Learning curve for the single-incision suburethral sling procedure for female stress urinary incontinence

Abstract

Objective: To evaluate the learning curve for the single-incision sling (SIS) procedure in a single-surgeon case series.

Methods: Data were retrospectively analyzed from women with non-recurrent symptomatic stress urinary incontinence confirmed by urodynamics and treated at San Gerardo Hospital, Monza, Italy, between October 2008 and November 2015. All women underwent the SIS procedure using a MiniArc sling fitted by the same urogynecologic surgeon. Blood loss, operative time, and complications were recorded. At follow-up visits, objective cure was assessed with a stress test and subjective outcome was determined by International Consultation on Incontinence Questionnaire-Short Form and Patient Global Impression of Improvement scores. Postoperative overactive bladder syndrome and voiding symptoms were recorded.

Results: In total, 192 patients underwent the SIS procedure. Estimated blood loss, operative time, and complication rate were not influenced by the number of procedures performed. Among 191 patients who completed 12 months of follow-up, neither objective nor subjective outcomes at longest follow-up available were influenced by surgeon's experience. Conversely, de novo overactive bladder syndrome (P<0.001) and voiding symptoms (P=0.029) decreased with increasing experience.

Conclusion: SIS showed encouraging objective and subjective outcomes with a minimal complication rate even at the beginning of the learning curve. However, increasing experience reduced postoperative voiding symptoms and overactive bladder syndrome.

Keywords: Complications; Midurethral sling; Mini-sling; Single-incision sling; Stress urinary incontinence; Surgical learning curve; Urogynecology.