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MP33-18 A COMPARISON OF OUTCOMES AFTER RETROPUBIC MID-URETHRAL SLING, DOES VALSALVA VOIDING AFFECT SUCCESS RATE?
THE JOURNAL OF UROLOGYâ
Vol. 191, No. 4S, Supplement, Sunday, May 18, 2014
SUI. Peri-operative complications were classified via the ClavienDindo scale. RESULTS: Minimum follow-up was 12 months (mean 14.6). Ninety one (45%) and 110 (55%) women opted for PVS and MUS, respectively. Preoperative demographics and clinical parameters, including age, body mass index, parity, pad usage, mean abdominal leak point pressure, severity of concomitant POP, SEAPI scores, and mean QoL indices did not differ significantly between the groups. There was no difference in the proportion of women undergoing concomitant hysterectomy (52.7% vs. 50%, p¼0.7). Treatment success was similar (75.8% vs. 80.9%, p¼0.38) and there was no difference in rates of postoperative voiding dysfunction (1.1% vs. 1.8%, p¼0.68) or de novo urgency incontinence (4.4% vs. 4.5%, p¼0.96). Length of hospitalization did not significantly differ (1.18 vs. 1.16 days, p¼0.9). There was no difference in the occurrence of Clavien-Dindo surgical complications between the two groups (6.6% vs. 10%, p¼0.39). CONCLUSIONS: Since the 2011 FDA warning, more women are forgoing the use of mesh in the treatment of SUI. In a contemporary cohort of women considered suitable candidates for either sling, both procedures offer comparable efficacy and complication rates. PVS may be safely offered to patients who would otherwise be good candidates for MUS if they are concerned with the implantation of mesh. Source of Funding: None
MP33-18 A COMPARISON OF OUTCOMES AFTER RETROPUBIC MID-URETHRAL SLING, DOES VALSALVA VOIDING AFFECT SUCCESS RATE? Blake Anderson*, David Hatcher, Rena Malik, Jessica Volsky, Gregory Bales, Doreen Chung, Chicago, IL INTRODUCTION AND OBJECTIVES: It is known that many women void via valsalva and that retropubic slings (RPS) may cause voiding dysfunction. The aim of this study was to compare outcomes after RPS in women with and without valsalva voiding. METHODS: 95 women had RPS placed for stress urinary incontinence (SUI) from 2011 to 2013. Baseline demographics, urodynamic findings, operative parameters, and post-operative course were examined retrospectively. Valsalva voiding was defined as abdominal straining witnessed while voiding during urodynamics. Standardized follow-up was at 1, 3, 6, and 12 months. The primary outcome was subjective success rate (absence of SUI with physical activity, coughing, or sneezing). We also looked at Urogenital Distress Inventory (UDI-6) score, Incontinence Impact Questionnaire (IIQ-7) score, post-void residual (PVR), pad use, complications, and revision rate. Tests of significance were done using Fisher’s exact tests and Student’s t-tests. RESULTS: Subjects included 45 (47%) valsalva voiders (VV) and 50 (53%) non-valsalva voiders (NV). No differences were seen between groups in mean age, PVR, or capacity. Abdominal leak point pressure without a catheter was significantly lower in VV (56 vs. 70 cm H2O, p¼0.045), yet VV had less severe IIQ-7 at baseline compared to NV, (9 6 vs. 137, p¼0.01). Catheter time was significantly shorter in VV compared to NV (2.5 vs. 4.1 days, p¼0.03). No differences were seen between groups in the rate of passing initial void trial (71% VV vs. 61% NV, p¼0.1). In the perioperative period, 4.7% of VV and 11.9% of NV required clean intermittent catheterization (CIC) (p¼0.16). No patients required CIC beyond 4 weeks. Complication rates (11.4% VV vs. 9.3% NV, p¼0.3) and revision rates (7.1% VV vs. 9.5% NV, p¼0.28) were similar. In total, 7 (7%) patients required revisions. Reasons were pain (1 VV, 2 NV), erosion (1 NV), voiding dysfunction (1VV, 1 NV), and sling failure (1 VV). Subjective success rates were similar with no significant differences at 1, 3, 6, and 12 months (91%, 94%, 100%, and 100 % for VV and 88%, 88%, 100%, and 93% for NV). At one month, VV had smaller change in postoperative pad use (-1.2 vs. -2.8, p¼0.04), IIQ-7 (-5 vs. -12, p¼0.0001), and UDI-6 (-4 vs. -8, p¼0.01), but there were no significant differences in these parameters between VV and NV at 3, 6, and 12 months.
