, 12.8 years). The median estimated voided volume and actual voided volume were 240 and 215 mL, respectively. The average percent error was 15% (63% of patients being within a 30% margin of error and 32.7% being within a 20% margin of error). On linear regression analysis, smaller voids of 101 to 200 mL were associated with greater accuracy (R2 = 0.37 P = 0.001) and diagnosis of anxiety was associated with a higher voided volume percent error (P = 0.028). Logistic regression analysis revealed that for every 1 year increase in age, there was a 3% decrease in odds of predicting voiding volume within 30% (odds ratios, 0.97; P = 0.041).</p><p><strong>Conclusions: </strong>Nearly two-thirds of women estimated their voided volume within 30% of the actual void and one-third of women could predict within 20%. This should be taken into consideration when obtaining patient history, particularly with age and diagnosis of anxiety, and may substantiate use of voiding diaries for accurate measurement in specific populations.</p>","PeriodicalId":48831,"journal":{"name":"Female Pelvic Medicine and Reconstructive Surgery","volume":"28 1","pages":"160-164"},"PeriodicalIF":1.4,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46550769","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of Preoperative Gabapentin on Clinical Outcomes After Outpatient Midurethral Sling Placement","authors":"E. Welch, K. Dengler, A. DiCarlo-Meacham, J. Wheat, G. Stone, C. Olsen, W. V. von Pechmann","doi":"10.1097/SPV.0000000000001141","DOIUrl":"https://doi.org/10.1097/SPV.0000000000001141","url":null,"abstract":"Objectives This study aimed to evaluate transient urinary retention in women undergoing outpatient midurethral sling placement who received preoperative gabapentin (treated) versus those who did not (untreated). Secondary outcomes included unexpected admission rates, analgesic usage, time to discharge, and pain. Methods This was a retrospective cohort study including women who underwent outpatient midurethral sling placement from 2015 to 2019. Exclusion criteria included suprapubic catheter placement, planned overnight admission, abnormal preoperative postvoid residual volume, and prolonged postoperative catheterization. Logistic regression was performed to evaluate gabapentin usage and urinary retention after adjusting for patient characteristics. Results Three hundred two women met the inclusion criteria, with 19.5% experiencing urinary retention after midurethral sling placement. Women older than 65 years were more likely to have urinary retention than those aged 18–65 years (29.8% vs 17.6%, P = 0.054). Of treated participants, 26% had urinary retention versus 18% of untreated participants (P = 0.162). Adjusting for age, parity, pain, operative time, blood loss, sling type, analgesic, scopolamine patch, or hemostatic agent use, treated participants had 72% higher odds of urinary retention (adjusted odds ratio, 1.72; 95% confidence interval, 0.88–3.38; P = 0.113). There was no difference in unexpected admission, analgesic usage, time to discharge, or pain between groups. Conclusions One of 5 women had urinary retention after outpatient midurethral sling placement. Although no statistically significant difference was found in urinary retention between groups, the odds of urinary retention in the treated group were increased. Because there was no difference in pain, analgesic usage, or time to discharge between groups, investigation regarding gabapentin use for outpatient urogynecologic surgery is needed.","PeriodicalId":48831,"journal":{"name":"Female Pelvic Medicine and Reconstructive Surgery","volume":"28 1","pages":"e39 - e43"},"PeriodicalIF":1.6,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47017164","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sex Differences in Commercial Patient Reviews of Women and Men Urogynecologic Surgeons","authors":"M. Mueller, Chen Chen, J. Geynisman-Tan, C. Bretschneider, S. Collins, C. Lewicky-Gaupp, O. Brown, K. Kenton","doi":"10.1097/SPV.0000000000001155","DOIUrl":"https://doi.org/10.1097/SPV.0000000000001155","url":null,"abstract":"Objective The objective of our study was to describe differences in commercial patient reviews of women and men urogynecologic surgeons. Materials and Methods Reviews of surgeons on Healthgrades.com in 4 metropolitan areas were included. Based on the qualitative assessment using qualitative content analysis of major and minor elements, we defined 4 theme categories: global experience, social interaction, technical skills, and ancillary aspects, each embedded with discrete elements. Differences in proportions of mentioned themes as well as quantitative ratings were evaluated by sex with the appropriate statistical tests. Results Three hundred sixty-four patient reviews (51% for women surgeons and 