Surgical Practice Patterns for Female Stress Urinary Incontinence: Analysis of Case Logs from Certifying American Urologists
CUA Online Library. Elterman D. 06/24/13; 31281; MP-04.09
CLICK HERE TO LOGIN
REGULAR CONTENT
REGULAR CONTENT
Login now to access Regular content available to all registered users.
Abstract
Rate & Comment (0)
Abstract
Introduction and Objectives:
Surgical correction of female stress urinary incontinence has undergone a transformation over the past decade with the introduction of mid-urethral sling procedures. Other techniques include classic repairs – Burch or Marshall-Marchetti-Krantz (MMK) – and peri-urethral bulking agents. We investigated contemporary trends in the use of these treatments.
Methods:
Annualized case log data for female incontinence surgeries from certifying and recertifying urologists were obtained from the American Board of Urology (ABU). Descriptive analysis of number of cases and type of cases per year were performed. Associations between surgeon characteristics (type of certification, annual volume, practice type and practice location) and use of female incontinence procedures were evaluated.
Results
A total of 6,355 non-pediatric urologists applied for certification or recertification between 2003 and 2012. Two-thirds of these urologists (4,185) reported performing any procedures for the treatment of female incontinence. The number of procedures reported sharply increased from 4,632 procedures in 2003 to 7,548 procedures in 2004. The number of cases remained relatively more stable between 2005 and 2012 (range 8,014 – 10,238 cases). The proportion of classic procedures decreased from 17% of studied female incontinence procedures in 2003 to 5% in 2004 to <1% since 2010 (p < 0.0005). Conversely, mid-urethral sling (“sling”) procedures have risen sharply from 3,210 procedures in 2003 to 7,200 in 2012 (p < 0.0005). The proportion of endoscopic injection treatments has remained fairly stable between 2003 and 2012. Urethrolysis procedures made up a very small proportion of incontinence cases. Annual urethrolysis case counts ranged from 2 per year to 560 per year with a median of 12 (interquartile range (IQR) 6 – 24). Older urologists performed more of the classic procedures and were significantly more likely to perform these procedures exclusively when compared with younger urologists (OR: 1.9 per 10 years age, CI 1.4 – 2.5; p < 0.0005).
Conclusions
The mid-urethral sling has been widely adopted by urologists over the last ten years. Concurrent with this increase in sling usage was a drastic decline in the use of classic repairs, implying that the newer mid-urethral slings were replacing these classic procedures for the treatment of female incontinence. In addition, the fact that the use of peri-urethral injections did not change significantly during this time period indicates that increased sling usage is responsible for the majority of the decline in classic repairs.
Introduction and Objectives:
Surgical correction of female stress urinary incontinence has undergone a transformation over the past decade with the introduction of mid-urethral sling procedures. Other techniques include classic repairs – Burch or Marshall-Marchetti-Krantz (MMK) – and peri-urethral bulking agents. We investigated contemporary trends in the use of these treatments.
Methods:
Annualized case log data for female incontinence surgeries from certifying and recertifying urologists were obtained from the American Board of Urology (ABU). Descriptive analysis of number of cases and type of cases per year were performed. Associations between surgeon characteristics (type of certification, annual volume, practice type and practice location) and use of female incontinence procedures were evaluated.
Results
A total of 6,355 non-pediatric urologists applied for certification or recertification between 2003 and 2012. Two-thirds of these urologists (4,185) reported performing any procedures for the treatment of female incontinence. The number of procedures reported sharply increased from 4,632 procedures in 2003 to 7,548 procedures in 2004. The number of cases remained relatively more stable between 2005 and 2012 (range 8,014 – 10,238 cases). The proportion of classic procedures decreased from 17% of studied female incontinence procedures in 2003 to 5% in 2004 to <1% since 2010 (p < 0.0005). Conversely, mid-urethral sling (“sling”) procedures have risen sharply from 3,210 procedures in 2003 to 7,200 in 2012 (p < 0.0005). The proportion of endoscopic injection treatments has remained fairly stable between 2003 and 2012. Urethrolysis procedures made up a very small proportion of incontinence cases. Annual urethrolysis case counts ranged from 2 per year to 560 per year with a median of 12 (interquartile range (IQR) 6 – 24). Older urologists performed more of the classic procedures and were significantly more likely to perform these procedures exclusively when compared with younger urologists (OR: 1.9 per 10 years age, CI 1.4 – 2.5; p < 0.0005).
Conclusions
The mid-urethral sling has been widely adopted by urologists over the last ten years. Concurrent with this increase in sling usage was a drastic decline in the use of classic repairs, implying that the newer mid-urethral slings were replacing these classic procedures for the treatment of female incontinence. In addition, the fact that the use of peri-urethral injections did not change significantly during this time period indicates that increased sling usage is responsible for the majority of the decline in classic repairs.
