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International Urogynecology Journal

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01-04-2016 | Original Article

The “learning curve” for retropubic mid-urethral sling procedures: a retrospective cohort study

Authors: Paul Hilton, Karen Rose

Published in: International Urogynecology Journal | Issue 4/2016

Abstract

Introduction and hypothesis

Mid-urethral tape procedures brought a paradigm shift in surgery for stress incontinence; little research into the development and maintenance of surgical competence for the procedure exists. The hypothesis behind this study is that the “learning curve” for retropubic mid-urethral sling procedures, judged by the surrogate of bladder perforation, is longer than previously thought.

Methods

This was a retrospective single-centre database and case note review of retropubic mid-urethral tape procedures. Unadjusted rates of bladder perforation, operating time, postoperative voiding difficulty, tape extrusion, and patient reported outcome were calculated; progress was evaluated using the cumulative sum method. Outcomes were assessed for 1 consultant, 2 subspecialty trainees (fellows), 7 advanced training skills module (ATSM) trainees (senior residents) and 6 core specialty trainees (residents) in years 4–7 of training.

Results

A total of 1,568 women were identified as having mid-urethral tape procedures; 568 (36 %) had additional procedures concurrently; 259 (20 %) were secondary procedures. The overall perforation rate for individual surgeons varied between 0 and 31 % and averaged 10.3 % amongst the core and ATSM trainees (a mean of 11 procedures), 4.5 % amongst the subspecialty trainees (a mean of 66 procedures) and 1.3 % for the consultant (1,284 procedures). The number of perforations for individual surgeons peaked at between 10 and 30 procedures undertaken. The number of cases performed to reach a target level of ≤5 % perforations varied between 20 and 80.

Conclusions

Whilst seductively simple in concept, mid-urethral tape procedures are not without risk; their inherently “blind” nature makes them difficult to teach. The “learning curve” to independent practice may be longer than previously considered.

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Title: The “learning curve” for retropubic mid-urethral sling procedures: a retrospective cohort study
Authors: Paul Hilton
Karen Rose
Publication date: 01-04-2016
Publisher: Springer London
Published in: International Urogynecology Journal / Issue 4/2016
Print ISSN: 0937-3462
Electronic ISSN: 1433-3023
DOI: https://doi.org/10.1007/s00192-015-2853-z

Keynote webinar | Spotlight on medication adherence

Springer Medicine

The “learning curve” for retropubic mid-urethral sling procedures: a retrospective cohort study

Abstract

Introduction and hypothesis

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Introduction and hypothesis

Methods

Results

Conclusions

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