The distribution of different surgical types for female stress urinary incontinence among patients’ age, surgeons’ specialties and hospital accreditations in Taiwan: a descriptive 10-year nationwide study

Abstract

This study aims to identify the changing trends of different surgical types for female stress urinary incontinence (SUI) and the distribution amongst various providers' characteristics. A total of 17,532 women who had undergone surgery for SUI during 1996-2005 were identified from the National Health Insurance Research Database for analysis. Retropubic urethropexy (RPU) was the most common surgical type (43%), followed by tension-free mid-urethral sling (MUS; 24%), and traditional pubovaginal sling (15%). MUS had an annual growth rate of 20.5%, whilst traditional pubovaginal sling was reduced by 11.3% annually after 2002. RPU was the most common procedure by both gynecologists and urologists. Gynecologists performed more Kelly plications, whereas urologists performed more traditional pubovaginal sling. MUS was more commonly performed in medical centers than in regional and local hospitals. There has been a notable growth and changing trend in various surgical types for female SUI in Taiwan.

Changing trends of surgical approaches for uterine prolapse: an 11-year population-based nationwide descriptive study

“…Therefore, patients choose a procedure based upon their personal goals for surgery, their general medical condition, and their concern for prolapse recurrence. This and our previous study also observed that patient age is one of the correlative factors which should be taken into account when selecting an appropriate surgical type [12].…”

“…Younger women (<50 years old) were more likely to have received uterine suspension in our study. This finding may be attributable to higher expectations of the quality of life among younger women [12]. Preservation of the uterus was recently shown to positively contribute to a patient's self-esteem, body image, confidence, and sexuality [5,8,17].…”

“…The different levels of hospital accreditation may mean that their doctors have different specialized surgical training including apprenticeship-style training, curriculum-and case-based programs, or independent and integrated specialty training programs [25]. Therefore, in addition to patient conditions, the choice of surgical procedures is dependent to some extent on the hospitals where the surgery is performed [12,26]. As for hospital ownership, more uterine suspensions were performed in private hospitals, followed by not-for-profit and government-owned hospitals; this may have been due to the more conservative, traditional character of government-owned hospitals.…”

“…The NHI program in Taiwan Detailed information on NHI was given in our previous work [12]. Briefly, the NHI program in Taiwan [12].…”

“…With our previous experience of analyzing changing trends for anti-incontinence surgery [12], we conducted this 11-year population-based nationwide study to describe changing trends of surgeries for uterine prolapse based on the National Health Insurance (NHI) claims data in Taiwan. Also, we evaluated some related variables, including patient age, concomitant anti-incontinence surgery, surgeon age and gender, and hospital parameters of accreditation (medical center, regional hospital, and local hospital), and ownership (government-owned, not-for-profit, and private) where the surgeries were performed.…”