Efficacy and Safety of Incontinence Surgery According to the Surgeon’s Specialty and Performance of a Preoperative Urodynamic Study
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Purpose: The aim of this study was to analyze the efficacy and to estimate the complication rate of incontinence surgery according to the surgeon’s specialty and whether a preoperative urodynamic study (UDS) was performed, using a nationally representative dataset. Methods: We enrolled 356,155 women over 20 years old who had undergone surgery for stress urinary incontinence between 2006 and 2015. Patients were followed for up to 3 years to analyze the reoperation and complication rates. Data were obtained from the National Health Claims Database of the National Health Insurance Service (NHIS) of Korea. Multiple Cox regression analysis was conducted to examine the efficacy and safety of incontinence surgery according to the surgeon’s specialty and whether a preoperative UDS was performed. Results: The hazard ratio (HR) for reoperation was significantly higher for procedures performed by nonurologists than for procedures performed by urologists (HR, 1.174; 95% confidence interval [CI], 1.103–1.249). Acute urinary retention, postoperative infections, procedure-associated pain, and other complications were also more common in procedures performed by nonurologists than in those performed by urologists. When stratified by whether a preoperative UDS was performed, the HR for reoperation according to the surgeon’s specialty varied by performance of a preoperative UDS. While the reoperation rate was significantly higher in procedures performed by non-urologists when a preoperative UDS was performed (HR, 1.208; 95% CI, 1.122–1.3), there was no significant difference in the HRs for reoperation according to specialty when a preoperative UDS was not performed. Conclusions: This population-based study showed that the postoperative outcomes of incontinence surgery were dependent upon the surgeon’s specialty and that the reoperation rate according to the surgeon’s specialty varied based on whether a preoperative UDS was performed.
Abstract
Purpose: The aim of this study was to analyze the efficacy and to estimate the complication rate of incontinence surgery according to the surgeon’s specialty and whether a preoperative urodynamic study (UDS) was performed, using a nationally representative dataset. Methods: We enrolled 356,155 women over 20 years old who had undergone surgery for stress urinary incontinence between 2006 and 2015. Patients were followed for up to 3 years to analyze the reoperation and complication rates. Data were obtained from the National Health Claims Database of the National Health Insurance Service (NHIS) of Korea. Multiple Cox regression analysis was conducted to examine the efficacy and safety of incontinence surgery according to the surgeon’s specialty and whether a preoperative UDS was performed. Results: The hazard ratio (HR) for reoperation was significantly higher for procedures performed by nonurologists than for procedures performed by urologists (HR, 1.174; 95% confidence interval [CI], 1.103–1.249). Acute urinary retention, postoperative infections, procedure-associated pain, and other complications were also more common in procedures performed by nonurologists than in those performed by urologists. When stratified by whether a preoperative UDS was performed, the HR for reoperation according to the surgeon’s specialty varied by performance of a preoperative UDS. While the reoperation rate was significantly higher in procedures performed by non-urologists when a preoperative UDS was performed (HR, 1.208; 95% CI, 1.122–1.3), there was no significant difference in the HRs for reoperation according to specialty when a preoperative UDS was not performed. Conclusions: This population-based study showed that the postoperative outcomes of incontinence surgery were dependent upon the surgeon’s specialty and that the reoperation rate according to the surgeon’s specialty varied based on whether a preoperative UDS was performed.
