COMPARISON OF PRACTICE PATTERNS WHEN USING THE MINIMALLY INVASIVE SLING

A.A. Romero, G.D. Webster, and C.L. Amundsen

Duke University Medical Center, Durham, NC

OBJECTIVE: We define the minimally invasive sling (MIS) as one of the recently popularized commercial trocar- delivered synthetic or biologic tape slings implanted to treat stress urinary incontinence in women. More than any other stress incontinence surgery this technique seems to have been embraced by both urologists and gynecologists. The purpose of this study was to survey urologists and gynecologists for practice differences using this technique.

MATERIALS AND METHODS:  A web-based questionnaire was e-mailed to all members of the American Urogynecologic Society (AUGS), and the Society for Urodynamics and Female Urology (SUFU).  If no response was received within 2 weeks, two additional e-mails were sent.  The survey included questions about surgeon demographics, type of MIS used, and operative and postoperative management.  Statistical analysis consisted of Chi-square analysis.

RESULTS:  Of 732 (574 AUGS and 158 SUFU) surveys sent, 291 were completed, for a respective 37% and 48% response.  Groups were statistically similar with regards to practice demographics. A majority in both groups did a MIS for an aLLP < 60 cm H20 and used synthetic material.  96% AUGS and 77% SUFU members performing prolapse repairs at the same time, p = .00.  53% of AUGS preferred a transvaginal approach and 41% of SUFU the transabdominal approach p = .00.  Both would replace the trocar at a new site should bladder penetration occur, and 56% and 58% respectively would use a urethral catheter for 48-72 hours in this event. This occurred in only 0.5 to 1.0% of cases by 47% of AUGS and 40% SUFU responders. Cystoscopy was performed at the end of the procedure in an overwhelming majority of members in both societies. 94% of both groups reported using pre-op antibiotics, but they were used postop by 24% AUGS and 83% SUFU members, p = .00.  General or regional anesthesia is used in 77% AUGS and 90% SUFU responders.  Both reported less de-novo urge incontinence and would wait the same time to manage obstruction as with the traditional sling. 

CONCLUSIONS:  Practice patterns between members of AUGS and SUFU are similar despite differences in training.  Post operative antibiotic use and approach for trocar placement were the only significant practice differences between the groups.  Surprisingly the majority of responders in both societies perform MIS in patients with low leak point pressures and prolapse, although there is little in the literature reporting outcomes in these populations.  In addition, few responders in both groups perform the procedure under local anesthesia as initially described.

Key Words:  minimally invasive sling, practice patterns

Disclosure – Nothing to disclose.