Female stress urinary incontinence surgery: ‘Resurgence of the Titans’

Abstract

Objective: To evaluate the trends in female stress urinary incontinence (SUI) surgery in a UK tertiary referral center during five years before the July 2018 tape suspension and to compare it with National Health Service (NHS) England data. Materials and methods: A retrospective study of female SUI procedures (bulking agents, mid-urethral sling [MUS], colposuspension, autologous fascial sling) in a single UK tertiary referral center between 2013 and 2018. The treatment choice was made through shared decision-making on the basis of national standardized information leaflets, patient’s own research, and discussion/clarification with the surgeon. Data on NHS England SUI surgery between 2012 and 2018 were extracted from a retrospective review of the hospital episode statistics. Results: Between 2013 and 2018, 448 procedures for SUI were performed at our center. In contrast to a significant 31% decline in the total number of SUI procedures in NHS England in that time period, no decline in the number of SUI procedures occurred in our center. However, the distribution of SUI procedures did change significantly. MUS procedures declined significantly (46% total and 45% relative), whereas bulking agents and colposuspensions showed a clear relative rise (+11% and +30%). The distribution of SUI procedures in NHS England also changed significantly with a decline in MUS procedures (39% total and 11% relative) and an increase in bulking agents (82% total and 9% relative). Conclusion: When all invasive treatment options are transparently presented to female patients with SUI, they prefer other surgical treatments as an alternative to MUS.