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CONCLUSIONS: In women with valsalva voiding, RPS appear to be a safe and effective treatment for SUI. Between VV and NV, no differences were seen in success rate, postoperative voiding dysfunction, complication rate, or revision rate. Source of Funding: none
MP33-19 ADVANCE MALE SLING: PRE-OPERATIVE PAD WEIGHT AS A PREDICTOR OF SURGICAL OUTCOME Casey Kowalik*, Christopher W. Lebeis, Arthur P. Mourtzinos, Burlington, MA INTRODUCTION AND OBJECTIVES: The AdVance male sling has been advocated for use in patients with mild to moderate urinary incontinence. Patients with severe urinary incontinence (24-hour pad usage 6 per day or pad weight 400 grams) have had reported cure following sling placement. The aim of this study is to determine whether pre-operative pad weight is an indicator of surgical outcome. METHODS: We prospectively evaluated 56 patients undergoing placement of an AdVance male sling for urinary incontinence following prostate surgery. Cure was defined as no pad usage or wearing one pad for security only as it remained dry. Improvement was defined as 50% reduction in pad weight. Failure was defined as <50% decrease in pad weight or the need for salvage therapy. Patients were assessed by pad count, pad weight, and self-assessment through IIQ and UDI scores at baseline and during follow-up, as well as reporting a percentage improvement following surgery. One patient was excluded as no post-operative pad weight was available. RESULTS: Pre-operatively, 21 patients (38%) had pad weight 0-100 grams (g), 21 (38%) had pad weight between 101-200g, 9 (16%) with pad weight between 201-300g, and 4 patients (7%) with pad weight >300g. At a median follow-up of 33 months, of the 21 patients with pad weight <100g, 95% (n¼20) were cured following sling placement. Of the patients not cured, median pre-operative pad weight was 252g versus 98g in those who were cured. The likelihood of sling failure increased significantly with pre-operative pad weight exceeding 200g (p¼0.0067) with a 54% failure rate (7/13). In patients with preoperative pad weights >200g, post-operative IIQ and UDI scores were significantly different from patients with pad weight <200g with p¼0.02 and p¼0.01, respectively. Patient reported percentage of improvement was also significantly different between patients with pad weight <200g and those with pad weight >200g (p¼0.02). Five of the 13 patients with pre-operative pad weights >200 grams went on to have salvage procedure compared to 1 patient in the group with pad weight <200g. CONCLUSIONS: Patients with pad weight >200g were more likely to fail and reported less subjective improvement compared to patients with pad weight <200g. When offering the AdVance male sling to patients with pre-operative pad weight >200 grams, patients should be counseled regarding the increased rate of failure. Source of Funding: none
MP33-20 ANTICHOLINERGIC CYCLING AND TREATMENT OUTCOMES IN OVERACTIVE BLADDER PATIENTS WITH URINARY INCONTINENCE Michael Chancellor*, Royal Oak, MI; Riya Pulicharam, I-Ning Cheng, Torrance, CA; Karen Campbell, Catherine Corbell, Manher Joshi, Denise Globe, Irvine, CA INTRODUCTION AND OBJECTIVES: Overactive bladder (OAB) is a prevalent medical condition affecting 16.5% of US adults. Anticholinergic (Ach) therapies are recommended as first-line pharmacotherapy in OAB (following behavioral therapy). A high failure rate to the first prescribed Ach is well-documented in the literature. However, there is a paucity of studies on follow-on Ach use and treatment outcomes in patients who fail their first prescribed Ach. In this study, we analyzed Ach cycling in a cohort of OAB patients with urinary incontinence (UI).
