Regional Audit of Mid-Urethral Tapes for Stress Urinary Incontinence in Northern Ireland
IUGA Academy. Stezaker. S. Jun 30, 2018; 212879; 539 Topic: Stress Incontinence
Dr. Sophie Stezaker.
Dr. Sophie Stezaker.

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Regional audit of mid-urethral tapes for stress urinary incontinence in Northern Ireland

Abdelrahman, A1;Stezaker, S2

1: Antrim Area Hospital; 2: Altnagelvin Area Hospital

Introduction: Tension free vaginal tapes are the most common surgical technique used to treat urinary stress incontinence, with over 15,000 women undergoing the operation in the United Kingdom (UK) each year. Despite the Medicines and Healthcare products Regulatory Agency (MRHA) concluding that the ‘benefits outweigh the risks’, media coverage of long term complications has highlighted the need for informed consent and thorough follow up for these patients.

Objective: To carry out a comprehensive regional audit of mid-urethral tapes for the treatment of urinary stress incontinence within Northern Ireland, particularly looking at the quality of consent, occurrence of complications and follow up for each patient. This is part of our larger quality improvement project to introduce a hospital wide standard consent and follow-up to improve the experience for women undergoing these procedures.

Methods: This was a retrospective regional audit of patients that underwent mid-urethral tapes between January 2013-December 2013 in Northern Ireland. There was 691 procedures performed; 340 were analysed. NICE guideline on ‘Urinary Incontinence in Women’ was used as audit standard.

Results: There was evidence of completion of physiotherapy in 78.6% (187/238). Urodynamics was performed in 89.7% (305/340). There was a regional variation in consent procedures. Notably self-catheterisation was mentioned in 70.4% and failure of surgery mentioned in 60.1%. A consultant had performed the procedure in 96.8% (329/340) with primary continence procedure performed in 92.4% (314/340) and repeat procedure in 5.1% (21/230). A transobturator approach was used in 189 cases and retropubic procedure in 147 cases. 95% (323/340) had no intra-operative injuries. Almost 80% had overall improvement in their symptoms.

Conclusions: Overall the use of mid-urethral tapes is a successful technique in the short term. The incidence of complications is in line with literature. Evidence of pre-operative conservative therapy is embedded. Urodynamics is part of the pre-operative process. There is low incidence of intra-operative complications. There is a similar incidence but different type of post-operative morbidity.


Work supported by industry: no.

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