Recurrent Urinary Tract Infection After Midurethral Sling: A Retrospective Study

Hammett, Jessica; Lukman, Revana; Oakes, Megan; Whitcomb, Emily L.

doi:10.1097/spv.0000000000000308

Cited by 15 publications

(9 citation statements)

References 10 publications

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“…We found an average 30-day postoperative UTI rate of 3.3%, which was lower than that documented by most other studies in the range of 10-20%. [2][3][4][5] In contrast to our data demonstrating no clinically significant differences in 30-day complications and reoperations, there were notable differences in the rate of postoperative UTIs based on race and ethnicity. Compared with American Indian or Alaska Native patients and both Hispanic and non-Hispanic White patients, Black or African American patients had fewer UTI diagnoses despite having a higher proportion with comorbidities that could increase their risk of developing a UTI (ie, diabetes).…”

Section: Discussioncontrasting

confidence: 99%

“…With 13.6% of women affected by stress urinary incontinence (SUI), midurethral sling operations are among of the most common urogynecologic procedures with 260,000 performed annually in the United States 1 . Despite generally being a well-tolerated outpatient procedure associated with a low risk of morbidity, reported rates of urinary tract infection (UTI) are high, in the range of (10–20%) 2–5 . Urinary tract infections account for more than 8 million office visits per year, longer hospital stays for inpatients, and increased antibiotic use 6,7 .…”

mentioning

confidence: 99%

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Postoperative Complications After Sling Operations for Incontinence: Is Race a Factor?

Pfeuti,

Madsen,

Habermann

et al. 2024

UROGC

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Importance Racial and ethnic disparities exist in urogynecologic surgery; however, literature identifying specific disparities after sling operations for stress incontinence are limited. Objective The objective of this study was to evaluate racial and ethnic disparities in surgical complications within 30 days of midurethral sling operations. Study Design This retrospective cohort study identified women who underwent an isolated midurethral sling operation between 2014 and 2021 using the American College of Surgeons National Surgical Quality Improvement Program database. Women were stratified by racial and ethnic category to assess the primary outcome, 30-day surgical complications, and the secondary outcome, comparison of urinary tract infections (UTIs). Results There were 20,066 patients included. Mean age and body mass index were 53.9 years and 30.8, respectively. More Black or African American women had diabetes and hypertension, and more American Indian or Alaska Native women used tobacco. The only difference in 30-day complications was stroke/cerebrovascular accident, which occurred in only 1 Asian, Native Hawaiian or other Pacific Islander patient (0.1%, P < 0.0001). The most frequent complication was UTI (3.3%). Black or African American women were significantly less likely to have a diagnosis of UTI than non-Hispanic White (P = 0.04), Hispanic White (P = 0.03), and American Indian or Alaska Native women (P = 0.04). Conclusions Surgical complications within 30 days of sling operations are rare. No clinically significant racial and ethnic differences in serious complications were observed. Urinary tract infection diagnoses were lower among Black or African American women than in non-Hispanic White, Hispanic White, and American Indian or Alaska Native women despite a greater comorbidity burden. No known biologic reason exists to explain lower UTI rates in this population; therefore, this finding may represent a disparity in diagnosis and treatment.

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Section: Discussioncontrasting

confidence: 99%

mentioning

confidence: 99%

Postoperative Complications After Sling Operations for Incontinence: Is Race a Factor?

Pfeuti,

Madsen,

Habermann

et al. 2024

UROGC

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“…Prior studies have reported a wide range of PO-UTI rates following POP/SUI surgery, with variation in surgical events, UTI definition, and period of interest. One large retrospective study of 7,461 midurethral sling procedures looked at RUTI within 1 year after surgery and found a 3.5% PO-RUTI rate based on positive urine culture of >10 5 CFU/mL, 21 which was lower than our 4.8% rate after SUI surgery. Their 1.2% preoperative RUTI rate was also lower than our 3.7% rate.…”

Section: Discussioncontrasting

confidence: 74%

Urinary Tract Infections After Urogynecologic Surgery: Risk Factors, Timeline, and Uropathogens

Jung

Chen

Brubaker

et al. 2022

UROGC

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ImportanceUrinary tract infection (UTI) is a common and potentially avoidable postoperative (PO) adverse event after urogynecologic surgery. Understanding pathophysiology will help prevent the associated morbidity of the disease and treatment of PO-UTI.ObjectiveThe objective of this study is to determine the following: (1) risk factors for both PO-UTI and PO recurrent UTI (RUTI) after urogynecologic surgery, (2) temporal distribution of UTI, and (3) uropathogen identification.Study DesignWomen undergoing urogynecologic surgery were retrospectively reviewed. Urinary tract infection was defined by culture or antibiotic prescription for symptoms. Recurrent UTI was defined as occurring outside a 6-week perioperative period. The χ2 test or Fischer exact and Student t tests or Mann-Whitney U test were used as appropriate. Individual odds ratio (OR), 95% confidence interval [CI], and sequential multivariable logistic regression were calculated. Statistical significance was set at P < 0.05.ResultsThe 6-week PO-UTI rate after 33,626 procedures was 12.9%. Recurrent UTI increased from 3.7% preoperatively to 4.4% postoperatively (P < 0.001). A 6-week preoperative UTI and RUTI increased the risk of 6-week PO-UTI (OR, 1.65; 95% CI < 1.26–2.16; P = 0.001 and OR, 2.19; 95% CI, 1.84–2.62; P < 0.001, respectively) and PO-RUTI (OR, 2.95; 95% CI, 2.11–4.11; P < 0.001 and OR, 6.79; 95% CI, 5.61–8.23; P < 0.001, respectively). Compared with pelvic organ prolapse (POP) surgery only, stress urinary incontinence (SUI) surgery (OR 1.57[1.30–1.89]), and combined POP/SUI surgery (OR, 1.36; 95% CI, 1.13–1.63]) increased the risk of PO-RUTI (P < 0.001). Urinary tract infection within 1 week preoperatively was protective against 6-week PO-UTI (OR, 0.68; 95% CI, 0.48–0.97; P = 0.035). No perioperative factors were protective of PO-RUTI.ConclusionsThe PO-RUTI rate in the first year after urogynecologic surgery is low; however, SUI procedures may increase PO-RUTI risk. Potentially, modifiable risk factors for both PO-UTI and PO-RUTI include UTI diagnosis within 6 weeks preoperatively or preoperative RUTI diagnosis. Retesting women the week before surgery to ensure adequate treatment of preoperative UTI may reduce 6-week PO-UTI.

