Reoperation for urinary incontinence: a nationwide cohort study, 1998-2007.
BACKGROUND
The synthetic midurethral slings were introduced in the 1990s and were rapidly replaced the Burch colposuspension as the gold standard treatment for urinary incontinence. It has been reported that the retropubic midurethral tape has an objective and subjective cure rate of 85% at 5 years of follow-up, but the rate of reoperation after retropubic midurethral tape at the long-term follow-up is less well described. The existing literature specifies an overall lifetime rate of reoperation of about 8-9% after an initial operation for urinary incontinence. There are, however, conflicting statements about the risk of reoperation after specific surgical procedures for urinary incontinence.


OBJECTIVE
The objective of the study was to describe the cumulative incidence of reoperation within a 5 year period after different types of surgical procedures for urinary incontinence based on a nationwide population.


METHODS
We used the Danish National Patient Registry to identify women who had surgery for urinary incontinence from 1998 through 2007 and the outcome was a reoperation within 5 years. Kaplan-Meier curves were used to estimate the rate of reoperation for 6 types of surgery for urinary incontinence (retropubic midurethral tape, transobturator tape, urethral injection therapy, Burch colposuspension, pubovaginal slings, and miscellaneous operations). Cox proportional hazard models were used to estimate the hazard ratio (HR) with 95% confidence intervals (CIs), adjusted for factors suspected to be associated with reoperation.


RESULTS
A total of 8671 women (mean age, 56.1 years, range 6.7-93.7 years) underwent surgical treatment for urinary incontinence. Among these women, 5820 (67%) received a synthetic midurethral sling at baseline. The cumulative incidence of reoperation after any surgical treatment for urinary incontinence was 10%. The lowest rate of reoperation was observed among women having pubovaginal slings (6%), retropubic midurethral tape (6%) and Burch colposuspension (6%) followed by transobturator tape (9%), and miscellaneous operations (12%), whereas the highest observed risk was for urethral injection therapy (44%). In a Cox proportional hazard model that adjusted for age, department volume, and calendar effect, the transobturator tape carried a 2-fold higher risk of reoperation (HR, 2.1; 95% CI, 1.5-2.9), and urethral injection therapy carried a 12 fold-higher risk (HR, 11.5; 95% CI, 9.3-14.3) compared with retropubic midurethral tape.


CONCLUSIONS
This nationwide cohort study provides physicians with a representative evaluation of the rate of reoperations after surgical procedures for urinary incontinence. Pubovaginal slings, Burch colposuspension, and retropubic midurethral tape had a similar risk of reoperation (6%). Women who were operated with transobturator tape had a significantly higher risk of reoperation compared with retropubic midurethral tape.
Center for Clinical Epidemiology, South, Odense University Hospital, and Research Unit of Clinical Epidemiology, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark. Electronic address: margrethefoss@hotmail.com.
Margrethe
M
Foss Hansen
Department of Obstetrics and Gynaecology, Herlev Hospital, Herlev, and Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
Gunnar
G
Lose
Department of Obstetrics and Gynaecology, Herlev Hospital, Herlev, and Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
Ulrik Schiøler
US
Kesmodel
Center for Clinical Epidemiology, South, Odense University Hospital, and Research Unit of Clinical Epidemiology, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark.
Kim Oren
KO
Gradel
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D015331:Cohort Studies; D003718:Denmark; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008875:Middle Aged; D016016:Proportional Hazards Models; D012042:Registries; D012086:Reoperation / Q000639:trends; D053825:Suburethral Slings; D014549:Urinary Incontinence / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000379:methods*; D055815:Young Adult
reoperation; repeat surgery; retropubic midurethral tape; transobturator tape; urinary incontinence