More Cystotomies Seen When Sling Is Combined With Reconstructive Surgery


RANCHO MIRAGE, CALIF. — The risk of cystotomy while placing a tension-free transvaginal tape suburethral sling tripled when surgeons performed concomitant pelvic floor reconstructive surgery, according to a review of 106 sling procedures.

“I'm not sure why that was the case. It certainly has not been reported very prominently in other series” and may be related to the relative inexperience of the 14 community physicians who performed the procedures, compared with surgeons in earlier reports, Michael J. Bonidie, M.D., said during the annual meeting of the Society of Gynecologic Surgeons.

Cystotomy rates also tripled in patients whose surgeons had done fewer than 10 tension-free transvaginal tape (TVT) sling procedures, compared with physicians who had done more than 10.

Only 3 physicians performed more than 10 TVT sling procedures, and 11 physicians did fewer than 10 of the sling surgeries during the study's 3-year period, reported Dr. Bonidie and Neeka L. Sanders, M.D., both of the Western Pennsylvania Hospital, Pittsburgh.

Cystotomies occurred in 6 of 60 patients (10%) who underwent sling surgery alone and 13 of 46 patients (28%) who underwent sling and pelvic floor reconstruction surgery, said Dr. Bonidie, director of urogynecology at the hospital.

Cystotomy rates were markedly higher among the less-experienced physicians, whether placing a TVT sling alone or doing a sling plus pelvic floor reconstruction procedure.

The cystotomy rates in the current study are higher than those reported in earlier series of suburethral sling surgeries, most of which were done by a select group of specialists who were single operators in their case series, Dr. Bonidie noted during the meeting.

One series of 350 TVT sling surgeries, for example, reported a 5% cystotomy rate, significant bleeding in 1%, and postoperative voiding dysfunction in 5% of patients.

“We deemed that to be acceptable risks for this procedure,” he said.

Today, several different types of slings made by different companies are marketed to general gynecologists who may have little or no experience with suburethral sling placement.

This proliferation inspired the investigators to review results in a community hospital setting, where physicians tend to place slings less frequently than their counterparts in more specialized settings.

All slings in the current series were placed vaginally using similar techniques and one of two sling products.

Dr. Bonidie is a consultant for Bard Urological and Ethicon Endosurgery, the two companies that make the slings used in this series.

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