Vol. 191, No. 4S, Supplement, Sunday, May 18, 2014
SUI. Peri-operative complications were classified via the ClavienDindo scale. RESULTS: Minimum follow-up was 12 months (mean 14.6). Ninety one (45%) and 110 (55%) women opted for PVS and MUS, respectively. Preoperative demographics and clinical parameters, including age, body mass index, parity, pad usage, mean abdominal leak point pressure, severity of concomitant POP, SEAPI scores, and mean QoL indices did not differ significantly between the groups. There was no difference in the proportion of women undergoing concomitant hysterectomy (52.7% vs. 50%, p¼0.7). Treatment success was similar (75.8% vs. 80.9%, p¼0.38) and there was no difference in rates of postoperative voiding dysfunction (1.1% vs. 1.8%, p¼0.68) or de novo urgency incontinence (4.4% vs. 4.5%, p¼0.96). Length of hospitalization did not significantly differ (1.18 vs. 1.16 days, p¼0.9). There was no difference in the occurrence of Clavien-Dindo surgical complications between the two groups (6.6% vs. 10%, p¼0.39). CONCLUSIONS: Since the 2011 FDA warning, more women are forgoing the use of mesh in the treatment of SUI. In a contemporary cohort of women considered suitable candidates for either sling, both procedures offer comparable efficacy and complication rates. PVS may be safely offered to patients who would otherwise be good candidates for MUS if they are concerned with the implantation of mesh. Source of Funding: None
MP33-18 A COMPARISON OF OUTCOMES AFTER RETROPUBIC MID-URETHRAL SLING, DOES VALSALVA VOIDING AFFECT SUCCESS RATE? Blake Anderson*, David Hatcher, Rena Malik, Jessica Volsky, Gregory Bales, Doreen Chung, Chicago, IL INTRODUCTION AND OBJECTIVES: It is known that many women void via valsalva and that retropubic slings (RPS) may cause voiding dysfunction. The aim of this study was to compare outcomes after RPS in women with and without valsalva voiding. METHODS: 95 women had RPS placed for stress urinary incontinence (SUI) from 2011 to 2013. Baseline demographics, urodynamic findings, operative parameters, and post-operative course were examined retrospectively. Valsalva voiding was defined as abdominal straining witnessed while voiding during urodynamics. Standardized follow-up was at 1, 3, 6, and 12 months. The primary outcome was subjective success rate (absence of SUI with physical activity, coughing, or sneezing). We also looked at Urogenital Distress Inventory (UDI-6) score, Incontinence Impact Questionnaire (IIQ-7) score, post-void residual (PVR), pad use, complications, and revision rate. Tests of significance were done using Fisher’s exact tests and Student’s t-tests. RESULTS: Subjects included 45 (47%) valsalva voiders (VV) and 50 (53%) non-valsalva voiders (NV). No differences were seen between groups in mean age, PVR, or capacity. Abdominal leak point pressure without a catheter was significantly lower in VV (56 vs. 70 cm H2O, p¼0.045), yet VV had less severe IIQ-7 at baseline compared to NV, (9 6 vs. 137, p¼0.01). Catheter time was significantly shorter in VV compared to NV (2.5 vs. 4.1 days, p¼0.03). No differences were seen between groups in the rate of passing initial void trial (71% VV vs. 61% NV, p¼0.1). In the perioperative period, 4.7% of VV and 11.9% of NV required clean intermittent catheterization (CIC) (p¼0.16). No patients required CIC beyond 4 weeks. Complication rates (11.4% VV vs. 9.3% NV, p¼0.3) and revision rates (7.1% VV vs. 9.5% NV, p¼0.28) were similar. In total, 7 (7%) patients required revisions. Reasons were pain (1 VV, 2 NV), erosion (1 NV), voiding dysfunction (1VV, 1 NV), and sling failure (1 VV). Subjective success rates were similar with no significant differences at 1, 3, 6, and 12 months (91%, 94%, 100%, and 100 % for VV and 88%, 88%, 100%, and 93% for NV). At one month, VV had smaller change in postoperative pad use (-1.2 vs. -2.8, p¼0.04), IIQ-7 (-5 vs. -12, p¼0.0001), and UDI-6 (-4 vs. -8, p¼0.01), but there were no significant differences in these parameters between VV and NV at 3, 6, and 12 months.
