Changing Trends in the Surgical Management of Stress Urinary Incontinence in Australia.

Abstract

Background: In the late 2000s, mid-urethral slings (MUS) emerged globally as the preferred surgical treatment for stress urinary incontinence (SUI). Despite their high safety and efficacy, through the late 2000s and 2010s, MUS became embroiled in widely publicised controversy surrounding mesh products used for pelvic organ prolapse.

Aims: To review recent trends in the surgical management of SUI in Australia in the context of recent medicolegal and media attention on transvaginal mesh devices.

Materials and methods: Data were obtained from the Australian Government Department of Human Services database from January 2007 to December 2023. Total procedure numbers for females ≥ 25 years were retrieved for the following Medicare Benefits Schedule (MBS) item numbers: 35599 (MUS), 37044 (Burch colposuspension), 37043 (Stamey or similar), 37042 (autologous fascial sling) and 37339 (peri-/transurethral bulking agents).

Results: A total of 69 145 MUS, 5749 Burch, 711 Stamey, 3243 fascial sling and 10 798 bulking agent procedures were recorded during this period. Total procedures peaked at 6877 in 2010 and reached a low of 2627 in 2022, with a turning point in 2016. There was a 61.8% reduction in procedure numbers between these years. The decline in total SUI procedures directly reflects MUS numbers, which dropped by 80.4% between 2011 (5876 cases) and 2022 (1154 cases). This correlates with progressive restrictions and medicolegal events concerning transvaginal mesh during this time.

Conclusions: There is a significant downtrend in overall surgical SUI management, especially MUS, being performed in Australia in recent years. The impact on surgical training and patient access to treatment options must be addressed.