All female patients who underwent SUI surgery at one institution from January 2011 to December 2016 were identified and sent a 5-item self-administered postal questionnaire. Results were analyzed using GraphPad Prism 6.0. The Questionnaires were returned by 364 of 570 patients identified (64% response rate), with a median age of 51 (range 17 “ 84) and mean follow up of 54 months. The majority of respondents underwent TOT insertion (79%), followed by TVT (17%), autologous sling (2%) and Burch colposuspension (2%). 94% of procedures were primary (6% revision). Two-thirds underwent pre-procedure urodynamics. 63/364 (17%) were identified to have a concurrent pelvic organ prolapse (POP) and were treated surgically if symptomatic.
69% of patients described their SUI as much or very much better (73% TOT, 53% TVT). A significantly greater proportion of patients undergoing TVT insertion did so as revision surgery when compared to TOT insertion (p=0.0037). Overall, 55% described an improvement/cure in their overactive bladder symptoms, while 8% said they were worse. A quarter complained of new voiding difficulty (23% TOT, 27% TVT), with 9% requiring intermittent self-catheterization. 52% declared no post-operative problems, with the remainder reporting UTI (20%), dyspareunia (13%), pelvic pain (12%) and new POP (5%). Ultimately, 7% stated that they had required further surgery, the majority of which was for recurrent SUI. Specifically, 0.8% (3/364) required surgery for tape erosion (all vaginal).
They report also that this study considered one of the largest cohorts to report patient-centered real-world outcomes with over 4 year follow up. Their results demonstrate a wane in efficacy of surgery over time, while quantifying the longer-term incidence of complications and the need for further surgery. All surgeons performing surgical procedures for SUI should audit their long-term outcomes in order to accurately counsel patients considering SUI surgery and aid in their decision-making.
Presented by: Pravisha Ravindra BMBS, PGCME, FRCS, University Hospitals of Leicester NHS Trust
Co-Authors: Mei-Ling Henry, Alvaro Bazo, Richard Parkinson, Nottingham, United Kingdom