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• W2731469715 abstract "No AccessJournal of UrologyAdult Urology1 Dec 2017Sling Procedures for the Treatment of Stress Urinary Incontinence: Comparison of National Practice Patterns between Urologists and Gynecologists Maxwell B. James, Marissa C. Theofanides, Wilson Sui, Ifeanyi Onyeji, Gina M. Badalato, and Doreen E. Chung Maxwell B. JamesMaxwell B. James More articles by this author , Marissa C. TheofanidesMarissa C. Theofanides More articles by this author , Wilson SuiWilson Sui More articles by this author , Ifeanyi OnyejiIfeanyi Onyeji More articles by this author , Gina M. BadalatoGina M. Badalato More articles by this author , and Doreen E. ChungDoreen E. Chung More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.06.093AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Sling procedures, which have become the dominant method of surgical management of stress urinary incontinence, are frequently performed by urologists and gynecologists. Few studies investigating trends in surgical management have focused on differences in provision of care between the specialties. In this study we compared national practice patterns of sling procedures by provider type. Materials and Methods: We analyzed the 2006 to 2013 ACS (American College of Surgeons) NSQIP (National Surgical Quality Improvement Program) database. CPT-4 codes were used to identify patients who underwent sling procedures and any concomitant pelvic floor procedures. Patient and operative characteristics were compared between urologists and gynecologists using bivariate and multivariate analysis. Results: Our analytical cohort included 22,192 sling procedures, of which 5,718 (25.8%) and 16,474 (74.2%) were performed by urologists and gynecologists, respectively. Urologists performed a greater percent of autologous fascial sling procedures than gynecologists (1.16% vs 0.06%, p <0.001). Concomitant prolapse repair was performed in 8,664 patients (44.1%), including 954 (16.7%) of urologists and 7,710 (46.8%) of gynecologists. On multivariable analysis urology patients were less likely to undergo concomitant prolapse repair or hysterectomy. Urology patients were more likely to have hypertension and be older, have a higher ASA® (American Society of Anesthesiologists®) class and be current smokers. Conclusions: Gynecologists perform the majority of sling procedures for stress urinary incontinence. While gynecologists perform more concomitant procedures, urologists tend to operate on older patients with more comorbidities. Urologists also perform a greater proportion of autologous fascial sling procedures. These findings demonstrate that, although gynecologists perform a greater number of surgeries, urologists treat a unique population of patients who require operative management of stress urinary incontinence. References 1 : An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Int Urogynecol J2010; 21: 5. Google Scholar 2 : Epidemiology and natural history of urinary incontinence in women. Urology2003; 62: 16. Google Scholar 3 : Urinary incontinence as a worldwide problem. Int J Gynaecol Obstet2003; 82: 327. Google Scholar 4 : Distress and quality of life characteristics associated with seeking surgical treatment for stress urinary incontinence. Health Qual Life Outcomes2009; 7: 8. Google Scholar 5 : The impact of the overactive bladder on health-related utility and quality of life. BJU Int2006; 97: 1267. Google Scholar 6 : The surgical trends and time-frame comparison of primary surgery for stress urinary incontinence, 2006-2010 vs 1997-2005: a population-based nation-wide follow-up descriptive study. Int Urogynecol J2014; 25: 1683. Google Scholar 7 : Single-incision mini-slings versus standard midurethral slings in surgical management of female stress urinary incontinence: a meta-analysis of effectiveness and complications. Eur Urol2011; 60: 468. Google Scholar 8 : Trends in the surgical management of stress urinary incontinence. Obstet Gynecol2012; 119: 845. Google Scholar 9 : Midurethral sling is the dominant procedure for female stress urinary incontinence: analysis of case logs from certifying American urologists. Urology2013; 82: 1267. Google Scholar 10 : Blueprint for a new American College of Surgeons: National Surgical Quality Improvement Program. J Am Coll Surg2008; 207: 777. Google Scholar 11 : Toward robust information: data quality and inter-rater reliability in the American College of Surgeons National Surgical Quality Improvement Program. J Am Coll Surg2010; 210: 6. Google Scholar 12 : Variations in stress incontinence and prolapse management by surgeon specialty. J Urol2007; 178: 1411. Link, Google Scholar 13 : Removal or revision of vaginal mesh used for the treatment of stress urinary incontinence. JAMA Surg2015; 150: 1167. Google Scholar 14 Association of American Medical Colleges Center for Workforce Studies: 2014 Physician Specialty Data Book. Association of American Medical Colleges 2014. Available at https://www.aamc.org/download/473260/data/2014physicianspecialtydatabook.pdf. Accessed March 16, 2017. Google Scholar 15 : 30 Day morbidity and reoperation following midurethral sling: analysis of 8,772 cases using a national prospective database. Urology2016; 95: 72. Google Scholar 16 : Comparison of midurethral sling outcomes with and without concomitant prolapse repair. Obstet Gynecol Sci2014; 57: 50. Google Scholar 17 : Does concomitant prolapse repair at the time of midurethral sling affect recurrent rates of incontinence?. Int Urogynecol J2011; 22: 819. Google Scholar 18 : The effect of concomitant prolapse repair on sling outcomes. J Urol2008; 180: 1003. Link, Google Scholar 19 : Concomitant apical prolapse repair and incontinence procedures: trends from 2001-2009 in the United States. Am J Obstet Gynecol2014; 211: 222.e1. Google Scholar 20 : Outcomes of minimally invasive suburethral slings with and without concomitant pelvic organ prolapse surgery. Int J Gynaecol Obstet2014; 127: 69. Google Scholar 21 : Does concomitant anterior/apical repair during midurethral sling improve the overactive bladder component of mixed incontinence?. Int Urogynecol J2014; 25: 1269. Google Scholar 22 : Prolapse surgery with or without stress incontinence surgery for pelvic organ prolapse: a systematic review and meta-analysis of randomised trials. BJOG2014; 121: 537. Google Scholar 23 : A midurethral sling to reduce incontinence after vaginal prolapse repair. N Engl J Med2012; 366: 2358. Google Scholar © 2017 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited bySmith J (2017) This Month in Adult UrologyJournal of Urology, VOL. 198, NO. 6, (1179-1181), Online publication date: 1-Dec-2017. Volume 198Issue 6December 2017Page: 1386-1391Supplementary Materials Advertisement Copyright & Permissions© 2017 by American Urological Association Education and Research, Inc.Keywordssuburethral slingsurologypractice patternsphysicians'urinary incontinencestressgynecologyMetricsAuthor Information Maxwell B. James More articles by this author Marissa C. Theofanides More articles by this author Wilson Sui More articles by this author Ifeanyi Onyeji More articles by this author Gina M. Badalato More articles by this author Doreen E. Chung More articles by this author Expand All Advertisement PDF downloadLoading ..." @default.
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• W2731469715 title "Sling Procedures for the Treatment of Stress Urinary Incontinence: Comparison of National Practice Patterns between Urologists and Gynecologists" @default.
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