A multicenter retrospective cohort study comparing urethral diverticulectomy with and without pubovaginal sling.
A multicenter retrospective cohort study comparing urethral diverticulectomy with and without pubovaginal sling.
- 2020
CONCLUSION: This large retrospective cohort study demonstrates greater resolution of stress urinary incontinence with the addition of a pubovaginal sling at the time of urethral diverticulectomy. There was a significant risk of postoperative urinary retention and recurrent urinary tract infection in the pubovaginal sling group. Copyright (c) 2020. Published by Elsevier Inc. OBJECTIVES: The objective of this study was to compare the clinical presentation, outcomes, complications and diverticulum recurrence rates in women who underwent urethral diverticulectomy with versus without a concurrent pubovaginal sling. RESULTS: We identified 485 diverticulectomy cases from 11 institutions that met inclusion/exclusion criteria; 96 (19.7%) had concomitant pubovaginal sling. Women that had pubovaginal sling were older (53 vs 46, p<0.001) and more had prior diverticulectomy (31% vs 8%, p<0.0001). Postoperative follow-up (14.6+/-26.9 months) was similar between groups. The pubovaginal sling group had greater preoperative stress urinary incontinence (71% vs 33%, p<0.0001), dysuria (47% vs 30%, p=0.002), and recurrent urinary tract infection (49% vs 33%, p=0.004). The addition of a pubovaginal sling at the time of diverticulectomy significantly improved the odds of stress urinary incontinence resolution after adjusting for prior diverticulectomy, prior incontinence surgery, age, race, and parity (aOR 2.27, 95% CI 1.02-5.03, p=0.043). It was not significantly protective against de novo stress urinary incontinence (aOR 0.86, 95% CI 0.25-2.92, p=0.807). Concomitant sling increased the odds of postoperative short-term (<6 weeks) urinary retention (aOR2.5, 95% CI 1.04-6.22, p=0.039) and long-term urinary retention (>6 weeks) (aOR 6.98, 95% CI 2.20-22.11, p=0.001) as well as recurrent urinary tract infection (aOR 3.27, 95% CI 1.26-7.76, p=0.013). There was no significant risk to develop de novo overactive bladder (aOR 1.48, 95% CI 0.56-3.91, p=0.423) or urgency urinary incontinence (aOR 1.47, 95% CI 0.71-3.06, p=0.30). It was not protective against recurrent diverticulum (aOR 1.38, 95% CI 0.67-2.82, p=0.374). Overall diverticulum recurrence rate was 10.1% and did not differ between groups. STUDY DESIGN: This multi-center retrospective cohort study included women who underwent urethral diverticulectomy between Jan 1, 2000 - Dec 31, 2016. Subjects were identified by Current Procedure Terminology code and records reviewed for demographics, medical/surgical history, symptoms, preoperative testing, concomitant surgeries, and postoperative outcomes. Symptoms, recurrence rates and complications were compared between women with and without a concomitant pubovaginal sling. The primary outcome was the presence of postoperative stress urinary incontinence symptoms. Based on a stress urinary incontinence rate of 50% with no pubovaginal sling and 10% with pubovaginal sling, we needed 141 diverticulectomy alone and 8 with pubovaginal sling to achieve 83% power with p < 0.05.
