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The Impact from Surgical Experience on Short- and Long-Term Success Rates After Mid-Urethral Sling Surgery.

Bjørn Holdø¹, Rune Svenningsen^2,3,4

¹Department of Obstetrics and Gynecology, Nordland Hospital, Bodø, Norway. bjorn.holdo@yahoo.no.

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Summary

Surgeon experience and volume improve objective cure rates for tension-free vaginal tape (TVT) procedures for female stress urinary incontinence (SUI). However, this effect was not observed for subjective cure rates or for obturator tape (OT) procedures.

Keywords:

Effect of treatment Mid-urethral sling surgery Stress urinary incontinence in women Surgeons’ annual volume Surgeons’ experience

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Area of Science:

Urology
Gynecology
Surgical Outcomes Research

Background:

Surgeon experience and procedure volume are linked to complication risks in female stress urinary incontinence (SUI) surgery.
The impact of surgeon expertise on the effectiveness of mid-urethral sling (MUS) procedures remains less understood.

Purpose of the Study:

To evaluate the influence of surgeon experience and annual procedure volume on the effectiveness of mid-urethral sling (MUS) operations for SUI.
To analyze outcomes based on surgeon's career volume and annual surgical activity.

Main Methods:

Analysis of 34,280 mid-urethral sling (MUS) procedures from the Norwegian Female Incontinence Registry (1998-2019).
Surgeons categorized by career experience (20 procedures/year).
Primary outcomes: objective cure (no stress test leakage) and subjective cure (SUI index <3) at 6-12 months; secondary outcomes included 3-year subjective cure and patient satisfaction.

Main Results:

Higher objective cure rates were observed for tension-free vaginal tape (TVT) procedures performed by experienced and high-volume surgeons.
No significant association between surgeon experience/volume and subjective cure rates for TVT procedures.
No impact of surgeon experience or volume on objective or subjective cure rates for obturator tape (OT) procedures.

Conclusions:

Surgeon experience and annual volume have a small, positive effect on objective cure rates specifically for TVT procedures.
The effectiveness of obturator tape (OT) surgery for SUI does not appear to be influenced by surgeon experience or volume.
Findings suggest a nuanced relationship between surgical expertise and outcomes, varying by MUS technique.