Sling procedures for the treatment of stress urinary incontinence: Comparison of national practice patterns between urologists and gynecologists

Sling procedures have become the dominant method of surgical management of stress urinary incontinence and are frequently performed by both urologists and gynecologists. Few studies investigating trends in surgical management have focused on differences in provision of care between the specialties.

In this study, we sought to compare national practice patterns of sling procedures by provider type.

We analyzed the 2006-2013 American College of Surgeons National Surgical Quality Improvement Program database. CPT-4 codes were used to identify patients who underwent sling procedures, and any concomitant pelvic floor procedures. Patient and operative characteristics were compared between urologists and gynecologists using bivariate and multivariate analysis.

Our analytic cohort included 22,192 sling procedures, of which 5718 (25.8%) and 16474 (74.2%) were performed by urologists and gynecologists respectively. Urologists performed a greater percent of autologous fascial slings than gynecologists (1.16% vs. 0.06%, p=<0.001). Concomitant prolapse repair was performed on 8664 (44.1%) patients, including 954 (16.7%) patients of urologists and 7710 (46.8%) patients of gynecologists. On multivariable analysis, urology patients were less likely to undergo concomitant prolapse repair or hysterectomy. Urology patients were more likely to have hypertension and to be older, of higher ASA class, and current smokers.

Gynecologists perform the majority of sling procedures for stress urinary incontinence. While gynecologists perform more concomitant procedures, urologists tender to operate on older patients with more comorbidities. Urologists also perform a greater proportion of autologous fascial slings. These findings demonstrate that although gynecologists perform a greater number surgeries, urologists treat a unique patient population who require operative management for stress urinary incontinence.

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The Journal of urology. 2017 Jul 03 [Epub ahead of print]

Maxwell B James, Marissa C Theofanides, Wilson Sui, Ifeanyi Onyeji, Gina M Badalato, Doreen E Chung

Department of Urology, Columbia University Medical Center, New York, NY. Electronic address: ., Department of Urology, Columbia University Medical Center, New York, NY. Electronic address: ., Department of Urology, Columbia University Medical Center, New York, NY. Electronic address: ., Department of Urology, Columbia University Medical Center, New York, NY. Electronic address: ., Department of Urology, Columbia University Medical Center, New York, NY. Electronic address: ., Department of Urology, Columbia University Medical Center, New York, NY. Electronic address: .

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