Stress incontinence surgery in the UK (1). Pre-operative work up and intra-operative complications....
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Transcript of Stress incontinence surgery in the UK (1). Pre-operative work up and intra-operative complications....
![Page 1: Stress incontinence surgery in the UK (1). Pre-operative work up and intra-operative complications. Analysis of the BSUG database R.P. Assassa, J. Duckett,](https://reader035.fdocuments.net/reader035/viewer/2022062801/56649e7a5503460f94b7b35f/html5/thumbnails/1.jpg)
Stress incontinence surgery in the UK (1). Pre-operative work up and
intra-operative complications.Analysis of the BSUG database
R.P. Assassa, J. Duckett, P.A. Moran on behalf of the BSUG Audit committee
Thanks to all BSUG members who have entered this data
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BSUG Audit DatabaseBSUG Audit Database
• Available to all BSUG members freeAvailable to all BSUG members free
• Need to register to useNeed to register to use
• Data ProtectionData Protection– Need clinical governance and Caldicott Need clinical governance and Caldicott
Guardian approvalGuardian approval
• Secure Data serverSecure Data server
• Only UK Only UK
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BSUG Audit DatabaseBSUG Audit Database
• Questionaires Questionaires – ICIQ-LUTSqol – KingsICIQ-LUTSqol – Kings– ICIQ-UI Short Form ICIQ-UI Short Form – ICIQ – VSICIQ – VS– ICIQ - OABICIQ - OAB
• ConsentConsent• 142 centres registered142 centres registered• 68 have entered data68 have entered data
• Median episodes per centre 113 (1-1726)Median episodes per centre 113 (1-1726)• 44 (65%) DGH and have entered 68% of data44 (65%) DGH and have entered 68% of data
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BSUG Audit DatabaseBSUG Audit Database
• 36,683 operations Aug 201236,683 operations Aug 2012
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BSUG Audit Database end 2009BSUG Audit Database end 2009
• 6989 prolapse operations6989 prolapse operations
• 7988 incontinence operations7988 incontinence operations– 593 Botox injections593 Botox injections– 50 cystoscopies alone50 cystoscopies alone– 13 urethral diverticulum13 urethral diverticulum– 12 long term suprapubic catheter12 long term suprapubic catheter– 6 vaginal fistulas6 vaginal fistulas
• 7,314 SUI surgery7,314 SUI surgery
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• Age 53.9 (sd 12.1, range 16-99)
• BMI 29 (sd 5.6, range 10-60)
• Pelvic floor exercises 5746 (78.6%)
Incontinence surgery in the UKIncontinence surgery in the UK
70%
16%
8%6%
physiotherapistContinence adviserNurse SpecialistGP/Self examination
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• An entry concerning use of urodynamics was made for 6,805 cases
• performed in 6608 (97%) of these
Incontinence surgery in the UKIncontinence surgery in the UK
3%
78%
17%
2%
0%
Not doneUSIMixedNormalother
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• 1,777 (24%) also had prolapse surgery
• No deaths
• No neurological injuries
• No per-operative DVTs
• 90% primary 10% repeat operations
• All slings routes had reported bladder injuries
Incontinence surgery in the UKIncontinence surgery in the UK
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Incontinence surgery in the UKIncontinence surgery in the UK
67%
11%
12%
3%
3%
2%
2%
Retropubic Tape
TOT Outside in
TOT Inside out
Single incision
BNI
Colposuspension
Anterior repair andBladder neck buttress
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Incontinence Surgery Type Total(% of ops)
Repeat(%)
Local+/- Sedation
Visceral Injuriesn (%)
Bleedingn (%)
Anterior repair + Bladder Neck Buttress 125 (2) 41(33) 0
Bladder injury 2(1.6)
Artificial Urinary Sphincter 1 (0) 1 (100) 0
Laparoscopic Colposuspension/urethropexy 18 (0) 2 (11) 0
Colposuspension-Open 127(2) 26 (20) 0Bladder injury 2(1.6) >500ml blood loss 4(3.1)
Transfused in theatre 2(1.6)
Autologous Sling 14 (0) 12 (86) 0Bladder injury 2(14)
Cystoscopic BNI 143 (2) 61 (43) 25 (17.5)
Non-Cystoscopic BNI 82 (1) 46 (56) 38 (46)>500ml blood loss 1(1.2)Transfused in theatre 1 (1.2)
Retropubic MUS4900 (67) 337 (7) 731 (15)
Bladder injury 160(3.3)Bowel injury 1 Ureteric injury 1
Vascular injury 2>500ml blood loss 26 (0.5)Transfused in theatre 3 (0.1)
Single Incision tape 214 (3) 17 (8) 72 (33) Bladder injury 1 (0.5)
Stamey Procedure 4 (0) 0 (0) 1(25)
TOT outside in 805 (11) 79 (10) 52 (6) Bladder injury 5 (0.6) >500ml blood loss 5(0.5)
TOT Inside out881(12) 136 (15) 27 (3)
Bladder injury 7 (0.8) Vascular injury 2 (0.2)>500ml blood loss 5(0.6)Transfused in theatre 1 (0.1)
Total7314
757 (10.3)
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Secondary ProceduresSecondary Procedures
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Procedures Under localProcedures Under local
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Bladder InjuriesBladder Injuries
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>500 ml Blood loss (%)>500 ml Blood loss (%)
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Consultant Staff gradeSubspec
Trainee (SST)Speciality
Trainee (ST) FTSTA UnansweredAnterior repair (AR)
+BNB112 (89.6) 1 (0.8) 4 (3.2%) 4 (3.2) 0 4
Artificial Urinary
Sphincter0 0 1 (100) 0 0 0
Laparoscopic
colposuspension 16 (88.9) 0 0 2 (11) 0 0
Colposuspension-
Open95 (74.8) 0 26 (20.5) 3 (2.4) 0 3 (2.4)
Autologuse Sling 14 (100) 0 0 0 0 0
Cystoscopic BNI 111 (77.6) 1 (0.7) 8 (5.6) 15 (10.5) 0 8
Non-Cystoscopic
BNI62 (75.6) 0 4 (4.9) 14 (17.1) 0 2
Retropubic MUSBladder perforations (%)
3486 (71.1) 61 (1.7%)
97 (2)9 (9.3%)
346 (7.1)11 (3.2%)
822 (16.8)71 (8.6%)
22 (100%)
1476 (4.1%)
Single Incision tape191 (89.3) 2 (0.9) 3 (1.4) 11 (5.1) 0 7 (3.3)
Stamey Procedure 2(50) 0 0 2 (50) 0 0
TOT Outside In
636 (79) 13 (1.6) 45 (5.6) 82 (10.2) 4 (0.5) 25 (3)
TVT Inside out 642 (72.9) 14 (1.6) 32 (3.6) 153 (17.4) 0 40 (4.4)
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Operations by lead surgeon
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Bladder perforations by surgeon
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ConclusionsConclusions
• The BSUG data base is a useful audit tool for surgery
• Use is becoming widespread in UK
• Participating centres are likely to be those most interested ?best results
• Possible under reporting of complications
• We are now able to produce National outcomes for reference
• Extend internationally