Abstract
Introduction
Concerns about vaginal mesh have reduced the use of mid-urethral slings (MUS) in some countries. In view of their potential withdrawal in Belgium and The Netherlands, we polled urogynaecologists on their practice for treating stress urinary incontinence (SUI) and what their experience is with alternative procedures, and we asked them how their patients perceive the risk and success rates.
Methods
A survey among members of the pelvic floor special interest group of the Flemish Society for Obstetrics and Gynaecology, Belgian Association of Urology and Dutch Society of Obstetrics and Gynaecology.
Results
Their primary procedure of choice is the MUS (99%). Sixty-five per cent performs at least 25 MUS yearly; they report high success (90%; IQR [85–92]) and low adverse outcome rates. Physicians anticipate complications as reported in the literature: 5% (IQR [410]) overactive bladder, 5% (IQR [2–10]) voiding problems, 2% (IQR [15]) exposures, 2% (IQR [1–5]) dyspareunia and 1% (IQR [1–3]) chronic pain. Eighty-five per cent of physicians report their patients express fears about having a MUS though usually they cannot precisely tell why. Reportedly they tell their physicians of concerns about pain (54%), exposure (45%), dyspareunia (25%), voiding problems (15%) or overactive bladder (8%). Only half of respondents had ever performed a colposuspension. The majority of these were older and performed colposuspension via laparotomy. Only six (4%) had performed > 20 colposuspensions yearly.
Conclusion
Dutch and Belgian urogynaecologists estimate success and adverse effect rates of MUS in line with the literature. Their patients most cited worries were fear of chronic pain and exposure. Only half of respondents had ever performed a colposuspension. They were older and performed the procedure via laparotomy.
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Acknowledgements
We thank Sophie Ghesquière, Ann-Sophie Page and Filip Claerhout for their help with developing the questionnaire. Special thanks to Bertin Degryse, mentor of ASD.
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J Deprest is a proctor for Coloplast, is the recipient of a Research Chair by Duomed “POP-ART” (Pelvic Organ Prolapse Advanced Research and Technology) and has been consulting for Clayton Utz Lawyers (Sidney, Australia). F Van der Aa is a proctor and consultant for Coloplast and Boston Scientific.
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D’hulster, AS., Housmans, S., Spaans, W. et al. Survey on surgery for stress urinary incontinence in an era mid-urethral slings are being questioned. Int Urogynecol J 31, 695–702 (2020). https://doi.org/10.1007/s00192-019-04135-0
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DOI: https://doi.org/10.1007/s00192-019-04135-0