Characteristics of Providers Performing Urogynecologic Procedures on Medicare Patients 2012-2014.

OBJECTIVE: To analyze the characteristics of providers performing stress urinary incontinence (SUI) and pelvic organ prolapse (POP) procedures in the United States. METHODS: The Centers for Medicare Services public database, released for years 2012 through 2014, was queried for SUI-related and POP-related Healthcare Common Procedure Coding System. Providers were categorized as Female Pelvic Medicine and Reconstructive Surgery (FPMRS) providers and non-FPMRS providers, using a list of FPMRS board-certified providers compiled through the American Board of Medical Subspecialties website. Other physician specialties that submitted SUI and POP procedures claims were tabulated. RESULTS: Six hundred twenty-nine FPMRS and 833 non-FPMRS providers submitted claims for SUI and POP procedures. The SUI procedures claims had the following provider specialty distribution: obstetrics and gynecology (OB/GYN)-FPMRS, 46.7%; urology, 26.3%; OB/GYN, 12.2%; and urology-FPMRS, 13.9%, with the remaining 0.9% being performed by other specialties. The POP procedures had the following specialty distribution: OB/GYN-FPMRS, 63.4%; OB/GYN, 16.7%; urology, 8.3%; and urology-FPMRS, 7.1%, with the remaining 4.5% being performed by other specialties.Provider distribution was compared between transvaginal mesh and sling insertion procedures to transvaginal mesh and sling removal procedures. The FPMRS providers claimed 63.6% of sling and transvaginal mesh insertion procedures and performed 84.9% of mesh and sling removal procedures. CONCLUSIONS: Medicare reimbursement data provides a unique insight into the distribution of provider specialties performing SUI-related and POP-related procedures in the Medicare population. The OB/GYN-FPMRS providers submitted the majority of claims for SUI and POP procedures from 2012 to 2014. The FPMRS providers are also performing the majority of mesh removal procedures.

Retropubic Midurethral Sling Colonization With Staphylococcus lugdunensis.

BACKGROUND: We present a case of Staphylococcus lugdunensis colonization of a midurethral sling. Staphylococcus lugdunensis is a common skin colonizer and has been isolated in cases of implanted prosthetic devices. CASE: A 52-year-old female presented with suprapubic pain and recurrent urinary tract infections with S. lugdunensis starting 3 months after a retropubic sling procedure. After several months of continued pain and a suspicion of a mesh-related infection, the sling was removed. Culture of the sling material grew oxacillin-susceptible S. lugdunensis. Her symptoms resolved after sling removal and a postoperative course of antibiotics. CONCLUSIONS: To our knowledge, this is the first reported case of S. lugdunensis colonization of vaginal mesh. Surgeons should be aware and knowledgeable about the possible complications arising from insertion of midurethral slings.