1. Stress incontinence surgery in the UK (1). Pre-operative work up and intra-operative complications. Analysis of the BSUG database R.P. Assassa, J. Duckett, P.A. Moran on behalf of the BSUG Audit committee Thanks to all BSUG members who have entered this data

2. BSUG Audit Database Available to all BSUG members freeAvailable to all BSUG members free Need to register to useNeed to register to use Data ProtectionData Protection –Need clinical governance and Caldicott Guardian approval Secure Data serverSecure Data server Only UKOnly UK

3. BSUG Audit Database QuestionairesQuestionaires –ICIQ-LUTSqol – Kings –ICIQ-UI Short Form –ICIQ – VS –ICIQ - OAB ConsentConsent 142 centres registered142 centres registered 68 have entered data68 have entered data Median episodes per centre 113 (1-1726)Median episodes per centre 113 (1-1726) 44 (65%) DGH and have entered 68% of data44 (65%) DGH and have entered 68% of data

4. BSUG Audit Database 36,683 operations Aug 201236,683 operations Aug 2012

5. BSUG Audit Database end 2009 6989 prolapse operations6989 prolapse operations 7988 incontinence operations7988 incontinence operations –593 Botox injections –50 cystoscopies alone –13 urethral diverticulum –12 long term suprapubic catheter –6 vaginal fistulas 7,314 SUI surgery7,314 SUI surgery

6. Age 53.9 (sd 12.1, range 16-99) BMI 29 (sd 5.6, range 10-60) Pelvic floor exercises 5746 (78.6%) Incontinence surgery in the UK

7. An entry concerning use of urodynamics was made for 6,805 cases performed in 6608 (97%) of these Incontinence surgery in the UK

8. 1,777 (24%) also had prolapse surgery No deaths No neurological injuries No per-operative DVTs 90% primary 10% repeat operations All slings routes had reported bladder injuries Incontinence surgery in the UK

10. Incontinence Surgery Type Total (% of ops) Repeat (%) Local+/- Sedation Visceral Injuries n (%) Bleeding n (%) Anterior repair + Bladder Neck Buttress 125 (2)41(33) 0 Bladder injury 2(1.6) Artificial Urinary Sphincter 1 (0)1 (100) 0 Laparoscopic Colposuspension/urethropexy 18 (0)2 (11) 0 Colposuspension-Open 127(2)26 (20) 0 Bladder injury 2(1.6) >500ml blood loss 4(3.1) Transfused in theatre 2(1.6) Autologous Sling 14 (0)12 (86) 0 Bladder injury 2(14) Cystoscopic BNI 143 (2)61 (43) 25 (17.5) Non-Cystoscopic BNI 82 (1)46 (56) 38 (46) >500ml blood loss 1(1.2) Transfused in theatre 1 (1.2) Retropubic MUS 4900 (67)337 (7) 731 (15) Bladder injury 160(3.3) Bowel injury 1 Ureteric injury 1 Vascular injury 2 >500ml blood loss 26 (0.5) Transfused in theatre 3 (0.1) Single Incision tape 214 (3)17 (8) 72 (33) Bladder injury 1 (0.5) Stamey Procedure 4 (0)0 (0) 1(25) TOT outside in 805 (11)79 (10) 52 (6) Bladder injury 5 (0.6)>500ml blood loss 5(0.5) TOT Inside out 881(12)136 (15) 27 (3) Bladder injury 7 (0.8) Vascular injury 2 (0.2) >500ml blood loss 5(0.6) Transfused in theatre 1 (0.1) Total 7314 757 (10.3)

11. Secondary Procedures

12. Procedures Under local

13. Bladder Injuries

14. >500 ml Blood loss (%)

15. ConsultantStaff grade Subspec Trainee (SST) Speciality Trainee (ST)FTSTA Unanswered Anterior repair (AR)+BNB 112 (89.6)1 (0.8)4 (3.2%)4 (3.2)04 Artificial Urinary Sphincter 001 (100)000 Laparoscopic colposuspension 16 (88.9)002 (11)00 Colposuspension- Open 95 (74.8)026 (20.5)3 (2.4)0 Autologuse Sling 14 (100)00000 Cystoscopic BNI 111 (77.6)1 (0.7)8 (5.6)15 (10.5)08 Non-Cystoscopic BNI 62 (75.6)04 (4.9)14 (17.1)02 Retropubic MUS Bladder perforations (%) 3486 (71.1) 61 (1.7%) 97 (2) 9 (9.3%) 346 (7.1) 11 (3.2%) 822 (16.8) 71 (8.6%) 2 2 (100%) 147 6 (4.1%) Single Incision tape 191 (89.3)2 (0.9)3 (1.4)11 (5.1)07 (3.3) Stamey Procedure 2(50)00 00 TOT Outside In 636 (79)13 (1.6)45 (5.6)82 (10.2)4 (0.5)25 (3) TVT Inside out 642 (72.9)14 (1.6)32 (3.6)153 (17.4)040 (4.4)

16. Operations by lead surgeon

17. Bladder perforations by surgeon

18. Conclusions The BSUG data base is a useful audit tool for surgery Use is becoming widespread in UK Participating centres are likely to be those most interested ?best results Possible under reporting of complications We are now able to produce National outcomes for reference Extend internationally