International Survey on Current Trends on Surgery for Female Stress Urinary Incontinence Surgery and Pelvic Organ Prolapse

Balzarro M1, Gubbiotti M2, Castellani D3, Pirola G2, Tafuri A1, Rossi de Vermandois J4, Polykarpova A5, Martoccia A6, Gemma L7, Autrán-Gómez A8, Tortolero Blanco L9, Theo J10, Giannantoni A11, Antonelli A12, Goldman H13, Rubilotta E12

Research Type


Abstract Category

Female Stress Urinary Incontinence (SUI)

Abstract 229
On Demand Female Stress Urinary Incontinence (SUI)
Scientific Open Discussion Session 18
Female Incontinence Pelvic Organ Prolapse Questionnaire Stress Urinary Incontinence
1. A.O.U.I Verona, dept of Urology, Italy, 2. S. Donato Hospital, dept. of Urology, Arezzo, 3. IRCCS INRCA, Dept. of Urology, Ancona, Italy, 4. Urology Clinic, Department of Medicine and Surgery, University of Perugia, Italy., 5. RUDN University, SM-Clinic, Moscow, Russia, 6. Urology Unit, Department of Medico - Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, Sapienza University of Rome, Latina, Italy., 7. Careggi Hospital, Dept. of Urology, Firenze, Italy, 8. University Hospital Fundación Jiménez Díaz, Dept. of Urology, Madrid, Spain, 9. University Hospital 12 de Octubre, Dept. of Urology, Madrid, Spain, 10. S.H. Ho Urology Centre, The Chinese University of Hong Kong, Dept. of Surgery, Hong Kong, China, 11. Functional and Surgical Urology Unit, Department of Medical and Surgical Sciences and Neurosciences, University of Siena, Italy, 12. A.O.U.I Verona, dept. of Urology, Italy, 13. Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA

Marilena Gubbiotti



Hypothesis / aims of study
This worldwide survey had the aim to evaluate the current approach on female stress urinary incontinence (SUI) surgery, on combined surgery in women with SUI and pelvic organ prolapse (POP), and on the use of prosthetic material.
Study design, materials and methods
This is an online worldwide survey on current trends in female SUI surgery, combined surgery for associated SUI and POP, use of mesh and tape in urogynaecology (April 2021-still ongoing). Social media (Twitter, Medical Group on Facebook, WhatsApp, Messenger), emails, were used to collect data by a link referring to a database. Demographic respondent’s data, use of pelvic floor muscle training in SUI patients, type of SUI surgery, performance of combined surgery for associated SUI and POP, and use of prosthetic materials were investigated. In some questions more than one answer was possible.
A total of 420 responders completed the survey. Urologists were 80.7% (339/420), and the remaining 19.3% were gynaecologists. Half of the respondents (49.8%). had completed a fellowship in female urology/urogynecology. Age and geographic location of responders is reported in table 1. Female urology/urogynaecology was practiced <10 years by the 64.3%. 
Pelvic floor muscle training was reported as the first treatment option for SUI by 74.9% (figure 2). In 80.6% of respondent’s mid urethral sling (MUS) was the preferred surgical treatment for uncomplicated SUI with urethral hypermobility (table 2). Autologous fascial sling (42.4%), bulking agents (31.9%), and abdominal colposuspension (212.6%) were the potential substitutes for MUS when MUS was not available. Combined surgery for associated SUI and POP is performed by 55.2%. Reasons to not perform associated surgery are reported in table 3. The routine use of transvaginal mesh for POP was reported by 44.8%, while 13.5% used it only for recurrent POP. After the April 2019 FDA ban on MESH only 29.5% of respondent stopped using MESH, while 37% still use it (table 4).
Interpretation of results
This survey was able to give a picture of the worldwide trend in SUI and POP surgery. MUS was still the preferred surgical procedure for uncomplicated SUI. When MUS is not available a more invasive treatment such as autologous fascial sling was preferred with respect to bulking agents due to the consolidated data on long term success rate. Considering that 64% of respondents would use an abdominal surgical approach (sling or Burch) the first goal for surgeons was to resolve SUI, rather than limiting surgical invasiveness and potential complications. Combined surgery for associated SUI and POP were performed by the majority of the responders (55.2%). This data confirmed that this topic is still debated. Approximately half of surgeons did not consider a combination surgery due to personal attitudes (“no confidence” or “not my standard approach”), while 52.1% decided on the basis of literature data. Surprisingly even after the FDA ban, the majority of respondents still use mesh for transvaginal POP repair.
Concluding message
This survey confirmed that MUS was the preferred SUI surgery and that female urologists/urogynecologists are still divided in the one step treatment of SUI associated to POP. The use of mesh was higher than expected particularly considering the mesh ban in several countries.
Figure 1
Figure 2
Funding None Clinical Trial No Subjects Human
31/05/2022 21:06:17