e345
CONCLUSIONS: In women with valsalva voiding, RPS appear to be a safe and effective treatment for SUI. Between VV and NV, no differences were seen in success rate, postoperative voiding dysfunction, complication rate, or revision rate. Source of Funding: none
MP33-19 ADVANCE MALE SLING: PRE-OPERATIVE PAD WEIGHT AS A PREDICTOR OF SURGICAL OUTCOME Casey Kowalik*, Christopher W. Lebeis, Arthur P. Mourtzinos, Burlington, MA INTRODUCTION AND OBJECTIVES: The AdVance male sling has been advocated for use in patients with mild to moderate urinary incontinence. Patients with severe urinary incontinence (24-hour pad usage 6 per day or pad weight 400 grams) have had reported cure following sling placement. The aim of this study is to determine whether pre-operative pad weight is an indicator of surgical outcome. METHODS: We prospectively evaluated 56 patients undergoing placement of an AdVance male sling for urinary incontinence following prostate surgery. Cure was defined as no pad usage or wearing one pad for security only as it remained dry. Improvement was defined as 50% reduction in pad weight. Failure was defined as <50% decrease in pad weight or the need for salvage therapy. Patients were assessed by pad count, pad weight, and self-assessment through IIQ and UDI scores at baseline and during follow-up, as well as reporting a percentage improvement following surgery. One patient was excluded as no post-operative pad weight was available. RESULTS: Pre-operatively, 21 patients (38%) had pad weight 0-100 grams (g), 21 (38%) had pad weight between 101-200g, 9 (16%) with pad weight between 201-300g, and 4 patients (7%) with pad weight >300g. At a median follow-up of 33 months, of the 21 patients with pad weight <100g, 95% (n¼20) were cured following sling placement. Of the patients not cured, median pre-operative pad weight was 252g versus 98g in those who were cured. The likelihood of sling failure increased significantly with pre-operative pad weight exceeding 200g (p¼0.0067) with a 54% failure rate (7/13). In patients with preoperative pad weights >200g, post-operative IIQ and UDI scores were significantly different from patients with pad weight <200g with p¼0.02 and p¼0.01, respectively. Patient reported percentage of improvement was also significantly different between patients with pad weight <200g and those with pad weight >200g (p¼0.02). Five of the 13 patients with pre-operative pad weights >200 grams went on to have salvage procedure compared to 1 patient in the group with pad weight <200g. CONCLUSIONS: Patients with pad weight >200g were more likely to fail and reported less subjective improvement compared to patients with pad weight <200g. When offering the AdVance male sling to patients with pre-operative pad weight >200 grams, patients should be counseled regarding the increased rate of failure. Source of Funding: none
MP33-20 ANTICHOLINERGIC CYCLING AND TREATMENT OUTCOMES IN OVERACTIVE BLADDER PATIENTS WITH URINARY INCONTINENCE Michael Chancellor*, Royal Oak, MI; Riya Pulicharam, I-Ning Cheng, Torrance, CA; Karen Campbell, Catherine Corbell, Manher Joshi, Denise Globe, Irvine, CA INTRODUCTION AND OBJECTIVES: Overactive bladder (OAB) is a prevalent medical condition affecting 16.5% of US adults. Anticholinergic (Ach) therapies are recommended as first-line pharmacotherapy in OAB (following behavioral therapy). A high failure rate to the first prescribed Ach is well-documented in the literature. However, there is a paucity of studies on follow-on Ach use and treatment outcomes in patients who fail their first prescribed Ach. In this study, we analyzed Ach cycling in a cohort of OAB patients with urinary incontinence (UI).