Long-term Urinary Outcomes After Transvaginal Uterovaginal Prolapse Repair With and Without Concomitant Midurethral Slings

Giugale, Lauren E.; Sridhar, Amaanti; Ferrante, Kimberly L.; Komesu, Yuko M.; Meyer, Isuzu; Smith, Ariana L.; Myers, Deborah L.; Visco, Anthony G.; Paraíso, Marie Fidela R.; Mazloomdoost, Donna; Gantz, Marie G.; Zyczynski, Halina M.

doi:10.1097/spv.0000000000001160

Cited by 4 publications

(6 citation statements)

References 23 publications

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“…Table 2 illustrates the calculated difference variables between baseline and follow-up in comparison to the established minimal clinically important difference (MCID) for each domain. The calculated difference for the M-ISI severity, M-ISI SUI, M-ISI UUI, and UDI-6 domains all exceeded the established MCID, indicating clinical significance 16,17 . The other domains did not exceed the established MCID values 17–19 …”

Section: Resultsmentioning

confidence: 86%

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Effects of Pure Barre Exercise on Urinary Incontinence Symptoms: A Prospective Observational Cross-Sectional Study

Briskin¹,

Luck²

2023

UROGC

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Importance Pure Barre is a form of physical exercise using low-impact, high-intensity, pulsatile isometric movements that may serve as a treatment option for urinary incontinence. Objective The objective of this study was to measure the effects of the Pure Barre workout on urinary incontinence symptoms and sexual function. Study Design This was a prospective observational study of new, female Pure Barre clients with urinary incontinence. Eligible participants completed 3 validated questionnaires at baseline and at follow-up after 10 Pure Barre classes within 2 months. Questionnaires included the Michigan Incontinence Symptoms Index (M-ISI), the Pelvic Floor Distress Inventory-20, and the Female Sexual Function Index-6. Matched differences in domain questionnaire scores between baseline and follow-up were analyzed. Results All questionnaire domains significantly improved for all 25 participants after 10 Pure Barre classes. Median M-ISI severity domain scores decreased from 13 (interquartile range, 9–19) at baseline to 7 at follow-up (interquartile range, 3–10; P < 0.0001). Mean ± SD M-ISI urgency urinary incontinence domain scores decreased from 6.40 ± 3.06 to 2.96 ± 2.13 (P < 0.0001). Mean ± SD M-ISI stress urinary incontinence scores decreased from 5.24 ± 2.71 to 2.48 ± 1.58 (P < 0.0001). Mean ± SD Urinary Distress Inventory domain scores decreased from 42.17 ± 17.15 to 29.67 ± 13.73 (P < 0.0001). Matched rank sum analysis indicated increasing Female Sexual Function Index-6 scores from baseline to follow-up (P = 0.0022). Conclusion The Pure Barre workout may be an enjoyable, conservative management option that improves symptoms of urinary incontinence and sexual function.

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Section: Resultsmentioning

confidence: 86%

“…The calculated difference for the M-ISI severity, M-ISI SUI, M-ISI UUI, and UDI-6 domains all exceeded the established MCID, indicating clinical significance 16,17 . The other domains did not exceed the established MCID values 17–19 …”

Section: Resultsmentioning

confidence: 86%

Effects of Pure Barre Exercise on Urinary Incontinence Symptoms: A Prospective Observational Cross-Sectional Study

Briskin¹,

Luck²

2023

UROGC

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“…[6][7][8][9] Importantly, rates of postoperative SUI vary depending on preoperative continence status and the surgical procedures performed, making a universal recommendation inappropriate. [10][11][12][13] Health economic evaluations can assist in clinical decision making by adding cost, utility, and effectiveness information to the process. These are not meant to be used in isolation but can aid in the decision-making process.…”

Section: Why This Mattersmentioning

confidence: 99%

“…Others argue that an sMUS placed when indicated as a second procedure can avoid adverse events associated with sling placement such as de novo overactive bladder, mesh exposure, and urinary retention 6–9 . Importantly, rates of postoperative SUI vary depending on preoperative continence status and the surgical procedures performed, making a universal recommendation inappropriate 10–13 …”

mentioning

confidence: 99%

Cost-Utility Analysis of Midurethral Sling Timing Among Women Undergoing Prolapse Surgery

