Mid-YouTube Slings: A Systematic Appraisal pf Social Media on Information Quality, Surgical Content and Bias about Mid-urethral Slings

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Abstracts / Journal of Minimally Invasive Gynecology 22 (2015) S27–S50

relationship between perioperative factors and duration of ISC following MUS. Materials and Methods: We conducted a retrospective cohort analysis of women who underwent outpatient retropubic MUS surgery between January 2009 and July 2014 at a tertiary care teaching institution. All procedures were performed by fellowship-trained Female Pelvic Medicine & Reconstructive Surgeons. Demographic, intraoperative, and postoperative data were obtained from the electronic medical record. Patients who had concomitant procedures, incomplete voiding trial (VT) data, or incomplete postoperative catheterization data were excluded. A standard retrograde-fill voiding trial was performed on all patients on the day of surgery prior to discharge. Those who did not pass their VT were included in the analysis. Subjects were categorized into one of two groups: ‘‘mild’’ retention, defined as having a postvoid residual (PVR) >1/3 and \ 2/3 the total bladder volume, and ‘‘severe’’ retention, defined as having a PVR R 2/3 the total bladder volume. Patients were instructed to discontinue catheterization after achieving two consecutive PVR volumes of \75 ml; duration of postoperative catheterization was determined in days. Continuous variables were compared between groups using the Mann-Whitney U test, and Spearman’s Rho correlation was used to measure the strength of association between continuous variables. Results: Of the 200 patients who met inclusion criteria, 47 (23.5%) did not pass their postoperative VT on the day of surgery. Four patients had incomplete postoperative catheterization data, leaving 43 patients for final analysis. Subjects had a mean  SD age of 49  11 years. The majority were white (69%) and parous (90%). The median (IQR) PVR volume postoperatively for the cohort was 250 ml (190, 325). Thirty-nine patients (90.7%) in the cohort were able to perform intermittent selfcatheterization (ISC). Median days of postoperative catheterization for the cohort was 2.00 (1.00, 4.00). Thirty-seven percent catheterized for 1 day, 32.5% for 2 days, 2.5% for 3 days, and 27.5% for >3 days. Seventeen (39.5%) met criteria for ‘‘mild’’ retention and 26 (60.5%) met criteria for ‘‘severe’’ retention. There was no difference in the number of days of postoperative catheterization between the ‘‘mild’’ and ‘‘severe’’ retention groups (median = 1, IQR = 1.00, 2.75 vs. median 2, IQR = 1.25, 4.00, p = 0.156). Neither days of catheterization or PVR were associated with time spent in the recovery room or average pain scores as measured on a standard postoperative verbal rating scale. Conclusion: The majority of women discharged performing ISC after retropubic MUS will void adequately within 1-2 days with few requiring ISC after 2 days. These data will be helpful when counseling patients regarding length of catheterization after MUS surgery. In addition, our data demonstrated a trend suggesting that women with more severe immediate postoperative urinary retention may require catheterization for a longer duration. DISCLOSURE OF RELEVANT FINANCIAL RELATIONSHIPS: Lisa L. Johnson: Nothing to disclose Bhumy Dave: Nothing to disclose Camaleigh Jaber: Nothing to disclose Alix Leader-Cramer: Nothing to disclose Christina Lewicky-Gaupp: Nothing to disclose Margaret Mueller: Nothing to disclose Kimberly Kenton: Nothing to disclose Non-Oral Poster 71 Mid-YouTube Slings: A Systematic Appraisal pf Social Media on Information Quality, Surgical Content and Bias about Mid-urethral Slings Larouche M,1 Stothers L,2 Geoffrion R,1 Lazare D,1 Clancy A,3 Koenig N,1 Cundiff GW.1 1Obstetrics and Gynecology, University of British Columbia, Vancouver, British Columbia, Canada; 2Urology, University

of British Columbia, Vancouver, British Columbia, Canada; Obstetrics and Gynecology, University of Ottawa, Ottawa, Ontario, Canada 3

Objectives: To measure accuracy and comprehensiveness of patient information available on YouTube related to mid-urethral sling (MUS) procedures. Materials and Methods: YouTube, a video sharing website, was searched under the terms ‘‘mid-urethral sling’’, ‘‘vaginal tape’’, ‘‘TVT’’, ‘‘TOT’’, ‘‘TVT surgery,’’ and ‘‘TOT surgery’’. The first result page was sorted by ‘‘relevance’’ and again by ‘‘most views.’’ Duplicates and results having less than 1000 views were eliminated. Five reviewers evaluated all included videos using a standardized questionnaire developed for this project. The questionnaire assessed target audience, main purpose, relevance, elements of informed consent (indication, alternatives, risks, and expected outcomes), surgical content, and evidence of bias. For surgical content, a pre-determined list of 16 expected surgical steps was compiled. Reviewers were blinded to each other’s assessment. Inter-rater reliability (IRR) was calculated using the kappa statistic for multiple raters. Questions related to quality of information, surgical content and relevance were analyzed descriptively. Results: Sixty-nine videos related to vaginal surgery were identified. After eliminating results with less than 1000 views and duplicates, we reviewed 57 videos. The median number of views was 9,809. Raters had the greatest variability when trying to identify the target audience of each video (kappa 0.47, moderate agreement). There was almost perfect agreement among raters assessing for the presence of bias (kappa 0.82 to 1.00). Video content was classified as physician educational material (66.7%), patient information (17.5%), advertisement (11%), lawsuit recruitment (1.8%), and unclear (3.5%). MUS was the primary topic of 80.7% (46/57) videos. Nine percent addressed prolapse surgery or transvaginal mesh. Among MUS videos, the most frequently discussed type was transobturator (43.5%) [retropubic (21.7%); mini-slings (19.6%); not specified or multiple types (15.2%)]. No video mentioned all 4 elements of informed consent, 6.5% mentioned three, 10.9% mentioned two, 28.2% mentioned one, and 54.3% did not mention any. There were 32 surgical videos, of which 50% had a narrator describing the procedure. No video showed the complete list of pre-determined surgical steps. The average number of listed steps was 7.6/16. Cystoscopy was mostly absent, being included in only six videos. Anesthesia, patient positioning and post-operative voiding trials were mentioned in only 3, 6, and 3 videos respectively. Only 4 videos mentioned at least one postoperative patient instruction. A marketing element for a MUS product was shown in 26% of videos. One video encouraged joining a health advocacy group against MUS and one was a testimonial of MUS complications. Conclusion: Patient information about MUS on YouTube is lacking and often biased, with very few videos mentioning elements of informed consent or post-operative patient instructions. In addition, physicians reviewing videos through this methodology for their own continuing education should be cognizant of the variability in demonstrated surgical steps. DISCLOSURE OF RELEVANT FINANCIAL RELATIONSHIPS: Maryse Larouche: Nothing to disclose Lynn Stothers: Astellas, Educational lecturer, Honorarium Roxana Geoffrion: Boston Scientific, Preceptor, No compensation up to now Darren Lazare: Astellas Pharmaceutical, Advisory Board, Honorarium; Allergan, Education, Educational Grant; Cooper Surgical, Education, Educational Grant Aisling Clancy: Nothing to disclose Nicole A Koenig: Nothing to disclose Geoffrey W. Cundiff: AMS, Medical Expert Witness, No remuneration