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IS SLING STIFFNESS ASSOCIATED WITH POSTOPERATIVE VOIDING DYSFUNCTION? A COMPARISION OF TWO POLYPROPYLENE MIDURETHRAL SLINGS
THE JOURNAL OF UROLOGY®
616
Vol. 181, No. 4, Supplement, Tuesday, April 28, 2009
Multivariate analysis of parameters according to surgical outcome. Improved+Fail
Odd ratio
p-value
319
99
4.081
0.001
DOES BARIATRIC SURGERY AFFECT URINARY INCONTINENCE?
0.892
0.836
Michelle J Semins*, E James Wright, Kimberley Steele, Andrew D Shore, Martin A Makary, Brian R Matlaga, Baltimore, MD
1.894
0.459
1.070
0.254
1.071
0.639
0.847
0.227
Age
< 55 q 55
92
30
Type of SUI
pure SUI
319
99
Mixed SUI
92
30
Mild
134
41
Moderate
269
83
Severe
8
5
(-)
368
121
(+)
43
8
Severity of SUI
Previous OP VLPP Type of MUS
1709
Cure
q 60
220
63
< 60
191
63
TVT
178
48
TOT
83
35
TVTO
108
37
TVT-s
42
9
CONCLUSIONS:The patient age was the only statistically significant parameter affecting the cure rate while the type of the tape was not. Source of Funding: None
1708 IS SLING STIFFNESS ASSOCIATED WITH POSTOPERATIVE VOIDING DYSFUNCTION? A COMPARISION OF TWO POLYPROPYLENE MIDURETHRAL SLINGS
INTRODUCTION AND OBJECTIVES: Morbid obesity has been reported to be a risk factor for urinary incontinence. Recent case series suggest that intentional weight loss will subjectively improve urinary incontinence. However, the impact of bariatric surgery on urinary incontinence remains uncharacterized and is an open area of investigation. Therefore, we performed a study to define the effect of bariatric surgery on urinary incontinence. METHODS: We evaluated claims over a 5 year period (20022006) in a national private insurance database, to identify female patients who underwent bariatric surgery with three years of follow-up claims data. The cohort of patients who underwent bariatric surgery (treatment) was matched to a cohort of obese female patients who did not undergo bariatric surgery (control) with similar follow-up from the surgery date (index date). Urinary incontinence was identified by ICD-9 coding. RESULTS: Following bariatric surgery, 62.4% (83/133) of subjects diagnosed with urinary incontinence prior to their surgery no longer had a coding diagnosis of urinary incontinence. In contrast, only 42.1% (56/133) of those in the non-bariatric surgery cohort lost their coding diagnosis of incontinence (p<0.0001). Of those that did not have pre-existing incontinence, 6.2% (235/3765) of the bariatric surgery cohort gained a new coding diagnosis of incontinence, whereas 7.1% (269/3765) of the control group gained such a coding diagnosis (p<0.0001). Bariatric Surgery Cohort (Treatment)
Sujith K. Reddy*, B. Jill Williams, Alexander Gomelsky, Shreveport, LA INTRODUCTION AND OBJECTIVES: Recent modifications to midurethral slings (MUS) by some manufacturers have resulted in stiffer slings which are less resistant to deformation in vitro. The performance of these materials after implantation and the incidence of voiding dysfunction have not been fully investigated. We retrospectively report on the postoperative voiding dysfunction after two types of suprapubic (SP) and transobturator (TO) MUS: high-stiffness (Bard) and low-stiffness (AMS). METHODS: Group 1 consisted of 80 consecutive women who underwent high-stiffness MUS (40 TO, 40 SP), under a manufacturerinstitutional agreement. Group 2 consisted of the most recent 80 consecutive women who underwent an established low-stiffness MUS (40 TO, 40 SP). All procedures were performed by one surgeon using standard placement and tensioning technique. All voiding trials were performed per protocol. Postoperative voiding dysfunction was subcategorized by: asymptomatic high post void residual (PVR), positional voiding, urinary retention < 30 days, and retention requiring urethrolysis. Secondary outcomes included validated quality of life (QOL) questionnaires. RESULTS: Of 40 women undergoing high-stiffness SP sling, 17 (42.5%) women had voiding dysfunction: high PVR (5%), retention < 30 days (25%) and urethrolysis (12.5%). In comparison, 3 (7.5%) women undergoing low-stiffness SP sling had voiding dysfunction: high PVR (5%) and retention < 30 days (2.5%) (p<0.001). The incidence of voiding dysfunction was similar between high-stiffness and low-stiffness TO slings (NS). Fifteen percent of women undergoing