abstract135 - WHAT CAN WE LEARN FROM LARGE DATA SETS? WHEN WE USE BULKING PROCEDURES AND COMPARISON TO MID URETHRAL SLINGS (MUS)
WHAT CAN WE LEARN FROM LARGE DATASETS? WHEN WE USE BULKING PROCEDURES AND COMPARISON TO MID URETHRALSLINGS (MUS)
F. BACH 1, P.TOOZS-HOBSON2, J. DUCKETT 3;
1BirminghamWomen's Hosp., Birmingham, United Kingdom, 2Birminghamwomen's Foundaiton NHS Trust, Birmingham, United Kingdom, 3MedwayNHS Fndn. trust, Gillingham, United Kingdom.
Introduction: Bulking agents areused in patients with stress urinary incontinence (SUI) by patientchoice, if unsuitable for other treatments or following treatmentfailure.
Objective: The aim of this study was to use theBSUG database to gain insight into clinicians’ choices aboutpatient selection, complications and efficacy in real lifeuse.
Methods: Permission was given to analyse 1386 cases ofbulking agents from the BSUG database. Anonymised data werecompared to a previous analysis of MUS.
Results: Outcome 1Age: The average age of primary bulking patients was higher (57.9years) than primary MUS (52.3). The age range was more widelydistributed for bulking.
Outcome 2 Re-do surgery: 783 (56%)bulking were a primary procedure and 539 (39%) had previously had acontinence procedure (64 unanswered 5%).
Outcome 3 Intra-operativecomplications (no concomitant surgery): None for bulking, compared to3.5% bladder perforation, 0.6% >500ml blood loss, 0.1% urethral &vascular injury for MUS.
Outcome 4 Hospital stay (no concomitantsurgery): Shorter with bulking when compared with MUS.
Outcome 5Patient outcomes: Patient global impression of improvement (PGI-I)is lower for bulking compared to MUS (graph 1). Change in OABsymptoms (graph 2) is a more even spread with the MUS outcome beingmore variable and bulking agents more likely to be neutral.
Outcome6 Success of bulking as a primary or secondary procedure: similarefficacy (graphs 1 & 2).
Outcome 7 Pre-operative UDS: bulkingagents are used more frequently with mixed rather than pure SUI(graph 3). Diagnoses of USI are most likely to improve PGII-I and UDOfare worst.
Conclusions: Primum non nocere.
Resultssuggest that bulking agents are more commonly used in complex casesthan straightforward SUI. Whilst the success of bulking agentsappears less than MUS, there were no intraoperative complicationsrecorded and this must be put into context for patient choice. Thisis relevant for Value based Healthcare on an organizational andindividual level.
Large datasets are useful to provide insightinto clinical practice and real life outcomes, and contributionshould be encouraged. The inclusive nature of national databases cangive patients more relevant information than strictly controlledRCTs.