To review recent trends in common functional urology and benign prostatic enlargement (BPE) surgery in England, using the Hospital Episode Statistics (HES) database.

Data between 2013-2024 were obtained from the HES database, a publicly available dataset recording details about procedures in NHS England. We recorded the procedures for treatment of female stress urinary incontinence (SUI), urge urinary incontinence (UUI), post-prostatectomy incontinence (PPI), vesicovaginal fistula (VVF) and outflow obstruction surgery for BPE.

SUI surgery saw radical changes in this study decade (Figure 1a). Initially the most common procedures were insertion of transobturator and tension-free vaginal tape (TOT and TVT). From 2019 we observe an almost complete halt in tape insertion, corresponding to publication of the Cumberledge report, which highlighted concerns about vaginal meshes. In the same period there was an increase in procedures to remove TVT/TOT, while injection of bulking agents became the mainstream treatment for female SUI, followed by renewed increases in colposuspension. The use of fascial slings in females and artificial urinary sphincter devices in men affected by PPI remained static.

For refractory UUI, intravesical Botulinum toxin A (Botox) remains the treatment modality of choice, with lower numbers seen for neuromodulation and even lower in ileocystoplasty, static across the years. VVF repairs decreased over the study period.

Transurethral Resection of the Prostate (TURP) remains the mainstay operation for BPE, though decreases in numbers are noted over the decade (Figure 1b). This corresponded to an increase in other resection modalities, with Holmium Laser Enucleation (HoLEP) representing the second most common choice, followed by minimally invasive techniques (Rezūm and UroLift).

There was a reduction in numbers across procedures between 2020 and 2022, corresponding to the COVID-19 pandemic, with 2023 and 2024 figures showing a new increase but remaining lower than pre-pandemic levels.

Due to concerns around tape-related complications, bulking agents are now the mainstream treatment of SUI in women, and BTX in UUI. No significant increases in neuromodulation were observed, despite increased access across the country. While HoLEP is becoming increasingly popular, TURP remains the mainstream option for BPE. There has only been a partial recovery in surgical numbers following the pandemic.

This study highlights significant shifts in surgical practices for UI and BPE in England, influenced by evolving clinical guidelines, emerging technologies, and external factors such as the COVID-19 pandemic. Ongoing surveillance of these trends is essential to inform healthcare planning and resource allocation, ensuring optimal patient outcomes.