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“…El objetivo principal de este estudio fue determinar la frecuencia de infección de vías urinarias posterior a la colocación de cinta medio uretral durante su primer año, infección de vías urinarias recurrente y los factores de riesgo, presentándose un 12.7% de IVU en el primer año postoperatorio, 3.4% de IVU recurrente, estos valores son similares a los reportados por Jessica Hammett, 12% y 3.5% respectivamente, (12) de igual manera en el meta-análisis de Schimpf et al, donde reportan incidencia de IVU 11%, (5) evaluaron 6286 pacientes, Nygaard et al, evaluaron 1252 paciente, reportan una incidencia del 7%-12% para IVU posterior a CMU y 2.4% de IVU recurrente, (6) frecuencias similares a las encontradas en este estudio, aumentando de esta manera la validez externa del mismo.…”

Section: Discussionunclassified

“…(11) A pesar de la frecuencia con la que se producen las IVU, hay relativamente pocos datos que evalúan los factores de riesgo de la IVU o la IVU recurrente en las poblaciones con CMU. (12) Los factores de riesgo asociados a la IVU posterior a CMU descritos son: la edad mayor de 65 años, uso de estrógeno vaginal, uso de sonda urinaria más de 6 semanas, obesidad mórbida, diabetes mellitus, incontinencia urinaria, obstrucción urinaria y cirugía urogenital previa. (13) Sin embargo a la fecha los resultados son controvertidos y no se han detectado parámetros urodinámicos asociados a la IVU postcolocación de CMU.…”

Section: Antecedentesunclassified

Risk factors for urinary tract infection after midurethral sling placement

et al. 2020

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Antecedentes: La infección de vías urinarias (IVU) es una de las infecciones bacterianas más comunes en las mujeres, las tasas de IVU después de la colocación de cinta medio uretral (CMU) son tan altas como 34% dentro de los primeros 3 meses de cirugía y hasta 50% después de 1 año. El objetivo de este estudio fue determinar la frecuencia de infección de vías urinarias y recurrencia en la aplicación de CMU al año e identificar factores de riesgo. Material y métodos: Estudio de casos y controles, en pacientes que se les colocó CMU, durante 2014-2017, al completar el primer año postoperatorio se identificaron dos grupos: IVU y NO IVU, se realizó estadística descriptiva de cada una de las variables, se realizó la comparación entre grupos. Se calculó Odds Ratio (OR), se realizó un ajuste en los riesgos para aquellas variables que resultaron significativas. Se utilizó el programa estadístico SPSS versión 25 para el análisis estadístico, se consideró una p<0.05 como resultado estadísticamente significativo. Resultados: Se incluyeron 267 pacientes a las cuales se les coloco CMU, encontrando IVU en 34 pacientes (12.7%), IVU recurrente en 9 pacientes (3.4%), se colocaron 250 cintas TOT (93.6%) y 17 cintas TVT (6.4%), se presentó infección del tracto urinario durante el primer año postoperatorio en 6 (35.2%) en TVT, 28 (11.2%) en TOT, dicha asociación fue estadísticamente significativa. Con respecto a los factores de riesgo, se encontró que la colocación de cinta TVT un OR=4.32 (IC95%=1.48-12.6) y el uso de sonda urinaria mayor a 48 horas con un OR=8.40 (IC95%=3.23-21.8). Conclusiones: La frecuencia de IVU e IVU recurrente posterior a la colocación de CMU fue similar a la reportada en la literatura, encontramos como factores de riesgo para IVU la colocación de TVT y el uso de sonda urinaria > 48 horas.

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Recurrent Urinary Tract Infection After Midurethral Sling: A Retrospective Study

Abstract: In this population, preoperative recurrent UTI was the only modifiable risk factor associated with an increased risk of postoperative recurrent UTI.

Cited by 15 publications

References 10 publications

Postoperative Complications After Sling Operations for Incontinence: Is Race a Factor?

Postoperative Complications After Sling Operations for Incontinence: Is Race a Factor?

Urinary Tract Infections After Urogynecologic Surgery: Risk Factors, Timeline, and Uropathogens

Risk factors for urinary tract infection after midurethral sling placement

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