AN ANALYSIS OF CYSTOTOMY RATES DURING TVT TYPE SUBURETHRAL SLINGS IN A COMMUNITY HOSPITAL SETTING

M.J. Bonidie, N.L. Sanders

The Western Pennsylvania Hospital, Pittsburgh, PA

OBJECTIVE:  The goal of this study was to analyze cystotomy rates during TVT type suburethral sling procedures in a community hospital setting.

MATERIALS AND METHODS:  A retrospective review of 106 consecutive TVT type sling procedures within the gynecology department performed by 14 physicians from January, 2000 to December, 2003 was done.  A series of case-control comparisons were made.  Comparisons included cystotomy rates for physicians performing greater than 10 vs. less than 10 procedures over the above stated period.  A comparison was also made between patients undergoing sling only vs. sling plus concomitant pelvic floor reconstructive surgery.  Chi-square and Fisher exact tests were used for each case-control comparison to calculate odds ratios and 95% confidence intervals.

RESULTS:  Patients who underwent suburethral sling and concomitant pelvic floor reconstructive surgery (n=48; rate 30.9%) were more likely than patients having a sling only (n=58; rate 10.1%) to have a cystotomy [OR 3.4; 95% CI 1.2–9.7].  Physicians performing <10 sling procedures during the period studied (n=11; rate 27%) were more likely than physicians performing >10 procedures over the same period (n=3; rate 13%) to encounter cystotomy [OR 2.4; 95% CI 0.88-6.7].  Patients having a sling only performed within the <10 physician group (n=23; rate 21%) were more likely than patients having sling only in the >10 physician group (n=35; rate 3%) to have a cystotomy [OR 13.2; 95% CI 1.3–132].

CONCLUSION:  For patients having a TVT type suburethral sling procedure, the risk of cystotomy may be increased if concomitant pelvic floor reconstructive surgery is performed.  Physicians who perform TVT type suburethral sling procedures less commonly may have a higher incidence of cystotomy.

Key Words:  suburethral sling, cystotomy

Disclosure - Consultant: M. Bonidie, Bard Urological, Ethicon Endosurgery.