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Balancing the possibility of needing a future incontinence procedure versus a future urethral sling revision surgery: a tradeoff analysis for continent women undergoing pelvic organ prolapse surgery

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A Commentary to this article was published on 24 April 2020

Abstract

Introduction and hypothesis

Although urinary incontinence surgery has potential benefits such as preventing de novo stress urinary incontinence in women undergoing pelvic organ prolapse (POP) surgery, it comes with the potential cost of overtreatment and complications. We compared future surgery rates in a population cohort of women undergoing vaginal pelvic organ prolapse surgery.

Methods

All women undergoing POP repair in California from 2005 to 2011 were identified from the Office of Statewide Health Planning and Development databases. Rates of repeat surgery in those with and without concomitant urethral sling procedures were compared. To control for confounding effects, multivariate mixed effects logistic regression models were constructed to compare each woman’s individualized risk of undergoing either sling revision surgery or future incontinence surgery.

Results

In the cohort, 38,456 underwent a sling procedure at the time of POP repair and 42,858 did not. The future surgery rate was higher for sling-related complications in the POP + sling cohort compared with future incontinence surgery in the POP alone cohort (3.5% versus 3.0% respectively, p < 0.001). The difference persisted in multivariate modeling, where most women (60%) are at a higher risk of requiring sling revision surgery compared with needing a future primary incontinence procedure (40%).

Conclusions

Women who undergo vaginal prolapse repair without an incontinence procedure are at a low risk of future incontinence surgery. Women without urinary incontinence who are considering vaginal POP surgery should be informed of the risks and benefits of including a sling procedure.

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References

  1. Chaikin DC, Groutz A, Blaivas JG. Predicting the need for anti-incontinence surgery in continent women undergoing repair of severe urogenital prolapse. J Urol. 2000;163:531–4.

    Article  CAS  Google Scholar 

  2. Klutke JJ, Ramos S. Urodynamic outcome after surgery for severe prolapse and potential stress incontinence. Am J Obstet Gynecol. 2000;182:1378–81.

    Article  CAS  Google Scholar 

  3. Visco AG, Brubaker L, Nygaard I, et al. The role of preoperative urodynamic testing in stress-continent women undergoing sacrocolpopexy: the Colpopexy and urinary reduction efforts (CARE) randomized surgical trial. Int Urogynecol J Pelvic Floor Dysfunct. 2008;19:607–14.

    Article  Google Scholar 

  4. Brubaker L, Cundiff GW, Fine P, et al. Abdominal sacrocolpopexy with Burch colposuspension to reduce urinary stress incontinence. N Engl J Med. 2006;354:1557–66.

    Article  CAS  Google Scholar 

  5. Wei JT, Nygaard I, Richter HE, et al. A midurethral sling to reduce incontinence after vaginal prolapse repair. N Engl J Med. 2012;366:2358–67.

    Article  CAS  Google Scholar 

  6. Jonsson Funk M, Levin PJ, Wu JM. Trends in the surgical management of stress urinary incontinence. Obstet Gynecol. 2012;119:845–51.

    Article  Google Scholar 

  7. Wu JM, Kawasaki A, Hundley AF, Dieter AA, Myers ER, Sung VW. Predicting the number of women who will undergo incontinence and prolapse surgery, 2010 to 2050. Am J Obstet Gynecol. 2011;205:230.e1–5.

    Article  Google Scholar 

  8. Jonsson Funk M, Siddiqui NY, Pate V, Amundsen CL, Wu JM. Sling revision/removal for mesh erosion and urinary retention: long-term risk and predictors. Am J Obstet Gynecol. 2013;208:73 e71–7.

    Google Scholar 

  9. Syan R, Dallas KB, Sohlberg E, Rogo-Gupta L, Elliott CS, Enemchukwu EA. Rates and risk factors for future stress urinary incontinence surgery after pelvic organ prolapse repair in a large population-based cohort in California. Urology. 2019;123:81–6.

    Article  Google Scholar 

  10. Iglesia CB. Vaginal prolapse repair—place midurethral sling now or later? N Engl J Med. 2012;366:2422–4.

    Article  CAS  Google Scholar 

  11. Van der Ploeg JM, van der Steen A, Zwolsman S, van der Vaart CH, Roovers J. Prolapse surgery with or without incontinence procedure: a systematic review and meta-analysis. BJOG. 2018;125:289–97.

