Challenges of Multidimensional Outcome Reporting after Suburethral Mid Urethral Sling Removal.

Authors:
Connie Wang
Connie Wang
University of Kansas Medical Center
United States
Nirmish Singla
Nirmish Singla
University of Michigan Medical School
United States
Feras Alhalabi
Feras Alhalabi
UT Southwestern Medical Center
Alana Christie
Alana Christie
University of Texas Southwestern Medical Center
United States
Gary E Lemack
Gary E Lemack
University of Texas Southwestern Medical Center
Dallas | United States
Philippe E Zimmern
Philippe E Zimmern
University of Texas Southwestern Medical Center
United States

J Urol 2018 06 4;199(6):1577-1583. Epub 2018 Jan 4.

Department of Urology and Division of Biostatistics, Simmons Comprehensive Cancer Center (AC), University of Texas Southwestern Medical Center, Dallas, Texas. Electronic address:

Purpose: We sought to determine the types and frequency of presenting symptoms in women undergoing suburethral mid urethral sling removal to improve outcome reporting after removal.

Materials And Methods: Following institutional review board approval women who underwent suburethral mid urethral sling removal of 1 mid urethral sling were evaluated for their presenting symptoms and correlation with the UDI-6 (Urogenital Distress Inventory-Short Form) questionnaire. Demographic data were recorded. Patient reported presenting symptoms were categorized into 5 domains, including storage symptoms, voiding symptoms, pain, recurrent urinary tract infections or urinary incontinence. The UDI-6 was reviewed preoperatively and 6 to 12 months postoperatively. We also calculated an ideal outcome, defined as resolution of incontinence, pain, resumption of sexual activity and no need for further anti-incontinence procedures.

Results: A total of 230 women from 2006 to 2017 met study inclusion criteria, including 116 who completed the UDI-6 postoperatively. Of the women 80% had 3 or more presenting symptoms with pain as the most common symptom. The most common combination of symptoms was all 5 domains, which was noted in 46 of the 230 women (20%). An increasing number of symptoms correlated with the total preoperative UDI-6 score. Symptom domains were associated with the corresponding UDI-6 subdomain questions. Domains not covered by the UDI-6, ie recurrent urinary tract infections and dyspareunia, accounted for 27% of reported symptoms. Due to limited data on sexual activity an ideal outcome was reached in 10% of patients but this rate was 40% after sexual activity information was excluded.

Conclusions: In this series the presenting symptoms were manifold in women undergoing suburethral mid urethral sling removal. The UDI-6 questionnaire correlated with many of these complaints. It may be used in outcome analysis in conjunction with self-reported symptoms.

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Source
http://dx.doi.org/10.1016/j.juro.2017.12.059DOI Listing
June 2018
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