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. 2012 Apr;119(4):845-51.
doi: 10.1097/AOG.0b013e31824b2e3e.

Trends in the surgical management of stress urinary incontinence

Michele Jonsson Funk  1 , Pamela J Levin, Jennifer M Wu
Affiliations

Trends in the surgical management of stress urinary incontinence

Michele Jonsson Funk et al. Obstet Gynecol. 2012 Apr.

Abstract

Objectives: To estimate the rates of stress urinary incontinence (SUI) surgery from 2000 to 2009 by type of procedure, year, age, and region of the country.

Methods: We used data between 2000 and 2009 from a database containing health care claims data from employer-based plans in the United States. We analyzed data for all women age 18-64 years, identifying all SUI procedures in this population. Rates per 100,000 person-years and 95% confidence intervals (CI) were calculated each year by procedure type, age, and region.

Results: The study population included 32.9 million women age 18-64 years observed for 74,007,937 person-years between 2000 and 2009. During that time, there were 182,110 SUI procedures for a rate of 246.1 per 100,000 person-years (95% CI 239.7-252.6). The most common SUI surgery was sling (198.3 per 100,000 person-years, 95% CI 192.8-203.9) followed by Burch (25.9 per 100,000 person-years, 95% CI 24.8-27.2). There was a dramatic increase in slings, with a corresponding decrease in Burch procedures from 2000 to 2009. Other SUI surgeries had lower rates. Although this trend was evident across all regions, the Northeast had the lowest rate of SUI surgery, whereas rates in the West, Midwest, and South were 1.44-times, 1.76-times, and 2.09-times higher, respectively.

Conclusion: In a dramatic shift over the past decade, slings have become the dominant procedure for SUI among women age 18-64 years. Although this trend was seen across the United States, considerable variability exists in the SUI surgery rates by region.

Level of evidence: III.

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Figures

Figure 1
Figure 1
Annual rates of different types of stress urinary incontinence (SUI) surgery for each year from 2000 to 2009. There was a significant increase in total SUI procedures over the calendar year (P<.001). There was also a significant increase for slings over calendar time (P<.001). For all remaining procedures, there was a significant decrease over calendar time: Burch (P<.001), collagen injection (P=.001), laparoscopic SUI procedures (P<.001), transvaginal hysterectomy with colpo-urethrocystopexy (P<.001), needle suspension (P<.001) and Kelly plication (P<.001).
Figure 2
Figure 2
Age-specific rates for all of stress urinary incontinence (SUI) surgeries from 2000 to 2009 stratified by two-year intervals. The increase in SUI surgery rate after adjusting for age is not statistically significant when 2002-2003 is compared to 2000-2001 (P=.09). For all subsequent two-year time intervals, there is a significant increase in the SUI surgery rate compared with 2000-2001 (2004-2005, P<.001; 2006-2007, P<.001; 2008-2009, P<.001).
Figure 3
Figure 3
Age-specific rates for of stress urinary incontinence (SUI) surgery for 2000-2009 stratified by region of the country. After adjusting for age, all regions have significantly higher rates of SUI surgery when compared to the Northeast (P<.001).
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