Muller, P., Gurol-Urganci, I., van der Meulen, J. et al. (2 more authors) (2021) Risk of reoperation 10 years after surgical treatment for stress urinary incontinence : a national population-based cohort study. American Journal of Obstetrics and Gynecology, 225 (6). 645.e1-645.e14. ISSN 0002-9378
Abstract
Background
There is a debate about the safety and effectiveness of surgical treatments for stress urinary incontinence. Controversy about the use of synthetic mesh sling insertion has led to an increased uptake of retropubic colposuspension and autologous sling procedures. Comparative evidence on the long-term outcomes from these procedures is needed.
Objective
To compare the risk of reoperation at 10 years after operation between women treated for stress urinary incontinence with retropubic colposuspension, mesh sling insertion, and autologous sling procedures.
Study Design
The records of admissions to National Health Service hosptials were used to identify women who had first-time stress incontinence surgery between 2006 and 2013 in England. The first incidence of the following outcomes was assessed: further stress incontinence surgery, surgery for a complication (either mesh removal, prolapse repair, or incisional hernia repair), and any reoperation (either further stress incontinence surgery, mesh removal, prolapse repair, or incisional hernia repair). The cumulative incidence of each of these outcomes up to 10 years after surgery was calculated, considering death as a competing event. Multivariable modeling was then used to estimate the reoperation hazard ratios for the different initial surgery types with adjustments for patient characteristics and concurrent prolapse surgery or hysterectomy.
Results
The analysis included 2262 women treated with retropubic colposuspension, 92,524 treated with mesh sling insertion, and 1234 treated with autologous sling. The cumulative incidence of any first reoperation at 10 years was 21.3% (95% confidence interval, 19.5–23.0) after retropubic colposuspension, 10.9% (10.7–11.1) after mesh sling insertion, and 12.0% (10.2–13.9) after autologous sling procedures. The women who had a retropubic colposuspension were significantly more likely to have a reoperation than women who had an autologous sling (adjusted hazard ratio for any reoperation: 1.79 [1.47–2.17]; for further stress incontinence surgery: 1.64 [1.19–2.26]; for surgery for complications: 1.89 [1.49–2.40]), whereas the women who had mesh slings had a similar hazard (for any reoperation: 0.90 [0.76–1.07]; for further stress incontinence surgery: 0.75 [0.57–0.99]; for surgery for complications: 1.11 [0.89–1.36]). A sensitivity analysis excluding the women who had concurrent prolapse surgery or hysterectomy produced similar results.
Conclusion
Retropubic colposuspension is associated with higher risk of reoperation at 10 years after surgery than mesh sling insertion or autologous sling procedures, with 1 in 5 women requiring reoperation.
Metadata
Item Type: | Article |
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Authors/Creators: |
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Copyright, Publisher and Additional Information: | © 2021 The Authors. Published by Elsevier Inc. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/). |
Keywords: | adverse events; autologous sling; complications; fascial sling; hernia repair; incontinence surgery; mesh removal; pelvic organ prolapse; retropubic coloposuspension; synthetic mesh sling |
Dates: |
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Institution: | The University of Sheffield |
Academic Units: | The University of Sheffield > Sheffield Teaching Hospitals |
Depositing User: | Symplectic Sheffield |
Date Deposited: | 22 Oct 2021 06:39 |
Last Modified: | 11 Mar 2022 13:52 |
Status: | Published |
Publisher: | Elsevier BV |
Refereed: | Yes |
Identification Number: | 10.1016/j.ajog.2021.08.059 |
Open Archives Initiative ID (OAI ID): | oai:eprints.whiterose.ac.uk:179508 |