Attitudes towards stress urinary incontinence surgery in Ireland: navigating the pause on mid-urethral sling use.

Abstract

Background: Mid-urethral slings (MUS) for the surgical management of stress urinary incontinence (SUI) have been suspended in Ireland since July 2018, significantly impacting treatment options and clinical practice.

Aims: This study aimed to explore the attitudes of consultant obstetricians, gynaecologists, and urologists in Ireland toward SUI surgery following the MUS suspension, including their prior practices, current approaches, and views on MUS safety and potential reinstatement.

Methods: A descriptive, anonymized questionnaire was electronically distributed in early 2023 to consultant members of the Irish Society of Urology and the Continence Foundation of Ireland. Non-consultants, non-medical professionals, and respondents outside Ireland were excluded. Data were analyzed using SPSS v28.

Results: Before the 2018 suspension, 89.5% (17/19) of respondents performed SUI surgeries, with 76.5% (13/17) using MUS-retropubic and 53% (9/17) MUS-transobturator techniques. Post-suspension, 63.2% (12/19) continued performing SUI surgery, primarily urethral bulking (83.3%, 10/12). Regarding safety, 83.3% (15/18) believed MUS led to fewer instances of post-operative voiding dysfunction and 66.7% (12/18) reported fewer complications such as vault prolapse or rectocele. Notably, 44.4% (8/18) had been involved in litigation related to MUS. Despite this, 52.6% (10/19) expressed willingness to resume MUS if the suspension was lifted.

Conclusions: MUS was the preferred SUI procedure prior to suspension due to perceived safety and effectiveness. Over half of consultants surveyed would consider resuming its use, highlighting a need for diverse, evidence-based treatment options and calling for a re-evaluation of the current suspension.