[Surgical treatment of female urinary incontinence]. / Kirurgisk behandling af urininkontinens hos kvinder.

INTRODUCTION: During the last decade, minimal invasive procedures have been introduced for treatment of urinary incontinence (UI) in women leading to shorter hospitalisation and fewer complications. The aim of this study was to outline clinical practice and attitudes among Danish UI surgeons. MATERIAL AND METHODS: Surgeons performing UI procedures were identified and mailed a questionnaire in 2007 concerning 2006. Questions included specialisation, number of procedures, type of surgery, complications and attitude towards learning surgery and maintaining a sufficient level of routine. RESULTS: In total, 94 operating gynaecologists and urologists were identified, 63 responded (71%) of whom 49 (78%) performed UI surgery. UI surgeons were gynaecologists 43 (88%) of these 24 (49%) were urogynecologists (working more than 50% with urogynecology) and five (10%) urologists. Tension-free Vaginal Tape (TVT) was the preferred sling in 2006. A total of 20 (47%) UI surgeons used only TVT, seven (17%) only transobturator slings (TOS) and 15 (36%) both TVT and TOS. Only 11 (24%) performed > 25 TVT per year and 11 (27%) performed > 25 TOS per year. In all, UI surgeons had experience with ten different slings. This study did not allow for a quantitative assessment of complications. The attitude was that 10-25 operations are needed to learn the procedure, and that > 10 operations per year are needed to maintain a sufficient level of routine. CONCLUSION: Practice and attitudes among urinary incontinence surgeons vary considerably and there is a lack of consensus. Many UI surgeons perform few operations with different techniques.

A Danish national survey of women operated with mid-urethral slings in 2001.

OBJECTIVE: To perform a national survey on self-reported cure, satisfaction and complications four years after mid-urethral sling (MUS) for urinary stress incontinence in Danish women operated in 2001. DESIGN: A postal questionnaire survey. POPULATION: All Danish women who received an MUS operation in 2001 extracted from the Danish National Patient Register. METHODS: The women received a validated postal questionnaire in 2005. The questionnaire included questions about subjective cure, satisfaction, complications and a Danish version of International Consultation on Incontinence Questionnaire-Short Form. The study was carried out in cooperation with the Danish National Board of Health. RESULTS: A total of 335 (92%) women responded to the questionnaire, among whom 105 (32%) felt completely cured, 119 (36%) were much improved, 55 (17%) were improved and 48 (15%) unchanged or worse. Cure rate varied between departments from 0% to 67%. Low-volume departments (<10 operations/year) had a significantly (p = 0.05) lower cure rate compared to the department with a higher volume. Altogether, 238 (73%) women were very satisfied with their operation. Self-reported bladder emptying difficulties were reported by 103 (32%) and the need for clean intermittent catherization (CIC) at any stage was reported by 21 (7%). No woman was still performing CIC. Of the women, 126 (42%) had made contact with the healthcare system because of their operation after discharge from hospital. CONCLUSIONS: Long-term outcome of MUS operations in Denmark in terms of cure, satisfaction and complication rates seems comparable to international results; however, the decentralized organization with many low-volume departments seems inappropriate.

[Urinary incontinence surgery in Denmark 2001-2003]. / Urininkontinenskirurgi i Danmark 2001-2003.

INTRODUCTION: The centralisation of surgical activity is an important aspect of the ongoing planning of the Danish Healthcare System. Knowledge of the actual status is crucial in the process of decision. In this article incontinence surgery in Denmark, including the frequency of complications, during a three year period is outlined. MATERIAL AND METHODS: This was a retrospective study, where data were extracted from the Danish National Patient Register (LPR) from 2001 to 2003. Data were supported by discharge letters and chart operation descriptions for women readmitted within 30 days after primary operation or if the hospital stays were prolonged. RESULTS: In total 2678 incontinence operations were performed in the period by 51 different departments. Seven departments carried out 51% of all the procedures, while 33 departments carried out 14% of all the procedures. The frequency of postoperative complications was 33.9% after an abdominal procedure, 10.8% after a Tension free Vaginal Tape (TVT) like procedure and 2.3% after urethral injection therapy. For abdominal procedures, "high volume" departments (> 45 operations/3 years) had significantly fewer complications compared to "low volume" departments (<15 operations/3 years), while no difference was found in the TVT-like group. Registration of complications and reoperations was incomplete and incorrect, especially in the TVT-like group. Mortality within 30 days was 0. CONCLUSION: This study shows a decentralised organisation of surgical incontinence activity in Denmark. Many departments carried out very few operations. There is a need for better registration, especially of TVT slings, and there is a need to reliably monitor the quality of incontinence surgery in Denmark. Surgical incontinence activity should be more centralised.