944
VOIDING FUNCTION, BLADDER PHYSIOLOGY AND PHARMACOLOGY, AND FEMALE UROLOGY
the SSLF group and 16.5% of the ULS group. There were more ureteral obstructions after ULS (3.2% vs 0%). The rate of neurological pain requiring intervention was higher in the SSLF group (12.4% vs 6.9%). This finding persisted at the 4 to 6-week postoperative visit in more SSLF patients than ULS patients (4.3% vs 0.5%). The ureteral obstruction was recognized and managed intraoperatively in all but 1 case in the ULF group. This is a very well done and precisely reported study that is useful for preoperative discussions of likely and possible adverse events. As the authors suggest, these data “provide a metric against which other vaginal procedures, including those that use synthetic or biologic mesh, can be assessed.” Alan J. Wein, MD, PhD (hon)
Re: Outcomes of Vaginal Prolapse Surgery among Female Medicare Beneficiaries: The Role of Apical Support K. S. Eilber, M. Alperin, A. Khan, N. Wu, C. L. Pashos, J. Q. Clemens and J. T. Anger Division of Urology, Department of Surgery, Cedars-Sinai Medical Center and Department of Urology, University of California, Los Angeles, Los Angeles, Department of Reproductive Medicine, University of California, San Diego School of Medicine, San Diego and United BioSource Corp., San Francisco, California, and Department of Urology, University of Michigan, Ann Arbor, Michigan Obstet Gynecol 2013; 122: 981e987.
Abstract for this article http://dx.doi.org/10.1016/j.juro.2014.12.080 available at http://jurology.com/ Editorial Comment: This study, partially funded by the National Institute of Diabetes and Digestive and Kidney Diseases, looked at only long-term reoperation rates after prolapse surgery performed with and without apical support, specifically in patients who underwent surgery during 1999 and who were followed through 2009. A 5% random national sample of such patients was analyzed. The primary outcome was the rate of repeat treatment, specifically reoperation for prolapse. Insertion of a pessary was also included as evidence of a symptomatic prolapse recurrence. Although it is difficult at some points in the article to separate “recurrence” from “reoperation,” the main point is that the highest cumulative reoperation rate was observed in women who initially underwent an isolated anterior colporrhaphy (20.2%). The reoperation rate was significantly greater than that seen in women who underwent anterior colporrhaphy combined with a procedure for apical support (11.6%, p
VOIDING FUNCTION, BLADDER PHYSIOLOGY AND PHARMACOLOGY, AND FEMALE UROLOGY
the SSLF group and 16.5% of the ULS group. There were more ureteral obstructions after ULS (3.2% vs 0%). The rate of neurological pain requiring intervention was higher in the SSLF group (12.4% vs 6.9%). This finding persisted at the 4 to 6-week postoperative visit in more SSLF patients than ULS patients (4.3% vs 0.5%). The ureteral obstruction was recognized and managed intraoperatively in all but 1 case in the ULF group. This is a very well done and precisely reported study that is useful for preoperative discussions of likely and possible adverse events. As the authors suggest, these data “provide a metric against which other vaginal procedures, including those that use synthetic or biologic mesh, can be assessed.” Alan J. Wein, MD, PhD (hon)
Re: Outcomes of Vaginal Prolapse Surgery among Female Medicare Beneficiaries: The Role of Apical Support K. S. Eilber, M. Alperin, A. Khan, N. Wu, C. L. Pashos, J. Q. Clemens and J. T. Anger Division of Urology, Department of Surgery, Cedars-Sinai Medical Center and Department of Urology, University of California, Los Angeles, Los Angeles, Department of Reproductive Medicine, University of California, San Diego School of Medicine, San Diego and United BioSource Corp., San Francisco, California, and Department of Urology, University of Michigan, Ann Arbor, Michigan Obstet Gynecol 2013; 122: 981e987.
Abstract for this article http://dx.doi.org/10.1016/j.juro.2014.12.080 available at http://jurology.com/ Editorial Comment: This study, partially funded by the National Institute of Diabetes and Digestive and Kidney Diseases, looked at only long-term reoperation rates after prolapse surgery performed with and without apical support, specifically in patients who underwent surgery during 1999 and who were followed through 2009. A 5% random national sample of such patients was analyzed. The primary outcome was the rate of repeat treatment, specifically reoperation for prolapse. Insertion of a pessary was also included as evidence of a symptomatic prolapse recurrence. Although it is difficult at some points in the article to separate “recurrence” from “reoperation,” the main point is that the highest cumulative reoperation rate was observed in women who initially underwent an isolated anterior colporrhaphy (20.2%). The reoperation rate was significantly greater than that seen in women who underwent anterior colporrhaphy combined with a procedure for apical support (11.6%, p
