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EP916
267 sub urethral slings – Audit using surgical database
Monday, 20 March and Tuesday, 21 March , 10:00, 13:25, 16:50, Poster Screen 20
Wednesday, 22 March, 11:12, Poster Screen 20

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Introduction:

Surgical Audit has been strongly recommended by RANZCOG especially in the wake of the FDA 2011 statement warning of serious complications and followed by a frenzy of litigation. A large comprehensive database provides an opportunity for the surgeon to reflect on techniques, equipment, patient selection, pre -and post operative follow up regularity and management protocols.

Methods:

 

A single surgeon series audit of 279 suburethral slings for stress incontinence is presented  with follow up data at 6 weeks, 6 months and 12 months post surgery. Complications are classified according to the IUGA Standardisation  Committee 2014 and compared with reported rates in systematic reviews. 

Results:

• 279 slings were inserted , alone or in combination with other prolapse procedures.
•Most slings were Monarc transobturator tape (266), and retropubic tapes TVT and Advantage (2) and Obtryx (11). IUGA class complications were assessed as 22 altogether or 7.8%.
•Cat 1: 6  - 4 x transient pain, provoked  x 1, dyspareunia transient x 1
•Cat 2: 2 - erosion minor
•Cat 3: 1  -erosion trimmed in office (expected 3% = 9)
•Cat 4: 11 – voiding dysfunction, 4 tapes divided, 6 prolonged catheterisation, 1 urethrotomy (expected 3% = 9)
•Cat 5: 0
•Cat 6: 2 transient groin pain
 

Conclusion:

This series compares very favourably with published figures of expected complications. The audit reflects the mesh usage trend, learning curve and the reduction of complications over time with surgical experience and perhaps more judicious patient selection.

 

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