high-stiffness TO sling had postoperative voiding dysfunction: high PVR (10%), retention <30 days (2.5%), and positional voiding (2.5%). In comparison, 12.5% of women had voiding dysfunction after low-stiffness TO sling: high PVR (5%), positional voiding (2.5%), retention < 30 days (2.5%), and urethrolysis (2.5%). Despite the differences in voiding dysfunction, QOL indices were significantly improved for all groups. CONCLUSIONS: We noted a significantly higher incidence of postoperative voiding dysfunction in women undergoing high-stiffness SP MUS, when compared with low-stiffness SP MUS. These slings may require even looser tensioning techniques than their low-stiffness counterparts. No significant difference was observed in high- and lowstiffness TO slings, suggesting that this approach may be less dependent on specific tensioning technique. Source of Funding: None
Non-Bariatric Surgery Cohort (Control
p-Value
Pre-Existing Incontinence (n=133) Had Incontinence Post-Index Date
50 (37.6%)
77 (57.9%)
Did Not Have Incontinence Post-Index Date
83 (62.4%)
56 (42.1%)
<0.0001a
No Pre-Existing Incontinence (n=3,765) Had Incontinence Post-Index Date
235 (6.2%)
269 (7.1%)
Did Not Have Incontinence Post-Index Date
3,530 (93.8%)
3,496 (92.9%)
<0.0001a
CMH X2(1) = 6.93
0.0085b
a Chi-Square Test; b Cochran Mantel Haentzel Test
CONCLUSIONS: Patients who undergo bariatric surgery are more likely to lose a previous diagnosis of urinary incontinence and less likely to gain a new diagnosis of urinary incontinence than are obese patients not treated with bariatric surgery. Source of Funding: None
1710 DETRUSOR OVERACTIVITY PRESSURE AND MIDURETHRAL SLING OUTCOMES Tondalaya Gamble*, Roger P Goldberg, Aimee Nguyen, Manhan Vu, Sylvia Botros, Jennifer Beaumont, Peter K Sand, Evanston, IL INTRODUCTION AND OBJECTIVES: To determine the impact of detrusor overactivity pressure on the outcome of midurethral sling procedures for the treatment of urodynamic stress urinary incontinence (USI) and detrusor overactivity (DO). METHODS: We retrospectively reviewed the charts of 428 women treated with transvaginal slings for USI and DO on urodynamic testing. Detrusor overactivity pressures were divided into 2 groups: Group I had DO pressures >/= 25cm H2O and Group II < 25cm H2O.
616
Vol. 181, No. 4, Supplement, Tuesday, April 28, 2009
Multivariate analysis of parameters according to surgical outcome. Improved+Fail
Odd ratio
p-value
319
99
4.081
0.001
DOES BARIATRIC SURGERY AFFECT URINARY INCONTINENCE?
0.892
0.836
Michelle J Semins*, E James Wright, Kimberley Steele, Andrew D Shore, Martin A Makary, Brian R Matlaga, Baltimore, MD
1.894
0.459
1.070
0.254
1.071
0.639
0.847
0.227
Age
< 55 q 55
92
30
Type of SUI
pure SUI
319
99
Mixed SUI
92
30
Mild
134
41
Moderate
269
83
Severe
8
5
(-)
368
121
(+)
43
8
Severity of SUI
Previous OP VLPP Type of MUS
1709
Cure
q 60
220
63
< 60
191
63
TVT
178
48
TOT
83
35
TVTO
108
37
TVT-s
42
9
CONCLUSIONS:The patient age was the only statistically significant parameter affecting the cure rate while the type of the tape was not. Source of Funding: None
1708 IS SLING STIFFNESS ASSOCIATED WITH POSTOPERATIVE VOIDING DYSFUNCTION? A COMPARISION OF TWO POLYPROPYLENE MIDURETHRAL SLINGS
INTRODUCTION AND OBJECTIVES: Morbid obesity has been reported to be a risk factor for urinary incontinence. Recent case series suggest that intentional weight loss will subjectively improve urinary incontinence. However, the impact of bariatric surgery on urinary incontinence remains uncharacterized and is an open area of investigation. Therefore, we performed a study to define the effect of bariatric surgery on urinary incontinence. METHODS: We evaluated claims over a 5 year period (20022006) in a national private insurance database, to identify female patients who underwent bariatric surgery with three years of follow-up claims data. The cohort of patients who underwent bariatric surgery (treatment) was matched to a cohort of obese female patients who did not undergo bariatric surgery (control) with similar follow-up from the surgery date (index date). Urinary incontinence was identified by ICD-9 coding. RESULTS: Following bariatric surgery, 62.4% (83/133) of subjects diagnosed with urinary incontinence prior to their surgery no longer had a coding diagnosis of urinary incontinence. In contrast, only 42.1% (56/133) of those in the non-bariatric surgery cohort lost their coding diagnosis of incontinence (p<0.0001). Of those that did not have pre-existing incontinence, 6.2% (235/3765) of the bariatric surgery cohort gained a new coding diagnosis of incontinence, whereas 7.1% (269/3765) of the control group gained such a coding diagnosis (p<0.0001). Bariatric Surgery Cohort (Treatment)
