AUA 2019: Does A Risk Calculator Correctly Predict De Novo Postoperative Stress Urinary Incontinence After Surgery For Pelvic Organ Prolapse In A Racially/Ethnically Diverse Population?

Chicago, IL (UroToday.com) The treatment of patients with pelvic organ prolapse (POP) is a prominent issue and prior to performing surgery for POP is the decision regarding whether a concomitant anti-incontinence procedure is indicated. Results of the CARE trial demonstrated that >50% of women will develop de novo SUI after abdominal sacrocolpopexy without an anti-incontinence procedure.¹ However, anti-incontinence procedures, such a mid-urethral slings, put the patient at risk for complications such as voiding dysfunction, and it is difficult to predict which patients will benefit from them. To address this question, a risk calculator was developed for prediction of de novo SUI based on patients-specific factors.² Although a useful tool, the calculator was developed using data from a largely white population, and so the data may not be generalizable. The authors of this study sought to evaluate whether the risk calculator was applicable to a more racially and ethnically diverse patient population.

To accomplish this goal the authors evaluated women at their institution who underwent POP repair from January 2014 to January 2017, and who did not have SUI prior to surgery. They performed a chart review to identify demographic and clinical characteristics, as well as to assess the presence of SUI prior to surgery. The data were entered into the available risk calculator to assess the risk of developing de novo SUI after surgery. The chart review then assessed whether patients actually did develop de novo SUI to evaluate the accuracy of the risk calculator in their patient population.

The patient population proved to be quite diverse, with 48.2% Hispanic, 22.2% Black, 16.1% White and 13.6% other. There were 95 patients included in the analysis. The mean predicted percentage risk of de novo SUI after POP repair without a concomitant anti-incontinence procedure was 36.2% (95% CI 31.4-34.6) in women who developed SUI and 33.0% (95% CI 31.4-34.6) in women who did not develop SUI. This difference was not statistically significant. A total of 14 women (14.7%) developed de novo SUI after surgery and these women had a significantly higher BMI, smoking rate, and severity of prolapse (as measured by POPQ Aa point).

Overall, this study provides a new insight into a risk calculator used to predict de novo SUI after POP surgery. The published risk calculator did not correctly predict SUI after POP repair in a racially and ethnically diverse patient population. It is important when creating tools used to predict outcomes after surgery that they be based on a diverse patient population so that the data is generalizable. Although the number of patients included in this analysis is small, it highlights a weakness of data sets that are used to create predictive models. Future efforts in creating large datasets should be inclusive of more racially and ethnically diverse populations.

Presented By: Sophie Sohval, MD, Shirly Solouki, MD, and Nitya Abraham, MD, Montefiore Medical Center, Bronx, NY

Written by: Dena Moskowitz, MD; Assistant Professor of Clinical Urology, University of California Irvine; @demoskowitz at American Urological Association's 2019 Annual Meeting (AUA 2019), May 3 – 6, 2019 in Chicago, Illinois

References:
1. Brubaker L, Cundiff GW, Fine P, et al. Abdominal sacrocolpopexy with Burch colposuspension to reduce urinary stress incontinence. N Engl J Med. 2006;354(15):1557–1566.

2. Jelovsek JE, Chagin K, Brubaker L, et al. A Model for Predicting the Risk of De Novo Stress Urinary Incontinence in Women Undergoing Pelvic Organ Prolapse Surgery. Obstet Gynecol. 2014;123(2 0 1):279-287. doi:10.1097/AOG.0000000000000094

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