    Article  Google Scholar 

  12. Chughtai B, Barber MD, Mao J, Forde JC, Normand ST, Sedrakyan A. Association between the amount of vaginal mesh used with mesh erosions and repeated surgery after repairing pelvic organ prolapse and stress urinary incontinence. JAMA Surg. 2017;152:257–63.

    Article  Google Scholar 

  13. Richardson ML, Elliott CS, Shaw JG, Comiter CV, Chen B, Sokol ER. To sling or not to sling at time of abdominal sacrocolpopexy: a cost-effectiveness analysis. J Urol. 2013;190:1306–12.

    Article  Google Scholar 

  14. Richter HE, Albo ME, Zyczynski HM, et al. Retropubic versus transobturator midurethral slings for stress incontinence. N Engl J Med. 2010;362:2066–76.

    Article  CAS  Google Scholar 

  15. Jelovsek JE, Chagin K, Brubaker L, et al. A model for predicting the risk of de novo stress urinary incontinence in women undergoing pelvic organ prolapse surgery. Obstet Gynecol. 2014;123:279–87.

    Article  Google Scholar 

  16. Ross JH, Carter-Brooks CM, Ruppert KM, Giugale LE, Shepherd JP, Zyczynski HM. Assessing the performance of the de novo postoperative stress urinary incontinence calculator. Female Pelvic Med Reconstr Surg 2019. https://doi.org/10.1097/SPV.0000000000000717.

    Article  PubMed  Google Scholar 

  17. Davenport MT, Sokol ER, Comiter CV, Elliott CS. Does the degree of cystocele predict De novo stress urinary incontinence after prolapse repair? Further analysis of the Colpopexy and urinary reduction efforts trial. Female Pelvic Med Reconstr Surg 2017;24(4):292–4.

    Article  Google Scholar 

  18. Rogo-Gupta L, Litwin MS, Saigal CS, Anger JT. Trends in the surgical management of stress urinary incontinence among female Medicare beneficiaries, 2002–2007. Urology. 2013;82:38–41.

    Article  Google Scholar 

  19. Welk B, Al-Hothi H, Winick-Ng J. Removal or revision of vaginal mesh used for the treatment of stress urinary incontinence. JAMA Surg. 2015;150:1167–75.

    Article  Google Scholar 

  20. Ballert KN, Biggs GY, Isenalumhe A Jr, Rosenblum N, Nitti VW. Managing the urethra at transvaginal pelvic organ prolapse repair: a urodynamic approach. J Urol. 2009;181:679–84.

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Urology, Stanford University School of Medicine, Stanford, CA, USA

    Kai Dallas, Raveen Syan, Ekene Enemchukwu & Christopher S. Elliott

  2. Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA, USA

    Lisa Rogo-Gupta

  3. Division of Urology, Santa Clara Valley Medical Center, 4th Floor Valley Specialties; 751 South Bascom Avenue, San Jose, CA, 95128, USA

    Christopher S. Elliott

Authors
  1. Kai Dallas
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  2. Lisa Rogo-Gupta
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  3. Raveen Syan
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  4. Ekene Enemchukwu
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  5. Christopher S. Elliott
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Contributions

K.D.: project development, data collection, manuscript writing; L.R.G.: project development, data collection, manuscript writing; R.S. project development, manuscript writing; E.E. project development, manuscript writing; C.S.E. project development, data collection, manuscript writing.

Corresponding author

Correspondence to Christopher S. Elliott.

Ethics declarations

Study is exempt from institutional board review as it went through State of California Protection of Human Subjects.

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Supported by the Valley Medical Foundation

Appendix

Appendix

Table 3 Procedure codes used to identify prolapse procedures
Full size table
Table 4 Procedure codes used to identify incontinence procedures
Full size table
Table 5 Diagnosis codes used to categorize complications
Full size table
Table 6 Procedure codes used to categorize complications
Full size table

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Dallas, K., Rogo-Gupta, L., Syan, R. et al. Balancing the possibility of needing a future incontinence procedure versus a future urethral sling revision surgery: a tradeoff analysis for continent women undergoing pelvic organ prolapse surgery. Int Urogynecol J 31, 1141–1150 (2020). https://doi.org/10.1007/s00192-020-04226-3

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  • DOI: https://doi.org/10.1007/s00192-020-04226-3

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