Complications in women undergoing Burch colposuspension versus autologous rectus fascial sling for stress urinary incontinence.
OBJECTIVE
We determined the clinicodemographic factors associated with complications of continence procedures, the impact of concomitant surgery on the complication rate and the relationship between the incidence of cystitis and the method of postoperative bladder drainage.


METHODS
We reviewed serious adverse events and adverse events in the Stress Incontinence Surgical Efficacy Trial, a randomized trial comparing Burch colposuspension to the autologous rectus fascial sling. Clinicodemographic variables were analyzed to determine those associated with adverse events using logistic regression analysis. Complications were stratified based on the presence or absence of concomitant surgery. Differences in complication rates (controlling for concomitant surgery) and cystitis rates (controlling for the bladder emptying method) were compared using Fisher's exact test.


RESULTS
Blood loss (p = 0.0002) and operative time (p <0.0001) were significantly associated with an adverse event. Patients who underwent concomitant surgery had a significantly higher serious adverse event rate (14.2% vs 7.3%, p = 0.01) and adverse event rate (60.5% vs 48%, p <0.01) than patients who underwent continence surgery alone. Cystitis rates were higher in the sling vs the Burch group up to 6 weeks postoperatively regardless of concomitant surgery status (p <0.01). Intermittent self-catheterization increased the cystitis rate by 17% and 23% in the Burch and sling groups, respectively.


CONCLUSIONS
Concomitant surgery at continence surgery increased the risk of complications. Sling surgery was associated with a higher risk of cystitis within the first 6 weeks postoperatively. Intermittent self-catheterization increased the risk of cystitis in each group. Complications were associated with surgical factors and not with patient related factors.
Chai
Toby C
TC
Division of Urology, University of Maryland-Baltimore, Baltimore, Maryland 21201, USA. tchai@smail.umaryland.edu
Albo
Michael E
ME
Richter
Holly E
HE
Norton
Peggy A
PA
Dandreo
Kimberly J
KJ
Kenton
Kimberly
K
Lowder
Jerry L
JL
Stoddard
Anne M
AM
D000328:Adult; D017677:Age Distribution; D000368:Aged; D003556:Cystitis / Q000453:epidemiology* / Q000209:etiology; D004322:Drainage / Q000009:adverse effects / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008875:Middle Aged; D011182:Postoperative Care / Q000379:methods; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology; D011336:Probability; D011474:Prosthesis Design; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D053825:Suburethral Slings / Q000009:adverse effects*; D016896:Treatment Outcome; D014546:Urinary Catheterization / Q000009:adverse effects; D014550:Urinary Incontinence, Stress / Q000175:diagnosis / Q000601:surgery*; D014563:Urodynamics; D013520:Urologic Surgical Procedures / Q000009:adverse effects* / Q000379:methods