^a Department of Obstetrics and Gynecology, University of California, Davis, Sacramento, California, USA, b Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, California, USA, c Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA

Received 17 July 2002; revised 24 October 2002; accepted 7 November 2002. ; Available online 1 April 2003.

Objective: To describe the prevalence, regional rates and demographic characteristics, morbidity, and mortality of stress urinary incontinence surgeries in the United States.

Methods: We used data from the 1998 National Hospital Discharge Survey and the 1998 National Census to calculate rates of surgeries for stress urinary incontinence by age, race, and region of the United States. From these data we estimated morbidity and mortality associated with incontinence surgery.

Results: In 1998, approximately 135,000 women had inpatient surgery for stress urinary incontinence in the United States. The mean age of these women was 54.0 (±13.3) years. The South had the highest rate of surgery (14.8 per 10,000 women), whereas the Northeast had the lowest (9.8 per 10,000). In the 79% of discharges for which race was stated, the surgery rate for whites (11.6 per 10,000) was almost five times greater than for blacks (2.6 per 10,000), whereas the perioperative complication rate for blacks was twice that for whites (20.6% compared with 9.7%). Almost 70% of incontinence surgeries were done in combination with other major gynecologic procedures. For all incontinence surgeries, approximately 18% had complications, and mortality was rare (0.01%).

Conclusion: Stress urinary incontinence surgery is common, especially among white women. Differences in regional and racial surgical rates may represent differences in physician practice, patient expectations, and access to or utilization of care.

Corresponding author. Address reprint requests to: L. Elaine Waetjen, MD, University of California, Davis, Department of Obstetrics and Gynecology, 4860 Y Street, Suite 2500, , Sacramento, CA 95817, , USA

*1 LLS is a Women's Reproductive Health Research Scholar supported by the National Institute of Child Health and Human Development, National Institutes of Health (K12 HD01262-02).