Browsing by Subject "Urinary Incontinence, Stress"
Now showing 1 - 5 of 5
- Results Per Page
- Sort Options
Item Cost Analysis of the Anterior Vaginal Wall Suspension Procedure to the Repair of Stress Urinary Incontinence with Early Grade Anterior Compartment Prolapse(2015-01-26) Rawlings, Tanner; Zimmern, Philippe E.INTRODUCTION: To evaluate the contemporary cost of the Anterior Vaginal Wall Suspension (AVWS) procedure to correct SUI with early grade compartment prolapsed. METHODS: The cost of AVWS for women undergoing AVWS alone (with no associated procedure) was analyzed from a prospective long-term database. Costing data was obtained from a tertiary care institution for operating room expenses, medical and surgical supplies, pharmacy, anesthesia supplies, and room and bed. Professional fees for the AVWS procedure were obtained from the Medicare Fee for Service Schedule. Costs for 2012 were adjusted by 3% to match 2013 costs. Due to non-normality in the data, the non-parametric Wilcoxon Rank Sum test was used to test for differences in cost by fiscal year or payer type. The Student t-test was used to ensure this population was a representative sample by testing for differences between the patients in this sample compared to the remainder of the patients that have undergone AVWS without concomitant surgery at our institution RESULTS: For 2012 - 2013, 34 of 48 women met inclusion criteria. One charity case was excluded, and others had concomitant procedures like hysterectomy. With the 3% inflation adjustment for 2012, the mean total cost was $3681 ± $764, with a median cost of $3664. Anesthesia, operating room, and room and bed costs differed significantly from 2012 to 2013. Only pharmacy cost differed between payer mix and Medicare. The sample analyzed had a shorter mean surgery time (69.6 min) compared to the overall AVWS population (86 min).). This cost data compares favorably to the average cost reported in contemporary U.S. literature for Tension free vaginal tape (TVT)( $8082 - 9579), transobturator tape (TOT) ($9017), and BC ($9320 - $105450) CONCLUSION: The AVWS mean total cost was $3681, with an increase in cost from 2012 to 2013 related to anesthesia, operating room, and room and bed costs, a figure much lower than most reported costs for comparable anti-incontinence procedures.Item Durability of Macroplastique In Women With Stress Urinary Incontinence Secondary to Intrinsic Sphincter Deficiency(2018-01-23) Carroll, Timothy F.; Zimmern, Philippe E.; Christie, Alana; Foreman, Melissa; Khatri, GauravINTRODUCTION/OBJECTIVES: Macroplastique (MPQ) is a urethral bulking agent used in the treatment of stress urinary incontinence (SUI) in women with intrinsic sphincter deficiency (ISD). MPQ has been emerging as a viable bulking agent in the United States since 2011 when Collagen (Contigen) became no longer available. Prior studies with Collagen suggest that a stable volume and circumferential configuration of bulking agent around the urethra result in improved clinical outcomes. However, little is known about the durability of the volume/configuration of MPQ over time. Three-dimensional ultrasound (3DUS) is an ideal modality to image the irregularly shaped and echogenic MPQ. Our goal is to evaluate the durability of MPQ in women with SUI secondary to ISD using serial 3DUS measurements. We hypothesize that MPQ will maintain its volume/configuration around the urethra over time. METHODS: Following IRB approval, charts of non-neurogenic women with SUI and ISD (low VLPP; lateral imaging of urethral support with no hypermobility) who underwent MPQ were reviewed from a prospectively maintained database. All had at least two 3DUS measurements after their last MPQ injection. Excluded were women with prior bulking agent injection, urethral hypermobility, or follow-up <6 months. 3DUS was performed using the Philips IU22 ultrasound system with endovaginal 3D 9-3V end-fire probe (Philips Healthcare, Bothell, WA) at 6-8 weeks post-injection and yearly thereafter. The same senior sonographer blinded to clinical outcomes evaluated volume and configuration circumferential/symmetric or asymmetric) at each 3DUS. RESULTS OBTAINED: Between 2011 and 2016, 38 of 146 women met study criteria. Those excluded were due to prior other bulking agent injection (21%) or insufficient 3DUS follow-up (79%). The average age and BMI were 64 and 28, respectively. 63% of patients had prior anti-incontinence surgery. The mean time from first to last 3DUS was 19 months (range: 6-42 months). The mean time between first and second ultrasound was 13 months. An average of 5.6cc were injected total in each patient (range 2.5-10cc). 76% of patients had 1 injection, while the remainder had 2 or more (24%). The change in volume from first 3DUS measurement to last 3DUS measurement decreased from a mean of 5.8cc to 5.5cc (mean change = -0.3 (95% Cl: -0.5, -0.04); p = 0.0262). 29 patients had symmetric MPQ at first 3DUS, out of whom only 4 (14%) had a follow-up 3DUS showing asymmetric MPQ distribution. CONCLUSIONS: At mid-term follow-up, MPQ maintains both its volume and configuration in the urethral wall.Item Late Presentation of Complications of Mid-Urethral Slings and Outcomes After Sub-Urethral Sling Removal(2024-01-30) Suzman, Evan; Shah, Anjana; Alhalabi, Feras; Christie, Alana; Zimmern, Philippe E.INTRODUCTION: Mid-urethral slings (MUS) are common procedures for surgical management of stress urinary incontinence (SUI) in women and have recognized complications, which are often underdiagnosed if they occur late and may result in complex care even after sub-urethral sling removal (SSR). This study focused on the evaluation of MUS complications occurring 10+ years after placement, and outcomes after sling release. METHODS: Demographics, past medical history, original MUS operative note, presenting symptoms, pre-SSR evaluation, peri-operative complications, post-SSR symptoms at last visit, were collected from EMR (EPIC) for patients who underwent SSR at least 10 years after MUS placement. For those not seen in the past 2 years, a standardized phone interview using validated questionnaires was performed by a neutral investigator not involved in the care of these patients. RESULTS: From 2006 to 2023, 58 patients met study criteria with mean age of 65 ± 10.5 years and predominantly Caucasian (91%). Nine were reached by phone and 4 were lost to follow-up. Time from initial MUS procedure to SSR removal was 16.7 ± 3.9 years. Most MUS were TVT (76%), followed by TOT (18%). At presentation, 90% of patients reported pain, 86% dyspareunia, 69% recurrent UTI, 52% SUI, and 53% urge urinary incontinence. Multiple presenting symptoms were observed in 83% of patients. At a mean follow-up of 2.2 years, SSR resulted in resolution of pain in 50% of patients, dyspareunia in 50%, recurrent UTI in 60%, SUI in 29%, and urge urinary incontinence in 37%, for each respective initial symptom. Some patients reported de novo pain (3%), UTIs (2%), SUI (9%) or urge urinary incontinence (7%). 7% required subsequent surgery for UI or persistent pain-related issues. CONCLUSIONS: It is important that pelvic reconstructive surgeons monitor patients who receive MUS over time and counsel patients considering MUS on these potential risks.Item [UT Southwestern Medical Center News](2010-06-02) Morales, KatherineItem [UT Southwestern Medical Center News](2009-03-17) Stafford, Erin Prather