Michelle Koski

Safety and Efficacy of Sling for Persistent Stress Urinary Incontinence After Bulking Injection

OBJECTIVES To evaluate the impact of injectable agents on subsequent incontinence surgery outcomes to assess safety and efficacy of this treatment combination. Periurethral bulking agents are a minimally invasive treatment option for stress urinary incontinence (SUI), but often lack durability necessitating further surgical intervention. METHODS Retrospective review of 43 patients with SUI following bulking agent who underwent subsequent sling placement from November 2000 to September 2009 were evaluated for demographics, symptoms, urodynamics (UDS), bulking agent characteristics, concomitant procedures, pad requirements per day (PPD), subjective outcomes, and complications. RESULTS Mean patient age was 67 years, with mean follow-up of 37.3 months. All demonstrated SUI, and mixed urinary incontinence (MUI) was noted in 81.4%. Almost half (48.8%) had undergone a prior antiincontinence procedure. Mean number of injections was 3. After a bulking injection, 25 autologous fascia pubovaginal slings, 13 midurethral slings, and 5 biological pubovaginal slings were placed. Concomitant pelvic surgery was performed in 37.2%. Postoperatively, mean PPD decreased from 5.3 to 0.65, with a 60.5% subjective cure rate (no pads or leakage under any circumstances). No association was seen between number or type of injection, or type of sling with regards to patient outcomes. Results were significantly related to concomitant surgery (P = .007). SUI recurred in 8 patients (18.6%), which was not statistically associated with other parameters. Complications included urinary retention (8 patients) de novo urgency (1 patient), UTI (4 patients), abdominal wound infection (3 patients), and cystotomy (1 patient). CONCLUSIONS Prior treatment with bulking agents does not appear to negatively affect outcomes for future antiincontinence surgery in our patient population.

MP40-16 OUTCOMES OF TREATMENT OF STRESS URINARY INCONTINENCE ASSOCIATED WITH FEMALE URETHRAL DIVERTICULA: A SELECTIVE APPROACH

CONCLUSIONS: Use of third line therapy for OAB has been reported to be less than 5%. This rate is higher at our institution, likely due to access to multiple FPMRS providers. The authors also use a care pathway that emphasizes early patient education on available options should they fail first and second line treatments. Even in a tertiary referral center it is likely that third line therapy is not being offered to many patients who would benefit from it. Our data demonstrate an opportunity for urologists to improve the quality of care and treatment success rates for OAB patients.

MP75-19 STRESS URINARY INCONTINENCE OUTCOMES FOLLOWING TRANSVAGINAL SLING INCISION

INTRODUCTION AND OBJECTIVES: Mid-urethral slings (MUS) have been commonly used in the operative management of stress urinary incontinence (SUI). Unfortunately, many women suffer from complications following MUS surgery that may necessitate a subsequent surgery such as a transvaginal sling incision (TVSI). The objective of this study is to assess the SUI outcomes following TVSI. METHODS: A retrospective review of patients who underwent TVSI from 2007 to 2013 was conducted. Indications for the surgery included bladder outlet obstruction (BOO), pelvic pain, dyspareunia, transvaginal exposure of mesh and erosion of mesh into the urinary tract. SUI at baseline and at 3 months follow-up was assessed. SUI was defined as any patient-reported symptoms of SUI, or demonstration of SUI on physical exam, or urodynamic examination. RESULTS: A total of 167 patients underwent TVSI with the most common indication being BOO (67.7%). Of the entire cohort, 88/167 (52.7%) had no SUI at baseline and following TVSI 26.1% of these patients had SUI at 3 months follow-up. Of the 113 patients with BOO at presentation, 67 (59.3%) patients had no SUI at baseline and 16/67 (23.9%) patients had SUI at 3 months follow-up. 17/39 (43.6%) patients with transvaginal mesh exposure had no SUI at baseline and 23.5% of these patients had SUI following TVSI. Of the 23 patients with mesh erosion into the urinary tract, 11 (47.8%) patients had no SUI at baseline and 6/11 (54.5%) patients had SUI at 3 months. Of the 66 patients with pelvic pain, 10/30 (33.3%) patients had SUI following TVSI who did not have SUI at baseline. Of the 78 patients with dyspareunia, 10/34 (29.4%) who did not have SUI at baseline had SUI following TVSI. There were 46 patients with SUI and BOO at baseline and following TVSI, 21 patients (45.7%) continued to have SUI at 3 months. Of the 33 patients with SUI and no BOO at baseline, concomitant slings were done on 5 patients at the time of TVSI (2 MUS and 3 autologous pubovaginal slings (aPVS). One patient with concomitant MUS had SUI at 3 months and no patient with a concomitant aPVS had SUI at 3 months. 19 patients have undergone subsequent SUI surgery or bulking injection (11 aPVS, 3 MUS, 2 bladder neck closures, and 3 bulking agents). CONCLUSIONS: For patients who do not have SUI at baseline, recurrent SUI following TVSI is not commonly seen. However, for those patients with mesh erosion into the urinary tract or SUI at presentation, recurrent/persistent SUI is seen in over 50% of patients. This knowledge can be used in counseling patients who undergo TVSI.