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A multicenter retrospective cohort study comparing urethral diverticulectomy with and without pubovaginal sling.

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Citation: American Journal of Obstetrics & Gynecology. 223(2):273.e1-273.e9, 2020 08.PMID: 32504566Institution: MedStar Health Research Institute | MedStar Washington Hospital CenterDepartment: Obstetrics and Gynecology/Female Pelvic Medicine and Reconstructive Surgery | Obstetrics and Gynecology/UrogynecologyForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: *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]Year: 2020 ISSN:

0002-9378

Name of journal: American journal of obstetrics and gynecologyAbstract: 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.All authors: Bradley SE, Escobar C, Gutman RE, Hamner JJ, Hudson P, Jackson E, Leach DA, Ogorek J, Panza J, Sassani J, Schroeder M, Smith PE, Wyman AM, Zeymo AOriginally published: American Journal of Obstetrics & Gynecology. 2020 Jun 03Fiscal year: FY2021Fiscal year of original publication: FY2020Digital Object Identifier:

https://dx.doi.org/10.1016/j.ajog.2020.06.002

Date added to catalog: 2020-08-26

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Item type	Current library	Collection	Call number	Status	Date due	Barcode
Journal Article	MedStar Authors Catalog	Article	32504566	Available		32504566

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.

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