title: Stress urinary incontinence surgery trends in academic female pelvic medicine and reconstructive surgery urology practice in the setting of the food and drug administration public health notifications.
abstract: To investigate the possible effects of the Food and Drug Administration (FDA) Public Health Notifications in 2008 and 2011 regarding surgical trends in transvaginal mesh (TVM) placement for stress urinary incontinence (SUI) and related mesh revision surgery in Female Pelvic Medicine & Reconstructive Surgery (FPMRS) practice in tertiary care academic medical centers in the United States.
  
  
  
  Surgical volume for procedures performed primarily by FPMRS surgeons at eight academic institutions across the US was collected using Current Procedural Terminology (CPT) codes for stress urinary incontinence repair and revision surgeries from 2007 to 2013. SAS statistical software was used to assess for trends in the data.
  
  
  
  There was a decrease in the use of synthetic mesh sling for the treatment of SUI at academic tertiary care centers over the past 7 years; however, this was not statistically significant. While the total number of surgical interventions for SUI remained stable, there was an increase in the utilization of autologous fascia pubovaginal slings (AFPVS). The number of mesh sling revision surgeries, including urethrolysis and removal or revision of slings, increased almost three-fold at these centers.
  
  
  
  These observed trends suggest a possible effect of the FDA Public Health Notifications regarding TVM on surgical practice for SUI in academic centers, even though they did not specifically warn against the use of synthetic mesh for this indication. Indications for surgery, complications, and outcomes were not evaluated during this retrospective study. However, such data may provide alternative insights into reasons for the observed trends. Neurourol. Urodynam. 36:1155-1160, 2017. © 2016 Wiley Periodicals, Inc.
authors.affiliation: Department of Urology, Medical University of South Carolina, Charleston, South Carolina.
authors.forename: Goran
authors.initials: G
authors.lastname: Rac
authors.affiliation: Department of Urology, Medical University of South Carolina, Charleston, South Carolina.
authors.forename: Austin
authors.initials: A
authors.lastname: Younger
authors.affiliation: Department of Urology, University of Michigan Health Science Center, Ann Arbor, Michigan.
authors.forename: James Q
authors.initials: JQ
authors.lastname: Clemens
authors.affiliation: Section of Urology and Renal Transplantation, Virginia Mason Medical Center, Seattle, Washington.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Kobashi
authors.affiliation: Department of Urology, New York University Langone Medical Center, New York, New York.
authors.forename: Aqsa
authors.initials: A
authors.lastname: Khan
authors.affiliation: Department of Urology, New York University Langone Medical Center, New York, New York.
authors.forename: Victor
authors.initials: V
authors.lastname: Nitti
authors.affiliation: Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: Ilana
authors.initials: I
authors.lastname: Jacobs
authors.affiliation: Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: Gary E
authors.initials: GE
authors.lastname: Lemack
authors.affiliation: Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: Elizabeth T
authors.initials: ET
authors.lastname: Brown
authors.affiliation: Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: Roger
authors.initials: R
authors.lastname: Dmochowski
authors.affiliation: Institute of Urology, Lahey Hospital and Medical Center, Burlington, Massachusetts.
authors.forename: Lara
authors.initials: L
authors.lastname: MacLachlan
authors.affiliation: Institute of Urology, Lahey Hospital and Medical Center, Burlington, Massachusetts.
authors.forename: Arthur
authors.initials: A
authors.lastname: Mourtzinos
authors.affiliation: Institute of Urology, Keck Medicine of University of Southern California, Los Angeles, California.
authors.forename: David
authors.initials: D
authors.lastname: Ginsberg
authors.affiliation: Urology of Kaiser Permanente Medical Center, San Diego, California.
authors.forename: Michelle
authors.initials: M
authors.lastname: Koski
authors.affiliation: Department of Urology, Medical University of South Carolina, Charleston, South Carolina.
authors.forename: Ross
authors.initials: R
authors.lastname: Rames
authors.affiliation: Department of Urology, Medical University of South Carolina, Charleston, South Carolina.
authors.forename: Eric S
authors.initials: ES
authors.lastname: Rovner
mesh_terms: D000046:Academic Medical Centers / Q000706:statistics & numerical data / Q000639:trends; D005205:Fascia / Q000637:transplantation; D005260:Female; D006176:Gynecology / Q000639:trends; D006801:Humans; D019919:Prosthesis Implantation / Q000639:trends*; D011634:Public Health; D019651:Plastic Surgery Procedures / Q000639:trends*; D012086:Reoperation / Q000639:trends; D012189:Retrospective Studies; D053825:Suburethral Slings / Q000639:trends*; D013526:Surgical Mesh / Q000639:trends; D014481:United States; D014486:United States Food and Drug Administration; D014550:Urinary Incontinence, Stress / Q000601:surgery*; D014572:Urology / Q000639:trends
keywords: Food and Drug Administration; academic medical center; mesh; revision surgery; sling; stress urinary incontinence