NEW YORK (Reuters Health) - The number of US women undergoing surgery for stress urinary incontinence jumped by nearly 45% from 1988 to 1998, according to a new report.

Despite the availability of more conservative treatment, the findings indicate that "surgery for stress incontinence in women is relatively common and that it is increasing in our country," study author Dr. L. Elaine Waetjen, from the University of California, Davis, told Reuters Health.

Approximately 135,000 women in the US underwent inpatient surgery for stress incontinence in 1998, up from 78,000 in 1988, Dr. Waetjen and her colleagues report in the April issue of Obstetrics and Gynecology. The average patient age was 54 years.

The findings are based on data from the 1998 National Hospital Discharge Survey and the 1998 National Census.

Surgeries were most common among women in the South, where there were 14.8 surgeries per 10,000 adult women, and least common in the Northeast, where there were 9.8 surgeries per 10,000 women.

And based on discharge reports, the surgery rate among white women was almost five times that of black women. But when they did undergo surgery, African-American women were about twice as likely to experience surgical complications, including infection, surgical injury and bleeding.

Overall, 18.3% of women experienced surgical complications. The mortality rate was 1 death for every 10,000 surgeries.

"I think it is important to understand how such differences may represent inequalities in utilization of and access to care," Dr. Waetjen said. "This could have important implications for healthcare policy, particularly as it relates to care of incontinent women."

Sixty-eight percent of surgeries were performed in combination with other major gynecologic procedures, such as hysterectomy.

Dr. Waetjen said she believes the implications of the findings, particularly the increasing rate of surgery for stress urinary incontinence, are both positive and negative.

"On the positive side, it may reflect increasing attention to the important medical condition of incontinence by both physicians and patients," she said. Conversely, the increase in surgery may reflect overuse of a treatment that, while effective in the short term, has little long-range data to back it up, she added.

Obstet Gynecol 2003;101:671-676.

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