Mia Swartz1, Sandip Vasavada, Howard Goldman. 1. Section of Female Pelvic Medicine and Reconstructive Surgery, Glickman Urological and Kidney Institute, The Cleveland Clinic, Cleveland, OH, USA. Mia.addison@gmail.com
Abstract
OBJECTIVES: Anti-incontinence procedures are common. However, perioperative practices are variable and no consensus guidelines exist. Our primary objective was to describe contemporary management of patients undergoing routine sling surgery alone. METHODS: A 15-item survey was designed to assess physician characteristics and perioperative management among urologists. Following institutional review board approval, the American Urological Association (AUA) administered the survey to 7433 urologists followed by an e-mail reminder 7 days later. Responders were excluded if they never performed sling surgery or were still in training. RESULTS: There were 960 (12.9%) urologists who responded, and 618 surveys met inclusion criteria. Sixty-nine (11.2%) were fellowship trained and most (53.2%) performed 5-25 slings annually, with the transobturator approach most commonly used (53.6%). The majority (69.1%) discharged patients the day of surgery. The most common rationale for admitting urologists is to facilitate voiding trials (42.4%). Hospital admission is highly correlated using retropubic slings (P < .001). Discharge with a catheter is routine for 157 (25.4%) urologists. A postvoid residual is most frequently used for voiding trials (49.8%). Most urologists (54.5%) prescribe antibiotics for longer than 5 days and cited reasons including prevention of sling infections/extrusions/erosions (54.5%) and urinary tract infections (18.1%). There was no correlation between management and fellowship training. Urologists >50 years used postoperative antibiotics more often (P < .01). CONCLUSIONS: This survey confirms the variance of management after sling surgery. Although the AUA recommends </=24 hours of postoperative antibiotics after slings, extended courses continue to be prescribed. This variability in practice patterns underscores the need for consensus guidelines regarding perioperative management of these patients. Copyright 2010 Elsevier Inc. All rights reserved.
OBJECTIVES: Anti-incontinence procedures are common. However, perioperative practices are variable and no consensus guidelines exist. Our primary objective was to describe contemporary management of patients undergoing routine sling surgery alone. METHODS: A 15-item survey was designed to assess physician characteristics and perioperative management among urologists. Following institutional review board approval, the American Urological Association (AUA) administered the survey to 7433 urologists followed by an e-mail reminder 7 days later. Responders were excluded if they never performed sling surgery or were still in training. RESULTS: There were 960 (12.9%) urologists who responded, and 618 surveys met inclusion criteria. Sixty-nine (11.2%) were fellowship trained and most (53.2%) performed 5-25 slings annually, with the transobturator approach most commonly used (53.6%). The majority (69.1%) discharged patients the day of surgery. The most common rationale for admitting urologists is to facilitate voiding trials (42.4%). Hospital admission is highly correlated using retropubic slings (P < .001). Discharge with a catheter is routine for 157 (25.4%) urologists. A postvoid residual is most frequently used for voiding trials (49.8%). Most urologists (54.5%) prescribe antibiotics for longer than 5 days and cited reasons including prevention of sling infections/extrusions/erosions (54.5%) and urinary tract infections (18.1%). There was no correlation between management and fellowship training. Urologists >50 years used postoperative antibiotics more often (P < .01). CONCLUSIONS: This survey confirms the variance of management after sling surgery. Although the AUA recommends </=24 hours of postoperative antibiotics after slings, extended courses continue to be prescribed. This variability in practice patterns underscores the need for consensus guidelines regarding perioperative management of these patients. Copyright 2010 Elsevier Inc. All rights reserved.