Midurethral sling dominates female SUI treatment

Analysis of US data reveals that the midurethral sling for female stress urinary incontinence (SUI) has been widely adopted over the past decade, and this is the primary reason for a decline in the use of traditional surgical techniques for the condition.

Jaspreet Sandhu (Memorial Sloan-Kettering Cancer Center, New York, USA) and colleagues used data from the 6-month case logs of 6355 urologic physicians applying for certification or recertification with the American Board of Urology.

Between 2003 and 2012, the number of female incontinence procedures performed by these physicians nearly doubled from 4632 to 8574, and the percentage of these that were sling procedures also increased from 69% to 83%.

The median annual number of sling procedures per urologist was 10 but those in the top 20% of sling users performed 24 or more per year. These urologists were more likely to be female themselves and performed a median of 44 incontinence procedures per year compared with eight among those performing fewer sling procedures per year. Additionally, 20% of these urologists classed themselves as specialists in female urology compared with only 5% of urologists with a lower sling volume.

The team notes that the number of periurethral injections each year stayed fairly stable between 2003 and 2012, suggesting that the decline in traditional repair procedures from 784 (17% of the total) to 56 (<1%) was primarily due to the uptake of the sling procedure.

The researchers report in Urology that urologists who were applying for their initial certification were significantly more likely to report sling use than those applying for recertification, which supports the hypothesis “that older recertifying surgeons are using traditional repairs and endoscopic injections more than younger initially certifying surgeons, who predominantly use midurethral slings.”

The authors say that the proliferation of surgical treatment for female SUI observed in their study “likely reflects the growth of the aging population, the proliferation of the midurethral sling, and greater awareness among patients and physicians of treatment options.”

They add: “The specialty of female pelvic medicine and reconstructive surgery has also led to an increased number of urologists who self-classify themselves as female pelvic medicine and reconstructive surgery surgeons and an increased number who have undertaken specialty training.”

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