In Medicare patients (age 65+) having midurethral sling vs. urethral bulking, variations in mortality, retreatment rates, and comorbidities that may be risk factors for retreatment were investigated by researchers for a study.

The Center for Medicare and Medicaid Services provided the 5% restricted data set for the retrospective cohort study, which was conducted between 2010 and 2018. Beneficiaries who received sling or bulking without concurrent surgery in the age group of 65 between 2011 and 2014 were included. They were then monitored until reoperation or retreatment, termination of Medicare, death, or December 31, 2018. Repeat treatments were included for persistent stress incontinence or complications. Utilizing Cox proportional hazards models, associations between index therapy and the requirement for a subsequent procedure were assessed.

For 1,700 patients who had slings, the median follow-up period was 5.7 years, but for 875 patients who underwent bulking, it was 5.2 years. About 10.2% of sling patients and 23.2% of bulking patients had passed away in the previous 5 years. When age, race, and comorbidities were considered, bulking patients had 1.73 times higher risk of dying throughout the research period than sling patients. About 12 of the 16 medical comorbidities were significantly more likely to be assessed in bulking individuals. By the age of 5, stress urinary incontinence (SUI) had been treated again in 6.7% of sling patients vs. 24.6% of bulking patients. Aside from hypertension, none of the examined comorbidities were connected to a variation in the likelihood of undergoing a later surgical treatment. Minority race and ethnic group members were less prone to withdraw.

In contrast to those receiving slings, older persons receiving bulking were sicker and had shorter life expectancies, suggesting that these characteristics strongly influence patient selection. Comorbidities did not put patients at risk of requiring a second surgery or retreatment.

Reference: goldjournal.net/article/S0090-4295(22)00299-0/fulltext