Stress urinary incontinence in the mesh complication era: current Australian trends.

To examine available data relating to the surgical management of stress urinary incontinence (SUI) in Australia before, during and after a well-publicised Senate Inquiry into transvaginal mesh use and consider outcomes in the context of global guideline changes.

The annual number of surgical procedures for the management of stress urinary incontinence (SUI) by procedure type and age group for the years 2008/09-2017/18 was obtained from the Australian Government Department of Human Services (DHS) database using Medicare Benefits Schedule (MBS) item numbers. The data extracted was limited to females, 25 years and older. These data were used to calculate age-specific and age-standardised rates, so as to accurately analyze trends in the usage of different procedures. Hospital Episode Statistics (HES) for mid-urethral sling (MUS) insertions were obtained for England's National Health Service (NHS) from the Health and Social Care Information Centre for the years 2008/09-2016/17. These data were also used to calculate annual age-standardised rates for comparative purposes.

Rates declined for most SUI procedures over time (Mid urethral slings (MUS), colposuspension, fascial slings) except for urethral bulking agents. The absolute number of MUS implanted in 2008/9 was 5729, which decreased to 3127 in the 2017/18 financial year. Over the decade the annual rate for MUS implantation per 100,000 population halved from 78 to 36. Over this same period, the rate of usage of bulking agents doubled, although represented a low volume of procedures (overall numbers increased from 304 to 698 representing an increase from 4 to 8 procedures per 100,000 population). The age-specific peak rate for MUS and Burch colposuspension changed over the decade from 55-64 years to 65-74 years suggesting that women are deferring surgical treatment until later in life. Over the last decade the total number of surgical procedures performed in Australia to treat SUI has decreased markedly from 6812 to 4279. This represents a decrease in the annual rate per 100,000 population from 93 to 49.

There are clear changes evident for SUI management in the past decade in Australia, including an overall decline in operative numbers, which correlate with international advisory notifications and local investigations. The results of the Australian Senate inquiry, including removal of single-incision mini-slings, greater availability of patient resources, and greater regulation of SUI procedures will likely have ongoing effects. Surgeons need to ensure sufficient training and patient education continue in order to maintain appropriate access for treatment of SUI in the future.

BJU international. 2020 Nov 23 [Epub ahead of print]

Rebecca Mathieson, Rebecca Kippen, Todd Manning, Janelle Brennan

Bendigo Health, Bendigo, Victoria, Australia., School of Rural Health, Monash University, Bendigo, Victoria, Australia.