Sassani¹,

Giugale

Lavelle³

et al. 2023

UROGC

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Importance There are no guidelines regarding the ideal timing of midurethral sling (MUS) placement following prolapse repair. Objective The objective of this study was to estimate the cost-utility of concomitant MUS versus staged MUS among women undergoing apical suspension surgery for pelvic organ prolapse. Study Design Cost-utility modeling using a decision analysis tree compared concomitant MUS with staged MUS over a 1-year time horizon. The primary outcome was the incremental cost-effectiveness ratio (ICER). Six scenarios were modeled to estimate cost-utilities for women with preoperative overt, occult, or no stress urinary incontinence (SUI) who underwent either minimally invasive sacrocolpopexy or vaginal native tissue apical suspension. Possible complications of de novo overactive bladder, urinary retention requiring sling lysis, mesh exposure, and persistent SUI were included. Costs from a third-party payer perspective were derived from Medicare 2022 reimbursements. One-way sensitivity analyses were performed. Results Among women without preoperative SUI, staged MUS was the dominant strategy for both surgical routes with higher utility and lower costs. For women with either occult or overt SUI undergoing sacrocolpopexy or vaginal repair, concomitant MUS was cost-effective (ICER = $21,114–$96,536 per quality-adjusted life-year). Therefore, concomitant MUS is preferred for patients with preoperative SUI as higher costs were offset by higher effectiveness. One-way sensitivity analyses demonstrated that ICERs were most affected by probability of cure following MUS. Conclusions A staged MUS procedure is the dominant strategy for women undergoing apical prolapse repair without preoperative SUI. In women with either overt or occult SUI, the ICER was below the willingness-to-pay threshold of $100,000 per quality-adjusted life-year, suggesting that concomitant MUS surgery is cost-effective.

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“…3,4 Long-term outcome studies have also demonstrated a high rate of successful treatment, with fewer than 9% of patients undergoing concomitant midurethral sling at the time of POP repair requiring subsequent retreatment for SUI. 5,6…”

mentioning

confidence: 99%

Comparison of Morbidity and Retreatment After Urethral Bulking or Midurethral Sling at the Time of Pelvic Organ Prolapse Repair

Russell,

Rhodes,

Gupta

et al. 2023

Obstetrics &Amp; Gynecology

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OBJECTIVE: To compare postprocedure retreatment rates for stress incontinence in patients who underwent either midurethral sling or urethral bulking at the time of concomitant repair of pelvic organ prolapse (POP). METHODS: This was a retrospective cohort study using data from the Premier Healthcare Database. Using Current Procedural Terminology codes, we identified patients who were undergoing POP repair and concomitant urethral bulking or midurethral sling between the years 2001 and 2018. Patients who underwent concomitant nongynecologic surgery, Burch urethropexy, or oncologic surgery, and those who did not undergo concomitant POP and anti-incontinence surgery, were excluded. Additional data collected included patient demographics, hospital characteristics, surgeon volume, and comorbidities. The primary outcome was a repeat anti-incontinence procedure at 2 years, and the secondary outcome was the composite complication rate. RESULTS: Over the study period, 540 (0.59%) patients underwent urethral bulking, and 91,005 (99.41%) patients underwent midurethral sling. The rate of a second procedure within 2 years was higher for urethral bulking, compared with midurethral sling (9.07% vs 1.11%, P<.001); in the urethral bulking group, 4.81% underwent repeat urethral bulking and 4.81% underwent midurethral sling. In the midurethral sling group, 0.77% underwent repeat midurethral sling and 0.36% underwent urethral bulking. After adjusting for confounders, midurethral sling was associated with a decreased odds of a repeat anti-incontinence procedure at 2 years (adjusted odds ratio 0.11, 95% CI 0.08–0.16). The probability of any complication at 2 years was higher with urethral bulking (23.0% vs 15.0%, P<.001). CONCLUSION: Urethral bulking at the time of POP repair is associated with a higher rate of repeat procedure and postoperative morbidity up to 2 years after surgery.

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Long-term Urinary Outcomes After Transvaginal Uterovaginal Prolapse Repair With and Without Concomitant Midurethral Slings

Cited by 4 publications

References 23 publications

Effects of Pure Barre Exercise on Urinary Incontinence Symptoms: A Prospective Observational Cross-Sectional Study

Effects of Pure Barre Exercise on Urinary Incontinence Symptoms: A Prospective Observational Cross-Sectional Study

Cost-Utility Analysis of Midurethral Sling Timing Among Women Undergoing Prolapse Surgery

Comparison of Morbidity and Retreatment After Urethral Bulking or Midurethral Sling at the Time of Pelvic Organ Prolapse Repair

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