An abstract authored by Löppenberg et al is an interesting analysis of information from a respected prospective database examining variations in the quality of care provided to patients undergoing sling placement by gynecologists and urologists. An article discussing the research appears in the May 2016 issue of Urology Times.
A significant limitation of this study is its inability to evaluate complications beyond 30 days postoperatively. Outcomes associated with sling placement, such as obstruction, delayed pelvic pain, mesh exposure/extrusion, recurrent UTIs, dyspareunia, and persistent incontinence can declare themselves in the extended recovery period and would not be captured in the National Surgical Quality Improvement Program database. Many of these complications are what trigger ultimate reoperation in this patient population.
That being said, considering the large cohort studied, there is very little indictment to be made about the quality of surgical care offered by gynecologists or urologists in terms of early complications of sling placement. Patients and referring physicians should feel comfortable that a knowledgeable urologist or gynecologist will have minimal complications in the first 30 days. This work confirms that sling insertion is safe, low risk, and carries minimal complications in the first 30 days, with essentially no difference between gynecologists and urologists during this early time period.
In a larger context, the American Board of Medical Specialties recognized female pelvic medicine and reconstructive surgery as a separate subspecialty in 2011, with accreditation of training programs by the American Council for Graduate Medical Education in 2012 and certification now being provided by both the American Board of Urology and the American Board of Obstetrics and Gynecology. This represents a standardization in training for pelvic floor specialists, with a foundational goal of ensuring these surgeons, whether from urology or gynecology backgrounds, have the same surgical skill sets and provide uniform quality care.
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It is the hope that such training now will eliminate disparities of any kind in outcomes of pelvic floor surgical interventions studied in the future.
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