Prevalence of female stress urinary incontinence (SUI) is 50% in certain age groups. Multiple tools are reported for standardization of stress urinary incontinence (SUI) diagnosis. Uro-gynecological committees are continuously working to update the guidelines for management of SUI. We conducted this survey to understand the provider trends in diagnosis and management of SUI. We targeted urologists and gynecologists from multiple countries and asked them to share the survey with their colleagues.

We conducted online questionnaire using google forms. The study was approved by our university internal board review committee. We targeted the health providers who are accepting SUI patients. Fifteen questions were asked. Five questions were concerned about participant practice, training, and demographics. Five questions were asked to explore the approaches to diagnosis. Five questions explored the preferred/offered treatment options (table 1 and table 2). De-identification of the responder was performed. We analyzed the responses according to the trends, training/specialty, and providers’ demographics.

We received a total of 85 responses, we excluded 8 incomplete/repeated responses. We received 55% of responses from Egypt, 25% from the USA and the remaining responses from Germany, Saudi Arabia, Pakistan, Iran, Nigeria, Palestine, and Qatar. Total of 77 providers' responses were analyzed, responders were 77.9% urologists and 20.7% gynecologists. All responders accept SUI patients except five providers who refer their SUI patients to another urologist. Only 20.8% and 26% of providers requested voiding diary and validated questionnaires for each patient respectively. Interestingly, 35.1% didn’t consider dietary changes as a line of treatment. 27% of providers will request urodynamic testing for each SUI patient. Only 48.1% considered pelvic floor training and physical therapy as a line of treatment for each patient. TVT was the most utilized procedure between gynecologists (68.75%) while TOT is the most utilized procedure between urologists (65%) (Table 2). Interestingly, 83.7% of responders from Egypt favored TOT as the most common surgical option, while 89.5% of US responders chose TVT.

There is a recent focus on standardization of SUI patients during diagnosis and treatment. Recent guidelines and statements from the urological and urogynecological societies recommended voiding diary and validated questionnaires for every patient. However, urodynamic testing should be reserved for the patients with a probability of surgical intervention. Reports suggested that non-invasive manipulations as the modification of dietary behavior and physiotherapy might be helpful to SUI population. European Association of urology recent guidelines recommended the pelvic floor training and physical therapy as the first line therapy. We are the first to explore physician trends in the management of SUI related to their geographical distribution. The physician trends in practice were not matching the recent recommendations. This might be variable because of different training backgrounds and personal experiences. Approaches should be focused to market the knowledge updates and recent guidelines for the best care of SUI patients.

Provider trends of SUI management are variable. This might be related to their demographic distribution, training backgrounds or personal experiences. Proper marketing of guidelines might help to achieve the best outcomes. More research is needed to understand the patient and provider preference of one option over another when the guidelines are equivocal (as in TOT versus TVT).