The evolving phase of continence surgery in a teaching hospital
IUGA Academy. Bisseling C. Jun 30, 2018; 212923; 424 Topic: Stress Incontinence
Catharina Bisseling
Catharina Bisseling

Access to Premium content is currently a membership benefit.


Click here to join IUGA or renew your membership.

Abstract
Discussion Forum (0)
Rate & Comment (0)

424

The evolving phase of continence surgery in a teaching hospital

Bisseling, C1; Bhal, K1; Davies, J1

1: Department of Urogynaecology, University Hospital of Wales, Cardiff, United Kingdom

Introduction: Midurethral tape (MUT) has been the gold standard surgical management of stress urinary incontinence (SUI). The use of all forms of vaginal mesh is currently under scrutiny. We describe how continence surgery has evolved over the past five years in our urogynaecology unit.

Objective: To review our practice in the surgical management of SUI in the last five years.

Methods: Data was extracted from the British Society of Urogynaecology (BSUG) database of all patients that have undergone surgery for SUI under the care of our lead urogynaecologist between January 2013 and 2018. The outcome for each procedure was analyzed including the trend in the type of procedures performed.

Results: Two hundred procedures were performed during the five-year review period (MUT = 134; Autologous fascial sling = 2; Colposuspension = 36; Peri-urethral bulking (PUB) = 28). There was a downward trend in the number of MUTs performed from 96% of all SUI procedures in 2013 to 21% in 2017/18. The rise in PUB was noted from 2016 and peaking at 54% of all SUI procedures in 2017/18.

Complication rates are noted in the table below:

Complication

N (%)

MUT

N = 134

Autologous fascial sling

N = 2

Colposuspension

N = 36

PUB

N = 28

Intra-operative

Bladder injury

6 (4%)

-

-

-

Bleeding >500mls

1 (1%)

-

6 (17%)

-

Other

1 (1%)

-

-

-

Post-operative

Catheterisation >10 days

4 (3%)

1 (50%)

6 (17%)

-

Wound complication

1 (1%)

-

4 (11%)

-

Readmission within 28 days

4 (3%)

-

1 (3%)

1 (4%)

Return to theatre within 28 days

1(1%)

-

-

-

Mesh exposure

3 (2%)

-

-

-

Other (including pain)

7 (5%)

-

-

-

Patient global impression of symptom improvement was reported in 96% of MUTs, 100% of autologous fascial slings, 97% of colposuspensions and 81% of PUB (minimum 3-month follow up).

Conclusions: This series depicts a change in the type of surgical procedures performed for SUI. Although subjective symptom improvement rates are broadly similar (>80% of patients reporting improvement), the type and complication rates varied between procedures. Since 2015/16 our patients have been choosing alternative procedures avoiding the use of mesh to manage their SUI. The recent controversies in the use of vaginal mesh and a recent medico-legal case ruling on informed consent have put decision making in continence surgery in a different light. Informed consent should involve an individualised approach encouraging an active role of the patient in the decision-making process and the use of local outcome rates for SUI surgery would be helpful during the counseling process. This evolution in surgical practice is likely to have implications on training juniors in the future. Exploring patient’s priorities and values as well as in depth discussion of pros and cons of all available treatment options as per the Montgomery ruling (2015) is of paramount importance especially when considering surgery to improve quality of life conditions.

References:

Montgomery v Lanarkshire Health Board [2015] SC 11 [2015] 1 AC 1430.

Disclosure:

Work supported by industry: no.

Code of conduct/disclaimer available in General Terms & Conditions

By continuing to browse or by clicking “Accept Terms & all Cookies”, you agree to the storing of third-party cookies on your device to enhance your user experience and agree to the user terms and conditions of this learning management system (LMS).

Cookie Settings
Accept Terms & all Cookies