참고문헌 (25)
- Haylen BT, "An International Urogynecological Association (IUGA)", International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction, 2010, pp.29, 4~20
- Choi JB, "Urinary incontinence is associated with the development of peptic ulcers in adult women: Data from the KNHANES IV", Medicine (Baltimore), 96, pp.e8266~ (2017)
- Hu TW, "Costs of urinary incontinence and overactive bladder in the United States: a comparative study", Urology, 63, pp.461~465 (2004)
- Opara J, "The prevalence of stress urinary incontinence in women studying nursing and related quality of life", Prz Menopauzalny, 13, pp.32~35 (2014)
- Reynolds WS, "Epidemiology of stress urinary incontinence in women", Curr Urol Rep, 12, pp.370~376 (2011)
- Choi H, "Meta-analysis of pelvic floor muscle training: randomized controlled trials in incontinent women", Nurs Res, 56, pp.226~234 (2007)
- Ulger Z, "Weight loss for urinary incontinence in overweight and obese women", N Engl J Med, 360, pp.2256~2257 (2009)
- Malallah MA, "Pharmacological treatment of pure stress urinary incontinence: a narrative review", Int Urogynecol J, 26, pp.477~485 (2015)
- Wu JM, "Trends in inpatient urinary incontinence surgery in the USA, 1998-2007", Int Urogynecol J, 22, pp.1437~1443 (2011)
- 조성용, "Nationwide Database of Surgical Treatment Pattern for Patients With Stress Urinary Incontinence in Korea", International Neurourology Journal, 18(2), pp.91~94 (2014), 대한배뇨장애요실금학회
- 김진욱, "Predictors of Voiding Dysfunction after Mid-urethral Sling Surgery for Stress Urinary Incontinence", International Neurourology Journal, 16(1), pp.30~36 (2012), 대한배뇨장애요실금학회
- Choi JB, "Estimating the impact of body mass index on bladder cancer risk: Stratification by smoking status", Sci Rep, 8, pp.947~ (2018)
- James MB, "Sling procedures for the treatment of stress urinary incontinence:comparison of national practice patterns between urologists and gynecologists", J Urol, 198, pp.1386~1391 (2017)
- Wu MP, "The distribution of different surgical types for female stress urinary incontinence among patients’ age, surgeons’ specialties and hospital accreditations in Taiwan: a descriptive 10-year nationwide study", Int Urogynecol J Pelvic Floor Dysfunct, 19, pp.1639~1646 (2008)
- Anger JT, "Variations in stress incontinence and prolapse management by surgeon specialty", J Urol, 178(4 Pt 1), pp.1411~1417 (2007)
- Slopnick EA, "National surgical trends and perioperative outcomes of midurethral sling placement for stress urinary incontinence", Urology, 99, pp.57~61 (2017)
- Elliott CS, "Might pelvic surgeons be unaware of their surgical failures? Patient reporting and perceptions after failed incontinence or pelvic organ prolapse surgery", Female Pelvic Med Reconstr Surg, 21, pp.298~300 (2015)
- Spelzini F, "Learning curve for the single-incision suburethral sling procedure for female stress urinary incontinence", Int J Gynaecol Obstet, 139, pp.363~367 (2017)
- Hilton P, "Assessing professional equipoise and views about a future clinical trial of invasive urodynamics prior to surgery for stress urinary incontinence in women: a survey within a mixed methods feasibility study", Neurourol Urodyn, 31, pp.1223~1230 (2012)
- Nager CW, "A randomized trial of urodynamic testing before stress-incontinence surgery", N Engl J Med, 366, pp.1987~1997 (2012)
- van Leijsen SA, "Can preoperative urodynamic investigation be omitted in women with stress urinary incontinence? A non-inferiority randomized controlled trial", Neurourol Urodyn, 31, pp.1118~1123 (2012)
- Brian J. Linder, "Can Urodynamic Parameters Predict Sling Revision for Voiding Dysfunction in Women Undergoing Synthetic Midurethral Sling Placement?", Female Pelvic Medicine & Reconstructive Surgery, 25(1), pp.63~66 (2019), Ovid Technologies (Wolters Kluwer Health)[DOI]
- Sirls LT, "The effect of urodynamic testing on clinical diagnosis, treatment plan and outcomes in women undergoing stress urinary incontinence surgery", J Urol, 189, pp.204~209 (2013)
- Houwert RM, "Risk factors for failure of retropubic and transobturator midurethral slings", Am J Obstet Gynecol, 201-202, pp.1~8 (2009)
- Lee JK, "Persistence of urgency and urge urinary incontinence in women with mixed urinary symptoms after midurethral slings: a multivariate analysis", BJOG, 118, pp.798~805 (2011)