English
0002-9378
10.1016/j.ajog.2020.06.002 [doi] S0002-9378(20)30617-7 [pii]
*Diverticulum/su [Surgery]
*Postoperative Complications/pc [Prevention & Control]
*Suburethral Slings
*Urethral Diseases/su [Surgery]
*Urinary Incontinence, Stress/pc [Prevention & Control]
Adult
Cohort Studies
Fascia/tr [Transplantation]
Female
Humans
Middle Aged
Postoperative Complications/su [Surgery]
Retrospective Studies
Urinary Incontinence, Stress/su [Surgery]
MedStar Health Research Institute
MedStar Washington Hospital Center
Obstetrics and Gynecology/Female Pelvic Medicine and Reconstructive Surgery
Obstetrics and Gynecology/Urogynecology
Journal Article
CONCLUSION: This large retrospective cohort study demonstrates greater resolution of stress urinary incontinence with the addition of a pubovaginal sling at the time of urethral diverticulectomy. There was a significant risk of postoperative urinary retention and recurrent urinary tract infection in the pubovaginal sling group. Copyright (c) 2020. Published by Elsevier Inc. OBJECTIVES: The objective of this study was to compare the clinical presentation, outcomes, complications and diverticulum recurrence rates in women who underwent urethral diverticulectomy with versus without a concurrent pubovaginal sling. RESULTS: We identified 485 diverticulectomy cases from 11 institutions that met inclusion/exclusion criteria; 96 (19.7%) had concomitant pubovaginal sling. Women that had pubovaginal sling were older (53 vs 46, p<0.001) and more had prior diverticulectomy (31% vs 8%, p<0.0001). Postoperative follow-up (14.6+/-26.9 months) was similar between groups. The pubovaginal sling group had greater preoperative stress urinary incontinence (71% vs 33%, p<0.0001), dysuria (47% vs 30%, p=0.002), and recurrent urinary tract infection (49% vs 33%, p=0.004). The addition of a pubovaginal sling at the time of diverticulectomy significantly improved the odds of stress urinary incontinence resolution after adjusting for prior diverticulectomy, prior incontinence surgery, age, race, and parity (aOR 2.27, 95% CI 1.02-5.03, p=0.043). It was not significantly protective against de novo stress urinary incontinence (aOR 0.86, 95% CI 0.25-2.92, p=0.807). Concomitant sling increased the odds of postoperative short-term (<6 weeks) urinary retention (aOR2.5, 95% CI 1.04-6.22, p=0.039) and long-term urinary retention (>6 weeks) (aOR 6.98, 95% CI 2.20-22.11, p=0.001) as well as recurrent urinary tract infection (aOR 3.27, 95% CI 1.26-7.76, p=0.013). There was no significant risk to develop de novo overactive bladder (aOR 1.48, 95% CI 0.56-3.91, p=0.423) or urgency urinary incontinence (aOR 1.47, 95% CI 0.71-3.06, p=0.30). It was not protective against recurrent diverticulum (aOR 1.38, 95% CI 0.67-2.82, p=0.374). Overall diverticulum recurrence rate was 10.1% and did not differ between groups. STUDY DESIGN: This multi-center retrospective cohort study included women who underwent urethral diverticulectomy between Jan 1, 2000 - Dec 31, 2016. Subjects were identified by Current Procedure Terminology code and records reviewed for demographics, medical/surgical history, symptoms, preoperative testing, concomitant surgeries, and postoperative outcomes. Symptoms, recurrence rates and complications were compared between women with and without a concomitant pubovaginal sling. The primary outcome was the presence of postoperative stress urinary incontinence symptoms. Based on a stress urinary incontinence rate of 50% with no pubovaginal sling and 10% with pubovaginal sling, we needed 141 diverticulectomy alone and 8 with pubovaginal sling to achieve 83% power with p < 0.05.
English
0002-9378
10.1016/j.ajog.2020.06.002 [doi] S0002-9378(20)30617-7 [pii]
*Diverticulum/su [Surgery]
*Postoperative Complications/pc [Prevention & Control]
*Suburethral Slings
*Urethral Diseases/su [Surgery]
*Urinary Incontinence, Stress/pc [Prevention & Control]
Adult
Cohort Studies
Fascia/tr [Transplantation]
Female
Humans
Middle Aged
Postoperative Complications/su [Surgery]
Retrospective Studies
Urinary Incontinence, Stress/su [Surgery]
MedStar Health Research Institute
MedStar Washington Hospital Center
Obstetrics and Gynecology/Female Pelvic Medicine and Reconstructive Surgery
Obstetrics and Gynecology/Urogynecology
Journal Article