LAUSR

s Presented at the Annual Research meeting of the British Society of Urogynaecology (BSUG), London. October 2019 1. Pain outcomes after mesh excision surgery Nazish Abbas, Fiona Reid, Martino Zacche, Maya Basu, David Iles, Rohna Kearney, Karen Ward Warrell Unit, St Mary's Hospital, Manchester Foundation Trust, Manchester, UK Introduction Since the “mesh pause” many women have been referred to our unit to seek help with mesh complications. Previous studies suggest pain improves in 50% of women after mesh excision (1) and some worsen (2). It is unclear who will benefit from mesh excision. The aim of this study is to evaluate our unit’s experience of pain outcomes after mesh excision. Methods Retrospective study of electronic records of women who attended Mesh Clinic between February 2017-July 2019. Demographics, type of mesh, details of surgery and pain outcomes were recorded. Categorical data were analysed with Chisquare test. Results 72 women underwent mesh excision. The mean age was 52.3 years (SD 13.4), BMI 30.6 (SD 6.8) and 88.9% were post-menopausal. Table 1 represents the distribution of type of mesh." 51 women reported pain prior to surgery; outcome data were available for 35 women. Pain improved in 40%, 60% had ongoing or worsening pain. Women who undergo complete excision were more likely to have resolution or improvement in pain than those who had partial removal (p= 0.011). After complete removal, 59.1% had improvement of pain, 23% undergoing partial removal had improvement. There was no difference between type of mesh and pain outcomes. Conclusions Women undergoing complete mesh excision may experience improvement in pain. Many felt pain improved initially but this recurred at 6 months postoperatively. Our study was limited due to its retrospective nature, small sample size and did not use a validated pain score. Further studies should be prospective with a validated questionnaire to assess pain preand post-operatively. Confounding factors such as neuropathic analgesia and initial placebo effect should be considered. References 1. Crosby EC, Abernethy M, Berger MB, DeLancey JO, Fenner DE, Morgan DM. Symptom resolution after operative management of complications from transvaginal mesh. Obstet Gynecol 2014 Jan; 123(1):134–9. 2. Danford JM, Osborn DJ, Reynolds WS, Biller DH, Dmochowski RR. Postoperative pain outcomes after transvaginal mesh revision. Int Urogynecol J. 2015 Jan; 26(1):65–9. 2. Multivariable analysis of continence surgery from the BSUG database Fiona Reid, Philip Toozs Hobson Birmingham Women's Hospital, Birmingham, UK. Introduction There is currently uncertainly surrounding surgery for stress urinary incontinence (SUI). Operations for SUI on the BSUG database were analysed to compare patient characteristics and outcomes. The hypothesis was that all surgeries would be effective for SUI with bulking agents having the lowest rates of success and complications. Methods Analysis included retropubic tapes (18726), bulking agents (3574), autologous slings (355) and colposuspensions (1054) recorded from the start of the database until Dec 2018. Patients who had concomitant surgery were excluded to avoid confusing outcomes. Very low volume centres were excluded from the analysis and multiple imputations were used to correct for missing data. Multivariable analysis was performed for global impression of improvement, change in stress incontinence, change in OAB symptoms, bladder damage and return to theatre/hospital. Analysis corrected for BMI, age, pre-operative urodynamic diagnosis, primary/repeat surgery, grade of operator and intraoperative bladder injury. No power calculation as all available data used. Results The results for tapes, bulking, autologous sling and colposuspension respectively are as follows: Age mean (SD): 51.98(11.54), 56.35(15.52), 50.77(10.96) and 50.05(10.73). BMI: no difference between groups. Global impression of improvement (better): 90.5%, 56.2%, 89.3% and 86.9%. Stress incontinence cured/improved: 94.4%, 72.3%, 97% and 95.2%. OAB symptoms cured/improved: 62%, 36.5%, 36.5% and 45.5%. OAB symptoms worsened: 10.3%, 7.4%, 21.2% and 16.9%. New OAB symptoms: 9.8%, 3.1%, 8.9% and 12.4%. Table 1 Distribution of type of mesh Type of mesh Frequency Percentage (%) Retropubic tape 34 47.2 Obturator tape 17 23.6 Single incision sling 5 6.9 Abdominal prolapse mesh 8 11.1 Vaginal prolapse mesh 5 6.9 >1 mesh 3 4.2 https://doi.org/10.1007/s00192-020-04351-z International Urogynecology Journal (2020) 31:1719–1723