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International Urogynecology Journal

, Volume 28, Issue 4, pp 629–636 | Cite as

What can we learn from large data sets? An analysis of 19,000 retropubic tapes

  • Fiona BachEmail author
  • Philip Toozs-Hobson
Original Article
  • 221 Downloads

Abstract

Introduction and hypothesis

Retropubic tapes are successful for treating stress urinary incontinence (SUI), but there is controversy around risk profiles. The British Society of Urogynaecology (BSUG) database allows analysis of surgery for patient safety, surveillance and benchmarking. Objectives of this study were to establish success and complication rates in routine practice, determine complication rates for trainees and consultants, explore reasons for outliers and assess perforation as a surrogacy of quality.

Methods

Approval was obtained from BSUG to use data on retropubic tapes. Data was anonymised, and patients gave prior consent. Analysis was done using the χ2 test, and a funnel plot of bladder perforation rate was calculated.

Results

There were 18,763 procedures recorded: 14,156 were performed by consultants, 64 by associate specialists (64), 1140 by subspecialty trainees, 2549 by registrars, 201 staff grades and 377 other. We found a 3.5 % bladder perforation rate, which was statistically higher for trainees than consultants (p < 0.05). The rate of other “standard” complications were low: 95.8 % of patients felt better on the Patient Global Impression of Improvement of Incontinence (PGI) scale. There was a significant difference (p < 0.05) in PGI and SUI outcome between patients who did and did not experience perforation.

Conclusions

Success rates with retropubic tapes are high, with low complication rates. Bladder perforation in “real”, not “trial” data was 3.5 %, which is lower than reported by the Cochrane review (4.5 %). Trainees have a higher perforation rate (p < 0.05) because of learning curves. Outliers are easily identified, and reasons for this should be explored, including proportion of trainees doing the surgery. This analysis confirms that bladder perforation is a valid surrogate for quality with a small but measurable difference. We have a responsibility to analyse data to improve patient care and encourage colleagues to support the International Urogynaecology Association (IUGA) database initiative.

Keywords

Retropubic tape Outcome measures BSUG database 

Abbreviations

SUI

Stress urinary incontinence

NICE

National Institute for Health and Care Excellence

BSUG

British Society of Urogynaecology

MUS-TVT

Midurethral sling–tension-free vaginal tape

SST

Subspecialty trainees

ST

Specialty trainees

FTSTA

Fixed-term specialty training appointments

UDS

Urodynamic studies

PGI

Patient Global Impression of Improvement of Incontinence

Notes

Acknowledgements

BSUG database committee; Paul Moran; Phil Assassa.

Compliance with ethical standards

Financial disclaimers/Conflicts of interest

PTH has acted as a speaker and advisor to Boston Scientific, Astellas, Allergan and SEP Pharma. He has had assistance to attend meetings from Astellas and SEP

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Copyright information

© The International Urogynecological Association 2016

Authors and Affiliations

  1. 1.Birmingham Women’s NHS Foundation trustBirminghamUK

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