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MP40-02: Comparison of Outcomes between Simple and Complex Patients Undergoing Autologous Pubovaginal Sling Placement

Saturday, May 13
3:30 PM - 5:30 PM
Location: BCEC: Room 153

Presentation Authors: Michael Maccini*, Tamara Lhungay, Tyler Doumaney, Lisa Parrillo, Brian Flynn, Aurora, CO

Introduction: Our objective was to determine if there were differences in outcome and reoperation rates between simple and complex patients undergoing autologous pubovaginal sling placement, and whether outcomes differed when mesh removal was performed at the same time as PVS placement.

Methods: We reviewed the charts of 239 patients who underwent autologous rectus fascia PVS placement by a single surgeon (BJF) from 2004 through 2015. Complex cases were defined as patients with urge incontinence or neurogenic bladder, urethral or vesicovaginal fistula, urethral diverticulum, or IUGA category 4 mesh complication (lower urinary tract mesh perforation). Cases were considered simple if they did not meet criteria for complex. 62 patients met criteria for the complex group, and 177 patients met criteria for the simple group. Logistic regression analysis was used to determine if there was a correlation between simple and complex patients and rates of cure (defined as <1 pad per day post-operatively), improvement, retention, reoperation, and complications (Clavien grade >2). We also examined whether concomitant mesh removal was correlated with differences in these outcome measures.

Results: Overall SUI improvement rate was similar in both groups (96.4% for simple group and 93.2% for complex group, p = 0.31). There was a trend toward higher SUI cure rate in the simple group, but this did not meet statistical significance (p = 0.062). Mesh removal and complex case were both associated with increased risk of reoperation (OR = 3.3 and 2.8, respectively). There was no statistical difference in rate of Clavien grade >2 complications (p = 0.55) between simple and complex cases. Concomitant mesh removal was associated with an increased risk of post-operative retention (OR = 2.9), but case complexity had no independent effect on post-operative retention rate (p = 0.91).

Conclusions: Complex patients undergoing PVS placement are at increased risk of undergoing a subsequent continence procedure. In addition, performing mesh excision and PVS in the same setting increases the risk of both post-operative retention and reoperation when compared to PVS alone.

Source Of Funding: none

Michael Maccini, MD

University of Colorado

Mike Maccini is a Urology resident at the University of Colorado School of Medicine and will be graduating in 2018. He obtained his MD from the University of Vermont College of Medicine with the class of 2012. He received his BA in Engineering Sciences from Dartmouth College in 2008. He grew up in Spokane, Washington.

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