49% for men surgeons) were identified for 141 gynecologic surgeons self-identifying as “urogynecologists.” The majority of the cohort (77%) held subspecialty certification in female pelvic medicine and reconstructive surgery. Reviews of women demonstrated a lower mean quantitative “likelihood to recommend” score compared with men (4.0 vs 4.3, P = 0.002) on the 5-point scale. Women received more mention in comfort (52% vs 40%, P = 0.023) and professionalism (19% vs 9%, P = 0.007) themes and less mention with respect to surgical outcomes (28% vs 53%, P < 0.001) and technical skills (5% vs 15%, P = 0.011) compared with men. Conclusions Commercial online patient reviews for urogynecologic surgeons reveal sex bias with women receiving lower scores overall and more comments related to social interaction and fewer comments related to surgical outcomes and technical skill compared with men.","PeriodicalId":48831,"journal":{"name":"Female Pelvic Medicine and Reconstructive Surgery","volume":"28 1","pages":"173 - 176"},"PeriodicalIF":1.6,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42168413","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Suprapubic Versus Transurethral Catheterization: Perioperative Outcomes After Colpocleisis","authors":"A. DiCarlo-Meacham, K. Dengler, E. Welch, S. Hamade, C. Olsen, N. Horbach, J. Welgoss, D. Mazloomdoost, W. V. von Pechmann","doi":"10.1097/SPV.0000000000001167","DOIUrl":"https://doi.org/10.1097/SPV.0000000000001167","url":null,"abstract":"Objectives Transient postoperative urinary retention occurs in approximately half of women after colpocleisis; however, the optimal strategy for postoperative catheter management is unclear. This study compared length of catheterization and postoperative complications after colpocleisis between planned suprapubic catheter placement and transurethral catheterization. Methods This is a retrospective cohort study including all women undergoing colpocleisis from January 2015 to December 2019 in a large female pelvic medicine and reconstructive surgery practice. Women undergoing planned placement of a suprapubic catheter intraoperatively during colpocleisis and women who were discharged with a transurethral catheter after failing an active voiding trial postoperatively after colpocleisis were included. Women with surgical complications requiring prolonged catheterization and those needing catheterization before surgery were excluded. Length of catheterization and postoperative complications were compared between groups. Results Two hundred fifty-eight women underwent colpocleisis during the study time frame and 170 were eligible for analysis: with 78 in the planned suprapubic catheter group and 92 in the transurethral catheter group. Length of catheterization with suprapubic catheter placement was significantly longer than transurethral catheter placement with median catheter days of 11 (95% confidence interval [CI], 10–14) versus 7 (95% CI, 6–7), which persisted after adjustment (HR, 2.61, 95% CI, 1.85–3.68, P < 0.001). No significant differences were found in overall complications or urinary tract infections. Conclusions Suprapubic catheter placement at the time of colpocleisis is associated with increased length of catheterization postoperatively compared with transurethral catheter for management of postoperative urinary retention. These data can aid surgeons in preoperative counseling and shared decision making with patients.","PeriodicalId":48831,"journal":{"name":"Female Pelvic Medicine and Reconstructive Surgery","volume":"28 1","pages":"149 - 152"},"PeriodicalIF":1.6,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44241964","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Failure Rate of Retropubic Midurethral Sling With and Without Concomitant Robotic Sacrocolpopexy","authors":"G. M. Rustia, Michael G. Baracy, Felicia J Drouillard, K. Hagglund, M. F. Aslam","doi":"10.1097/SPV.0000000000001159","DOIUrl":"https://doi.org/10.1097/SPV.0000000000001159","url":null,"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.","PeriodicalId":48831,"journal":{"name":"Female Pelvic Medicine and Reconstructive Surgery","volume":"28 1","pages":"177 - 180"},"PeriodicalIF":1.6,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48763229","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Methenamine Hippurate With Cranberry Capsules Versus Cranberry Alone for Urinary Tract Infection Prevention in a Short-Term Indwelling Foley Catheter Population After Urogynecologic Surgery: A Double-Blinded Randomized Controlled Trial","authors":"T. Tam, E. Aldrich, C. Crisp, E. Yook, J. Yeung, R. Pauls","doi":"10.1097/SPV.0000000000001147","DOIUrl":"https://doi.org/10.1097/SPV.0000000000001147","url":null,"abstract":"Importance There is little consensus on an effective nonantibiotic agent for