Effects of Concomitant Surgeries During Midurethral Slings (MUS) on Postoperative Complications, Voiding Dysfunction, Continence Outcomes, and Urodynamic Variables

Sat, 02 Jun 2012 06:40:42 +0000

Publication year: 2012
Source:Urology, Volume 79, Issue 6
Toby C. Chai, Kimberly Kenton, Yan Xu, Larry Sirls, Halina Zyczynski, Tracey S. Wilson, David D. Rahn, Emily L. Whitcomb, Yvonne Hsu, Elizabeth A. Gormley
Objective To determine whether concomitant surgeries affected outcomes in a randomized trial comparing retropubic midurethral sling (MUS) vs transobturator MUS. Methods Subjects (n = 597) were stratified into 4 groups based on type of concomitant surgeries: group I had anterior/apical with or without posterior repairs (n = 79, 13%); group II had posterior repairs or perineorrhaphy only (n = 38, 6%); group III had nonprolapse procedures (n = 34, 6%); and group IV had no concomitant surgeries (n = 446, 75%). Complication rates, voiding dysfunction, objective and subjective surgical failure rates, and changes in urodynamic values (postop minus preop) were assessed and compared in these 4 groups. Results There were no differences in complications, voiding dysfunction, and subjective failure outcomes between these 4 groups. Group I had lower odds ratio of objective surgical failure compared with group IV (OR 0.38, 95% CI 0.18-0.81, P = .05). The OR of failure of all patients undergoing concomitant surgeries (groups I-III) was lower than group IV (OR 0.57, 95% CI 0.35-0.95, P = .03). The change in Pdet@Qmax (from pressure-flow) was significantly higher in group III vs IV ( P = .01). The change in Q max. (from uroflowmetry) was significantly less in groups I and II vs group IV ( P = .046 and .04, respectively). Conclusion Concomitant surgeries did not increase complications. Subjects who underwent certain concomitant surgeries had lower failure rates than those undergoing slings only. These data support safety and efficacy of performing concomitant surgery at the time of MUS.

Lower Urinary Tract Symptoms and Diet Quality: Findings From the 2000-2001 National Health and Nutrition Examination Survey

Sat, 02 Jun 2012 06:40:42 +0000

Publication year: 2012
Source:Urology, Volume 79, Issue 6
Bradley A. Erickson, Mary Vaughan-Sarrazin, Xin Liu, Benjamin N. Breyer, Karl J. Kreder, Peter Cram
Objective To evaluate the association between dietary quality and the prevalence of lower urinary tract symptoms (LUTS). Methods We used urinary symptom and dietary data obtained from the 2000-2001 National Health and Nutrition Examination Survey (NHANES) for the study. Dietary quality was assessed using the 10-component United States Department of Agriculture (USDA) Healthy Eating Index (HEI). We used bivariate methods to examine rates of LUTS among men with poor versus good diets. Multivariable logistic regression was used to calculate odds ratios after applying sample weights and controlling for age, race/ethnicity, smoking status, diabetes, alcohol intake, and exercise. Results Our study cohort consisted of 1385 men aged ≥40 years, of whom 279 (21.1%) reported LUTS. We found higher rates of LUTS among men with poor dietary intake of dairy (22.4% vs 16.4%, P = .013) and among men with poor intake of protein (24.6% vs 17.9%, P = .012) as well as among those with overall poor diet (25.8 vs 17.8%, P = .018) with little dietary variety (26.1 vs 17.6%, P = .001). On multivariate analysis, an unhealthy diet (odds ratios [OR] = 1.7; 95% confidence interval [CI] = 1.05-2.90) was associated with more LUTS, whereas alcohol intake was protective from LUTS (OR = 0.67; 95% CI = 0.48-0.93). Conclusion In an analysis of NHANES data, we found that poor diet quality was independently associated with patient-reported LUTS.