Results of the British Association of Urological Surgeons Female stress urinary incontinence procedures outcomes audit 2014-2017

To analyse the results of the British Association of Urological Surgeons' stress urinary incontinence audit, and present the contemporary management of stress urinary incontinence by UK urologists.

The BAUS audit tool is an online resource, to which all UK urologists performing procedures for stress urinary incontinence (SUI) are invited to submit data. The data entries for procedures performed 2014-2016 were collated and analysed.

Over the three-year period analysed, 2,917 procedures were reported by 109 surgeons, with a median of 20 procedures reported per surgeon. A total of 2,366 procedures (81.1%) were recorded as a primary surgery, with 548 procedures (18.8%) performed for recurrent SUI. Within the time period analysed, changes were noted in the frequency of all procedures performed with a trend towards a reduction in the use of synthetic mid-urethral tapes (MUT), and a commensurate increase in the use of urethral bulking agents and autologous fascial slings. 107 (3.9%) perioperative complications were recorded, with no association identified with patient age, BMI or surgeon volume. Follow up data was available on 1832 patients (62.8%) at a median of 100 days post-operatively. Reduced pad use was reported in 1311 (84.5%) of patients with follow-up data available and 86.3% reported a pad use of one or less per day. 375 (85%) reported being satisfied or very satisfied with the outcome of their procedure at follow up, although data entry for this domain was poor. 15.2% (263/1727) of patients reported de novo overactive bladder (OAB) symptoms which was the most commonly reported post-operative complication. For those reporting pre-existing OAB prior to their SUI surgery, 28.7% (307/1,069) of patients reported they got better after their procedure, whilst 61.9% (662/1,069) of patients reported no change and 9.4% (100/1,069) patients got worse.

This review has identified that despite urological surgeons undertaking a relatively low volume of procedures per year, SUI surgery by UK urologists is associated with excellent short term surgeon and patient reported outcomes and low numbers of low grade complications. Complications do not appear to be associated with surgeon volume, nor do they appear higher in those undergoing mesh surgery. Shortfalls in data collection have been identified, and a longer follow up period is required to adequately comment on long term complications such as chronic pain and tape extrusion / erosion rates. This article is protected by copyright. All rights reserved.

BJU international. 2018 Sep 17 [Epub ahead of print]

S Cashman, S Biers, T Greenwell, C Harding, R Morley, S Fowler, N Thiruchelvam, BAUS Section of Female Neurological and Urodynamic Urology

Luton and Dunstable Hospital NHS Foundation Trust., Cambridge University Hospitals NHS Trust., University College London Hospitals., Newcastle upon Tyne Hospitals NHS Foundation Trust., Imperial College NHS Trust., British Association of Urological Surgeons.

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