Abstract
Introduction and Objectives:
Surgical correction of female stress urinary incontinence has undergone a transformation over the past decade with the introduction of mid-urethral sling procedures. Other techniques include classic repairs – Burch or Marshall-Marchetti-Krantz (MMK) – and peri-urethral bulking agents. We investigated contemporary trends in the use of these treatments.
Methods:
Annualized case log data for female incontinence surgeries from certifying and recertifying urologists were obtained from the American Board of Urology (ABU). Descriptive analysis of number of cases and type of cases per year were performed. Associations between surgeon characteristics (type of certification, annual volume, practice type and practice location) and use of female incontinence procedures were evaluated.
Results
A total of 6,355 non-pediatric urologists applied for certification or recertification between 2003 and 2012. Two-thirds of these urologists (4,185) reported performing any procedures for the treatment of female incontinence. The number of procedures reported sharply increased from 4,632 procedures in 2003 to 7,548 procedures in 2004. The number of cases remained relatively more stable between 2005 and 2012 (range 8,014 – 10,238 cases). The proportion of classic procedures decreased from 17% of studied female incontinence procedures in 2003 to 5% in 2004 to <1% since 2010 (p < 0.0005). Conversely, mid-urethral sling (“sling”) procedures have risen sharply from 3,210 procedures in 2003 to 7,200 in 2012 (p < 0.0005). The proportion of endoscopic injection treatments has remained fairly stable between 2003 and 2012. Urethrolysis procedures made up a very small proportion of incontinence cases. Annual urethrolysis case counts ranged from 2 per year to 560 per year with a median of 12 (interquartile range (IQR) 6 – 24). Older urologists performed more of the classic procedures and were significantly more likely to perform these procedures exclusively when compared with younger urologists (OR: 1.9 per 10 years age, CI 1.4 – 2.5; p < 0.0005).
Conclusions
The mid-urethral sling has been widely adopted by urologists over the last ten years. Concurrent with this increase in sling usage was a drastic decline in the use of classic repairs, implying that the newer mid-urethral slings were replacing these classic procedures for the treatment of female incontinence. In addition, the fact that the use of peri-urethral injections did not change significantly during this time period indicates that increased sling usage is responsible for the majority of the decline in classic repairs.
Introduction and Objectives:
Surgical correction of female stress urinary incontinence has undergone a transformation over the past decade with the introduction of mid-urethral sling procedures. Other techniques include classic repairs – Burch or Marshall-Marchetti-Krantz (MMK) – and peri-urethral bulking agents. We investigated contemporary trends in the use of these treatments.
Methods:
Annualized case log data for female incontinence surgeries from certifying and recertifying urologists were obtained from the American Board of Urology (ABU). Descriptive analysis of number of cases and type of cases per year were performed. Associations between surgeon characteristics (type of certification, annual volume, practice type and practice location) and use of female incontinence procedures were evaluated.
Results
A total of 6,355 non-pediatric urologists applied for certification or recertification between 2003 and 2012. Two-thirds of these urologists (4,185) reported performing any procedures for the treatment of female incontinence. The number of procedures reported sharply increased from 4,632 procedures in 2003 to 7,548 procedures in 2004. The number of cases remained relatively more stable between 2005 and 2012 (range 8,014 – 10,238 cases). The proportion of classic procedures decreased from 17% of studied female incontinence procedures in 2003 to 5% in 2004 to <1% since 2010 (p < 0.0005). Conversely, mid-urethral sling (“sling”) procedures have risen sharply from 3,210 procedures in 2003 to 7,200 in 2012 (p < 0.0005). The proportion of endoscopic injection treatments has remained fairly stable between 2003 and 2012. Urethrolysis procedures made up a very small proportion of incontinence cases. Annual urethrolysis case counts ranged from 2 per year to 560 per year with a median of 12 (interquartile range (IQR) 6 – 24). Older urologists performed more of the classic procedures and were significantly more likely to perform these procedures exclusively when compared with younger urologists (OR: 1.9 per 10 years age, CI 1.4 – 2.5; p < 0.0005).
Conclusions
The mid-urethral sling has been widely adopted by urologists over the last ten years. Concurrent with this increase in sling usage was a drastic decline in the use of classic repairs, implying that the newer mid-urethral slings were replacing these classic procedures for the treatment of female incontinence. In addition, the fact that the use of peri-urethral injections did not change significantly during this time period indicates that increased sling usage is responsible for the majority of the decline in classic repairs.
Code of conduct/disclaimer available in General Terms & Conditions
{{ help_message }}
{{filter}}