The effect of concomitant prolapse repair on sling outcomes.
OBJECTIVE
We analyzed the effect of concomitant prolapse surgery performed at the time of sling surgery on short-term postoperative outcomes in women with urinary incontinence.


METHODS
We analyzed 1999 to 2001 Medicare claims data on a 5% national random sample of female beneficiaries who underwent sling procedures. Subjects were tracked for 12 months after surgery to assess short-term complications. Concomitant prolapse repairs and prolapse repairs performed in the first 12 months after sling surgery were identified by CPT-4 procedure codes. Postoperative complications and treatments were identified by ICD-9 diagnosis codes and CPT-4 procedure codes, respectively. Bivariate and multivariate analyses were performed to measure the effect of concomitant prolapse surgery on sling outcomes.


RESULTS
Concomitant prolapse repairs were performed in 34.4% of sling cases. Women who underwent prolapse repair at the time of the sling surgery were significantly more likely to be diagnosed with postoperative outlet obstruction (9.4% vs 5.5%, p <0.007) than those who did not. Women who underwent concomitant prolapse repair were less likely to undergo a repeat procedure for stress incontinence in postoperative year 1 (4.7% vs 10.2%, p = 0.0005). Multivariate analysis revealed that women who underwent prolapse repair at the time of the sling surgery were significantly less likely to undergo a reoperation for prolapse within 1 year after the sling surgery (OR 0.31, 95% CI 0.22-0.44).


CONCLUSIONS
Our findings suggest that addressing prolapse at the time of stress incontinence surgery may avoid an early repeat operation for either prolapse or stress incontinence. However, rates of postoperative outlet obstruction are higher.
Anger
Jennifer T
JT
Department of Urology, David Geffen School of Medicine and School of Public Health, University of California, Los Angeles, Los Angeles, California 90404, USA. janger@mednet.ucla.edu
Litwin
Mark S
MS
Wang
Qin
Q
Pashos
Chris L
CL
Rodríguez
Larissa V
LV
D005260:Female; D006801:Humans; D006278:Medicare; D015999:Multivariate Analysis; D011183:Postoperative Complications; D012086:Reoperation; D053825:Suburethral Slings; D016896:Treatment Outcome; D014481:United States; D014549:Urinary Incontinence / Q000150:complications / Q000601:surgery*; D014563:Urodynamics; D014596:Uterine Prolapse / Q000150:complications / Q000601:surgery*