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Surgeon’s experience and clinical outcome after retropubic tension-free vaginal tape—A case series

Artikel i vetenskaplig tidskrift
Författare B. Holdø
K. Møllersen
M. Verelst
Ian Milsom
R. Svenningsen
F. E. Skjeldestad
Publicerad i Acta Obstetricia et Gynecologica Scandinavica
Volym 99
Nummer/häfte 8
Sidor 1071-1077
ISSN 0001-6349
Publiceringsår 2020
Publicerad vid Institutionen för kliniska vetenskaper, Avdelningen för obstetrik och gynekologi
Sidor 1071-1077
Språk en
Länkar dx.doi.org/10.1111/aogs.13830
Ämnesord complications, long-term results, mixed urinary incontinence, stress urinary incontinence, surgeon's experience, tension-free vaginal tape
Ämneskategorier Reproduktionsmedicin och gynekologi

Sammanfattning

Introduction: The retropubic tension-free vaginal tape procedure has been the preferred method for primary surgical treatment of stress and stress-dominant mixed urinary incontinence in women for more than 20 years. In this study, we assessed associations between surgeon's experience with the primary tension-free vaginal tape procedure and both perioperative complications and recurrence rates. Material and methods: Using a consecutive case-series design, we assessed 596 patients treated with primary retropubic tension-free vaginal tape surgery performed by 18 surgeons from 1998 through 2012, with follow up through 2015 (maximum follow-up time: 10 years per patient). Data on perioperative complications and recurrence of stress urinary incontinence from medical records was transferred to a case report form. Surgeon's experience with the tension-free vaginal tape procedure was defined as number of such procedures performed as lead surgeon (1-19 [“beginners”], 20-49 and ≥50 procedures). All analyses were done with a 5% level of statistical significance. We applied the Chi-square test in the assessment of perioperative complications. The regression analyses of recurrence rate by number of tension-free vaginal tape procedures performed were restricted to the three surgeons who performed ≥50 procedures. Results: We found a significantly higher rate of bladder perforations (P =.03) and a higher rate of urinary retentions among patients whose tension-free vaginal tape procedures were performed by “beginners” (P =.06). We observed a significant reduction in recurrence rates with increasing number of tension-free vaginal tape procedures for one surgeon (P =.03). Conclusions: Surgeon's experience with the tension-free vaginal tape procedure is associated with the risk of bladder perforation and urinary retention, and may be associated with the long-term effectiveness of the procedure. © 2020 The Authors. Acta Obstetricia et Gynecologica Scandinavica published by John Wiley & Sons Ltd on behalf of Nordic Federation of Societies of Obstetrics and Gynecology (NFOG)

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