Are older women more likely to receive surgical treatment for stress urinary incontinence since the introduction of the mid‐urethral sling? An examination of Hospital Episode Statistics data

Abstract

Objective To examine the trends in surgical treatment of stress urinary incontinence (SUI) in older women since the introduction of the mid‐urethral sling. Design Analysis of data from Hospital Episode Statistics (HES) between 2000 and 2012. Setting and Population All surgical procedures for SUI in the National Health Service (NHS) in England. Methods Retrospective cohort analysis of Hospital Episode Statistics for England from 2000 to 2012. Main outcome measures Number of invasive, less invasive, and urethral bulking procedures performed in women in three age groups. Results There was a 90% fall in the number of invasive surgical treatments for SUI and a four‐fold increase in the number of mid‐urethral slings over this time. The total number of surgical procedures for SUI increased from 8458 to 13 219. However, the rise in the number of procedures in women aged over 75 was more modest—a three‐fold increase from a low start of 187—and these women now make up a smaller proportion of all women receiving a mid‐urethral sling (MUS). Conclusions Despite the development and wide availability of a less invasive, safe and effective operation for stress urinary incontinence in older women, they do not appear to have benefitted. The reasons for this require prospective investigation.

Demographic risk factors for mid-urethral sling failure. Do they really matter?

“…All these data resulted in the observation that despite the fact that mid-urethral slings are truly minimally invasive, elderly women do not seem to benefit, probably because of doubts connected with effectiveness of the procedure [ 20 ]. Meanwhile, in another cohort retrospective study where 488 patients over 70 years old were included, the authors showed that there are no differences in sling success rates between the elderly and a younger population [ 21 ].…”

Surgical interventions for women with stress urinary incontinence: systematic review and network meta-analysis of randomised controlled trials

“…In the surgical treatment of stress urinary incontinence, MUS has become the most common procedure worldwide. 15 16 …”

“… 17 A study using NHS England data has shown that the number of surgeries for stress urinary incontinence increased from 8458 in 2000-01 to a peak of 13 219 in 2008-09, before decreasing to 11 845 in 2012. 15 Similarly, a US study estimated a 27% increase in the rate of surgeries over a 10 year period (2000 to 2009), 18 associated with a rapid adoption of MUS and a corresponding decrease in invasive procedures such as open colposuspension. 15 18 The lifetime risk of surgery for stress incontinence or pelvic organ prolapse in the US has reportedly increased from 11% in 1995 19 20 21 to 20% in 2011.…”

“… 15 Similarly, a US study estimated a 27% increase in the rate of surgeries over a 10 year period (2000 to 2009), 18 associated with a rapid adoption of MUS and a corresponding decrease in invasive procedures such as open colposuspension. 15 18 The lifetime risk of surgery for stress incontinence or pelvic organ prolapse in the US has reportedly increased from 11% in 1995 19 20 21 to 20% in 2011. 21 22 …”

Complications following vaginal mesh procedures for stress urinary incontinence: an 8 year study of 92,246 women

“…Mesh insertion is the most common surgical procedure used to treat stress urinary incontinence (SUI) in women 1 , with 3.7 million meshes sold worldwide between 2005 and 2013 2 . However the safety of these procedures is the subject of international debate and scrutiny 3 with court actions against mesh manufacturers underway in various countries, including Australia, Belgium, Canada, England, Israel, Italy, the Netherlands, Scotland, USA, and Venezuela 4 .…”