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

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

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

BSUG Audit DatabaseBSUG Audit Database

• 36,683 operations Aug 201236,683 operations Aug 2012

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

• 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

• 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

• 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

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

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)

Secondary ProceduresSecondary Procedures

Procedures Under localProcedures Under local

Bladder InjuriesBladder Injuries

>500 ml Blood loss (%)>500 ml Blood loss (%)

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)

Operations by lead surgeon

Bladder perforations by surgeon

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