Sujith K. Reddy*, B. Jill Williams, Alexander Gomelsky, Shreveport, LA INTRODUCTION AND OBJECTIVES: Recent modifications to midurethral slings (MUS) by some manufacturers have resulted in stiffer slings which are less resistant to deformation in vitro. The performance of these materials after implantation and the incidence of voiding dysfunction have not been fully investigated. We retrospectively report on the postoperative voiding dysfunction after two types of suprapubic (SP) and transobturator (TO) MUS: high-stiffness (Bard) and low-stiffness (AMS). METHODS: Group 1 consisted of 80 consecutive women who underwent high-stiffness MUS (40 TO, 40 SP), under a manufacturerinstitutional agreement. Group 2 consisted of the most recent 80 consecutive women who underwent an established low-stiffness MUS (40 TO, 40 SP). All procedures were performed by one surgeon using standard placement and tensioning technique. All voiding trials were performed per protocol. Postoperative voiding dysfunction was subcategorized by: asymptomatic high post void residual (PVR), positional voiding, urinary retention < 30 days, and retention requiring urethrolysis. Secondary outcomes included validated quality of life (QOL) questionnaires. RESULTS: Of 40 women undergoing high-stiffness SP sling, 17 (42.5%) women had voiding dysfunction: high PVR (5%), retention < 30 days (25%) and urethrolysis (12.5%). In comparison, 3 (7.5%) women undergoing low-stiffness SP sling had voiding dysfunction: high PVR (5%) and retention < 30 days (2.5%) (p<0.001). The incidence of voiding dysfunction was similar between high-stiffness and low-stiffness TO slings (NS). Fifteen percent of women undergoing high-stiffness TO sling had postoperative voiding dysfunction: high PVR (10%), retention <30 days (2.5%), and positional voiding (2.5%). In comparison, 12.5% of women had voiding dysfunction after low-stiffness TO sling: high PVR (5%), positional voiding (2.5%), retention < 30 days (2.5%), and urethrolysis (2.5%). Despite the differences in voiding dysfunction, QOL indices were significantly improved for all groups. CONCLUSIONS: We noted a significantly higher incidence of postoperative voiding dysfunction in women undergoing high-stiffness SP MUS, when compared with low-stiffness SP MUS. These slings may require even looser tensioning techniques than their low-stiffness counterparts. No significant difference was observed in high- and lowstiffness TO slings, suggesting that this approach may be less dependent on specific tensioning technique. Source of Funding: None
Non-Bariatric Surgery Cohort (Control
p-Value
Pre-Existing Incontinence (n=133) Had Incontinence Post-Index Date
50 (37.6%)
77 (57.9%)
Did Not Have Incontinence Post-Index Date
83 (62.4%)
56 (42.1%)
<0.0001a
No Pre-Existing Incontinence (n=3,765) Had Incontinence Post-Index Date
235 (6.2%)
269 (7.1%)
Did Not Have Incontinence Post-Index Date
3,530 (93.8%)
3,496 (92.9%)
<0.0001a
CMH X2(1) = 6.93
0.0085b
a Chi-Square Test; b Cochran Mantel Haentzel Test
CONCLUSIONS: Patients who undergo bariatric surgery are more likely to lose a previous diagnosis of urinary incontinence and less likely to gain a new diagnosis of urinary incontinence than are obese patients not treated with bariatric surgery. Source of Funding: None
1710 DETRUSOR OVERACTIVITY PRESSURE AND MIDURETHRAL SLING OUTCOMES Tondalaya Gamble*, Roger P Goldberg, Aimee Nguyen, Manhan Vu, Sylvia Botros, Jennifer Beaumont, Peter K Sand, Evanston, IL INTRODUCTION AND OBJECTIVES: To determine the impact of detrusor overactivity pressure on the outcome of midurethral sling procedures for the treatment of urodynamic stress urinary incontinence (USI) and detrusor overactivity (DO). METHODS: We retrospectively reviewed the charts of 428 women treated with transvaginal slings for USI and DO on urodynamic testing. Detrusor overactivity pressures were divided into 2 groups: Group I had DO pressures >/= 25cm H2O and Group II < 25cm H2O.