SURGERY FOR RECURRENT STRESSINCONTINENCE IN THE UK 2007-2015
D. G. TINCELLO1, F.BACH 2, P. TOOZS-HOBSON 3;
1HealthSciences, Univ. of Leicester, Leicester, United Kingdom, 2BirminghamWomen's Hosp., Birmingham, United Kingdom, 3Birminghamwomen's Foundaiton NHS Trust, Birmingham, United Kingdom.
Introduction: Although surgeryfor stress urinary incontinence (SUI) is effective, roughly one womenin eight will have persistent or recurrence stress incontinence.Systematic reviews reveal no data from randomised trials to informtreatment choices and little evidence of the effectiveness ofrecurrent SUI surgery(1,2). The British Society of Urogynaecologydatabase has been in operation for over 10 years and contains detailsof most urogynaecology surgery done in the UK. We have reviewed dataon recurrent SUI surgery over the last 10 years.
Objective:To examine BSUG database records for treatment options for recurrentstress incontinence and to compare outcomes.
Methods: Datafrom 2007-2015 were obtained from the BSUG database committee. Afterdata cleaning, previous surgery patterns were compared by year, andoutcomes compared by operation. Group comparisons were by Chi Squareand numerical comparisons by appropriate non-parametrictests.
Results: Results: 2,938 records were obtained. 269cases were not previous continence surgery cases leaving a finalcohort of 2,669, although 231 had no details of previous surgery.Median age was 59 years (20-88), with median BMI 28.4 (17.8-60.6).2,164 (88.8%) had one previous procedure, (207) 8.5% had two, 53(2.2%) had three, and 14 (0.6%) more than three. The first procedurewas most commonly retropubic tape (28.6%), colposuspension (24.5%),transobturator tape (17.4%) or bladder neck injection (14.3%). Pelvicfloor exercises were offered to 76.2% women overall. 96.2% women hadurodynamic investigation performed: 76.5% women had urodynamic stressincontinence, 18.6% had mixed incontinence, 0.7% had detrusoroveractivity, and 3.4% had a normal investigation. Median annualprocedures were 273 with a non-linear increase across the yearspeaking at 500 in 2013. Midurethral tape (MUT) was most common(77.3%), followed by bladder neck injections (BNI) (10.2%) andcolposuspension (5.7%). From 2012 colposuspension and fascial slingwere performed more often; fascial slings increased from 1.6% to10.9% cases (p<0.0001). Follow details were available for 1,763(66.1%) women. 89.2% women had an outpatient follow up at 6 weeks for649 (37.4%), three months for 667 (38.5%) and six months for 354(20.4%). Outcome data were poorly reported. Median ICIQ-UI SF score(882 women (33.0%)) fell from 16 (0-21) to 0 (0-21) (621 women(23.3%) (p<0.001). Patient Global Impression of Improvement(PGI-I) data were available for 1,616 (60.5%) women; 1,319 (81.6%)were “much better” or “very much better”. “Change in stressincontinence” data were available for 1,499 (56.2%) women. Ofthese, 993 (66.2%) were “cured” and 344 (22.9%) “improved”.Both PGI-I scores (p<0.001) and “change in stress incontinence”(p<0.001) differed by surgery type, with midurethral tapes,colposuspension and fascial sling more likely to achieve cure ormajor improvement than bladder neck injection.
Conclusions:MUT and bladder neck injections are the most common procedures forrepeat SUI but treatment patterns have changed in the last 8 years.Follow up data in the BSUG database are incomplete but suggest MUT,colposuspension and fascial sling are superiorprocedures.
References: 1. Effectiveness of midurethralslings in recurrent stress urinary incontinence: a systematic reviewand meta-analysis. Int Urogynecol J. 2012;23(7):831-841. 2.Treatment of recurrent stress urinary incontinence after failedminimally invasive synthetic suburethral tape surgery in women.Cochrane Database Syst Rev. 2013;2:CD009407.