Population-based trends in ambulatory surgery for urinary incontinence.
OBJECTIVE
Surgical procedures for stress urinary incontinence (SUI) have become progressively less invasive and easier to perform with the development of new technologies such as the midurethral sling. For these reasons, it seems logical to conclude that midurethral slings would supplant other surgical treatments for incontinence. The purpose of this study was to assess the impact of this technology on trends in ambulatory surgery for incontinence over the past decade.


METHODS
We searched Current Procedure Terminology codes and the State Ambulatory Surgery Database from 2001 through 2009 to identify all ambulatory procedures for incontinence. Next, we calculated age-adjusted rates separately for each procedure. We then fit a multilevel model to characterize patient and regional factors associated with the preferential use of midurethral slings over alternative treatments.


RESULTS
Midurethral slings and submucosal injections comprised >90 % of all ambulatory procedures for SUI during the time period examined. Age-adjusted rates of midurethral slings increased dramatically, from 2.36 to 9.45/10,000 population (p < 0.001), whereas rates of submucosal injections remained relatively stable, from 1.75 to 1.41/10,000 population (p = 0.226). Not surprisingly, older ([odds ratio (OR) 0.61; 95 % confidence interval (CI) 0.56-0.66] and more infirm patients (OR 0.60; CI 0.44-0.83) were more likely to receive submucosal injection therapy than to receive midurethral slings.


CONCLUSIONS
Rates of midurethral slings have increased significantly by fourfold. Rates of submucosal injections, however, have remained fairly stable during this time period, suggesting that sling dissemination has led to an increase in rates of incontinence procedures as opposed to replacing old technologies in the ambulatory setting.
Department of Urology, University of Michigan, Building 520, 3rd floor, 3175A, 2800 Plymouth Road, Ann Arbor, MI 48109, USA. suskina@gmail.com
Anne M
AM
Suskind
Samuel R
SR
Kaufman
Rodney L
RL
Dunn
John T
JT
Stoffel
J Quentin
JQ
Clemens
Brent K
BK
Hollenbeck
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000556:Ambulatory Surgical Procedures / Q000706:statistics & numerical data / Q000639:trends*; D003430:Cross-Sectional Studies; D016208:Databases, Factual; D005260:Female; D006801:Humans; D008875:Middle Aged; D012189:Retrospective Studies; D053825:Suburethral Slings; D014550:Urinary Incontinence, Stress / Q000601:surgery*; D055815:Young Adult