Presentation Authors: Pravisha Ravindra*, Mei-Ling Henry, Alvaro Bazo, Richard Parkinson, Nottingham, United Kingdom
Introduction: The need for long-term follow up data in female patients undergoing surgery for stress urinary incontinence (SUI) has been repeatedly highlighted by Cochrane reviews and the FDA. This is especially relevant in the current climate of controversy over the safety of mesh-related products. We aimed to assess the subjective long-term outcomes of patients who had undergone SUI surgery at our institution in this real-world study.
Methods: All female patients who underwent SUI surgery at one institution from January 2011 to December 2016 were identified and sent a 5-item self-administered postal questionnaire. Results were analysed using GraphPad Prism 6.0.
Results: Questionnaires were returned by 364 of 570 patients identified (64% response rate), with a median age of 51 (range 17 â€“ 84) and mean follow up of 54 months. The majority of respondents underwent TOT insertion (79%), followed by TVT (17%), autologous sling (2%) and Burch colposuspension (2%). 94% of procedures were primary (6% revision). Two-thirds underwent pre-procedure urodynamics. 63/364 (17%) were identified to have a concurrent pelvic organ prolapse (POP) and were treated surgically if symptomatic. _x000D_
69% of patients described their SUI as much or very much better (73% TOT, 53% TVT). A significantly greater proportion of patients undergoing TVT insertion did so as revision surgery when compared to TOT insertion (p=0.0037). Overall, 55% described an improvement/cure in their overactive bladder symptoms, while 8% said they were worse. A quarter complained of new voiding difficulty (23% TOT, 27% TVT), with 9% requiring intermittent self-catheterisation. 52% declared no post-operative problems, with the remainder reporting UTI (20%), dyspareunia (13%), pelvic pain (12%) and new POP (5%). Ultimately, 7% stated that they had required further surgery, the majority of which was for recurrent SUI. Specifically, 0.8% (3/364) required surgery for tape erosion (all vaginal).
Conclusions: This study is one of the largest cohorts to report patient-centred real-world outcomes with over 4 year follow up. Our results demonstrate a wane in efficacy of surgery over time, while quantifying the longer-term incidence of complications and the need for further surgery. All surgeons performing surgical procedures for SUI should audit their long-term outcomes in order to accurately counsel patients considering SUI surgery and aid in their decision-making.