the prevention of urinary tract infection (UTI) after pelvic reconstructive surgery. Objective The aim of the study was to investigate the impact of methenamine hippurate with cranberry capsules on rates of UTI after pelvic reconstructive surgery, among patients requiring short-term catheterization. Study Design In this randomized, double-blinded placebo-controlled trial, patients discharged with a catheter after pelvic reconstructive surgery were approached to participate. Participants were randomized to receive cranberry with methenamine or cranberry with placebo. Primary outcome was number of UTIs treated within 1 week after surgery. Secondary outcomes included incidence of UTIs treated within 6 weeks postoperatively, bacterial species on culture, urinary pH, catheter duration, patient adherence, and satisfaction. A sample size of 88 participants per arm was planned. Results From June 2019 to July 2021, 185 patients were randomized and 182 analyzed; 89 received placebo and 93 received methenamine. Both groups were similar. Incidence of UTI at 1 week was significantly higher in the placebo group (79.8%) compared with the methenamine group (66.7%; odds ratio, 1.97; 95% confidence interval, 1.01–3.87; P = 0.048). This difference increased by 6 weeks postoperatively (89.9% vs 72.0%; odds ratio, 3.45; 95% confidence interval, 1.51–7.87; P = 0.003). There were fewer pseudomonal UTIs in the methenamine group (P = 0.041). Duration of catheterization and urinary pH were similar. Overall adherence and level of satisfaction was high. Conclusions In this high-risk population, methenamine was well tolerated and significantly reduced UTI rates. Methenamine with cranberry should be considered as an effective prophylactic therapy to reduce this common complication after pelvic surgery.","PeriodicalId":48831,"journal":{"name":"Female Pelvic Medicine and Reconstructive Surgery","volume":"28 1","pages":"e55 - e61"},"PeriodicalIF":1.6,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43886460","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-term Urinary Outcomes After Transvaginal Uterovaginal Prolapse Repair With and Without Concomitant Midurethral Slings.","authors":"Lauren Giugale, Amaanti Sridhar, Kimberly L Ferrante, Yuko M Komesu, Isuzu Meyer, Ariana L Smith, Deborah Myers, Anthony G Visco, Marie Fidela R Paraiso, Donna Mazloomdoost, Marie Gantz, Halina M Zyczynski","doi":"10.1097/SPV.0000000000001160","DOIUrl":"10.1097/SPV.0000000000001160","url":null,"abstract":"<p><strong>Importance: </strong>Many health care providers place concomitant midurethral slings during pelvic organ prolapse repair, yet growing evidence supports staged midurethral sling placement.</p><p><strong>Objectives: </strong>The aim of this study was to compare urinary function after transvaginal uterovaginal prolapse repair with and without midurethral sling.</p><p><strong>Study design: </strong>Secondary analysis of the Study of Uterine Prolapse Procedures Randomized Trial (hysterectomy with uterosacral ligament suspension vs mesh hysteropexy). Our primary outcome was Urinary Distress Inventory score (UDI-6) through 5 years compared between women with and without a concomitant sling within prolapse repair arms. Sling effect was adjusted for select clinical variables and interaction terms (α = .05).</p><p><strong>Results: </strong>The sling group included 90 women (43 hysteropexy, 47 hysterectomy), and the no-sling group included 93 women (48 hysteropexy, 45 hysterectomy). At baseline, the sling group reported more bothersome stress (66% vs 36%, P < 0.001) and urgency incontinence (69% vs 48%, P = 0.007). For hysteropexy, there were no significant long-term differences in UDI-6 scores or bothersome urine leakage between sling groups. For hysterectomy, women with sling had better UDI-6 scores across time points (adjusted mean difference, -5.1; 95% confidence interval [CI], -9.9 to -0.2); bothersome stress and urgency leakage were less common in the sling group (stress adjusted odds ratio, 0.1 [95% CI, 0.0-0.4]; urge adjusted odds ratio, 0.5 [95% CI, 0.2-1.0]). Treatment for stress incontinence over 5 years was similar in the sling (7.9%) versus no-sling (7.6%) groups.</p><p><strong>Conclusions: </strong>Five-year urinary outcomes of concomitant midurethral sling may vary by type of transvaginal prolapse surgery, with possible benefit of midurethral sling at the time of vaginal hysterectomy with apical suspension but not after mesh hysteropexy.</p>","PeriodicalId":48831,"journal":{"name":"Female Pelvic Medicine and Reconstructive Surgery","volume":"28 3","pages":"142-148"},"PeriodicalIF":1.4,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8928054/pdf/nihms-1768263.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10813474","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}