Victoria Kershaw1, Rachel Nicholson2, Paul Ballard3, Aethele Khunda3, Santhosh Puthuraya2, Elaine Gouk2. 1. South Tees Hospitals NHS Foundation Trust, James Cook University Hospital, Marton Road, Middlesbrough, TS4 3BW, UK. victoria.kershaw@nhs.net. 2. North Tees & Hartlepool NHS Foundation Trust, Hardwick, Stockton on Tees, TS19 8PE, UK. 3. South Tees Hospitals NHS Foundation Trust, James Cook University Hospital, Marton Road, Middlesbrough, TS4 3BW, UK.
Abstract
INTRODUCTION AND HYPOTHESIS: Suspension of midurethral sling (MUS) surgery in the UK has led to a call for further evidence regarding long-term morbidity and the efficacy of treatments when mesh complications are encountered. We reviewed how many patients who underwent MUS surgery in Teesside, UK, returned to theatre due to a complication and what the outcomes were following this surgical intervention. METHODS: All patients coded to have undergone an MUS procedure between 1 January 2010 and 31 December 2014 in Teesside were reviewed retrospectively (n = 924). Case notes were analysed for patients who returned to theatre up until December 2017 due to complications related to their original MUS. RESULTS: Seventy-one of 924 (7.7%) women returned to theatre for some form of surgical intervention. There was a statistically significant difference in return-to-theatre rate between the transobturator and retropubic approach groups (63/661; 9.5%; confidence interval (CI) 7.3-11.8% v 8/263; 3.0%; CI 0.96%, 5.1%, odds ratio (OR) 3.35, p = 0.001); 2.8% (26/924) underwent shortening, reburying, incision or MUS excision; 1.0% (9/924) underwent steroid injection along the MUS tract; 1.7% (16/924) underwent surgical treatment of detrusor overactivity; 3.0% (28/924) required further stress incontinence surgery. The risk of unresolved chronic pain post-MUS surgery following treatment of complications was 0.2% (2/924). CONCLUSIONS: Our results show a reassuringly low rate of mesh removal following MUS surgery. Furthermore, outcomes were good following surgical management of MUS complications. We advocate compulsory registration of all MUS procedures, follow-up data and complications to provide robust long-term evidence for the future.
INTRODUCTION AND HYPOTHESIS: Suspension of midurethral sling (MUS) surgery in the UK has led to a call for further evidence regarding long-term morbidity and the efficacy of treatments when mesh complications are encountered. We reviewed how many patients who underwent MUS surgery in Teesside, UK, returned to theatre due to a complication and what the outcomes were following this surgical intervention. METHODS: All patients coded to have undergone an MUS procedure between 1 January 2010 and 31 December 2014 in Teesside were reviewed retrospectively (n = 924). Case notes were analysed for patients who returned to theatre up until December 2017 due to complications related to their original MUS. RESULTS: Seventy-one of 924 (7.7%) women returned to theatre for some form of surgical intervention. There was a statistically significant difference in return-to-theatre rate between the transobturator and retropubic approach groups (63/661; 9.5%; confidence interval (CI) 7.3-11.8% v 8/263; 3.0%; CI 0.96%, 5.1%, odds ratio (OR) 3.35, p = 0.001); 2.8% (26/924) underwent shortening, reburying, incision or MUS excision; 1.0% (9/924) underwent steroid injection along the MUS tract; 1.7% (16/924) underwent surgical treatment of detrusor overactivity; 3.0% (28/924) required further stress incontinence surgery. The risk of unresolved chronic pain post-MUS surgery following treatment of complications was 0.2% (2/924). CONCLUSIONS: Our results show a reassuringly low rate of mesh removal following MUS surgery. Furthermore, outcomes were good following surgical management of MUS complications. We advocate compulsory registration of all MUS procedures, follow-up data and complications to provide robust long-term evidence for the future.
Authors: Joanne R Morling; David A McAllister; Wael Agur; Colin M Fischbacher; Cathryn M A Glazener; Karen Guerrero; Leanne Hopkins; Rachael Wood Journal: Lancet Date: 2016-12-21 Impact factor: 79.321
Authors: Cathryn Ma Glazener; Suzanne Breeman; Andrew Elders; Christine Hemming; Kevin G Cooper; Robert M Freeman; Anthony Rb Smith; Fiona Reid; Suzanne Hagen; Isobel Montgomery; Mary Kilonzo; Dwayne Boyers; Alison McDonald; Gladys McPherson; Graeme MacLennan; John Norrie Journal: Lancet Date: 2016-12-21 Impact factor: 79.321
Authors: Frank P Albino; Ketan M Patel; Maurice Y Nahabedian; Michael Sosin; Christopher E Attinger; Parag Bhanot Journal: Plast Reconstr Surg Date: 2013-11 Impact factor: 4.730
Authors: Andrea Braga; Giorgio Caccia; Giovanni Ruggeri; Luca Regusci; Andrea Papadia; Maurizio Serati Journal: Int Urogynecol J Date: 2019-08-28 Impact factor: 2.894
Authors: Sari Tulokas; Päivi Rahkola-Soisalo; Mika Gissler; Tomi S Mikkola; Maarit J Mentula Journal: Int Urogynecol J Date: 2020-01-20 Impact factor: 2.894