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

Lookup NU author(s): Paul Hilton

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Abstract

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.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.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 a parts per thousand currency sign5 % perforations varied between 20 and 80.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.

Publication metadata

Author(s): Hilton P, Rose K

Publication type: Article

Publication status: Published

Journal: International Urogynecology Journal

Year: 2016

Volume: 27

Issue: 4

Pages: 565-570

Print publication date: 01/04/2016

Online publication date: 02/10/2015

Acceptance date: 15/09/2015

ISSN (print): 0937-3462

ISSN (electronic): 1433-3023

Publisher: Springer

URL: http://dx.doi.org/10.1007/s00192-015-2853-z

DOI: 10.1007/s00192-015-2853-z

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