title: Trends in reoperation for female stress urinary incontinence: A nationwide study.
abstract: OBJECTIVE
  Using the National Health Insurance (NHI) database in Taiwan, the study aimed to evaluate the rates and associated factors for reoperation of female stress incontinence.
  
  
  METHODS
  Records of female patients who had received a primary surgical treatment for stress incontinence from January 2000 to December 2006 were retrieved. Among these, patients who had reoperations during follow-up till December 2010 were identified. The data were analyzed for reoperation rates, surgery methods, patient demography, surgeon, and hospital attributes.
  
  
  RESULTS
  Among 14,613 patients with a mean follow-up of 86.28 ± 26.76 months, 563 (3.85%) had reoperations, an incidence rate of 54.37 per 10,000 person year (PY). Injection procedures had the highest reoperation rate of 893.30/10,000 PY. The adjusted hazard ratio (HR) of reoperation was higher for mid-urethral sling when compared to pubovaginal sling (HR 1.54, 95% CI 1.16-2.05) or retropubic urethropexy including Burch operation (HR 1.30, 95% CI 1.04-1.61). Surgeons with high service volumes tended to have fewer reoperations. No correlations were noted between the reoperation rate with patient age, surgeon age/gender, year of operation and hospital status. However, urologists had higher reoperation rates than gynecologists. For repeat surgery, the majority of patients chose the same specialty but different surgical types. Mid-urethral sling was used most commonly in 48.85% of reoperations.
  
  
  CONCLUSIONS
  Substantial number of patients need reoperation for stress incontinence. The choice of primary surgery type and surgeon specialty may affect the reoperation rates. Mid-urethral sling is the most common reoperation choice.
authors: Division of Urogynecology and Pelvic Floor Reconstruction, Department of Obstetrics and Gynecology, Chi Mei Foundation Hospital, Tainan, Taiwan.|Center of General Education, Chia Nan University of Pharmacy and Science, Tainan, Taiwan.
authors: Ming-Ping
authors: MP
authors: Wu
authors: Department of Obstetrics and Gynecology, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung, Taiwan.
authors: Cheng-Yu
authors: CY
authors: Long
authors: Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University College of Medicine, Taoyuan, Taiwan.
authors: Ching-Chung
authors: CC
authors: Liang
authors: Department of Hospital and Health Care Administration, Chia Nan University of Pharmacy and Science, Tainan, Taiwan.|Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan.
authors: Shih-Feng
authors: SF
authors: Weng
authors: Department of Urology, Medical College and Hospital, National Cheng Kung University, Tainan, Taiwan.
authors: Yat-Ching
authors: YC
authors: Tong
mesh_terms: D000328:Adult; D000368:Aged; D016208:Databases, Factual; D005260:Female; D006801:Humans; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000639:trends*; D012086:Reoperation; D012307:Risk Factors; D012737:Sex Factors; D053825:Suburethral Slings / Q000639:trends; D013624:Taiwan / Q000453:epidemiology; D013997:Time Factors; D016896:Treatment Outcome; D014550:Urinary Incontinence, Stress / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000009:adverse effects / Q000295:instrumentation / Q000639:trends*
keywords: mid-urethral sling; reoperation; surgery; urine incontinence