Sling procedures for SUI increase fourfold but do not replace alternatives

A study investigating trends in ambulatory surgery for stress urinary incontinence (SUI) shows a significant, fourfold increase in the annual rate of sling procedures performed over a contemporary 9-year period.

Submucosal injection therapy appears to be maintaining a niche for the treatment of certain patients, however, reported first author Anne M. Suskind, MD, here on Saturday.

Dr. Suskind and co-authors from the University of Michigan, Ann Arbor, investigated the effect of the introduction of midurethral slings on SUI ambulatory surgery procedures using data from Florida’s State Ambulatory Surgery Database. Cases performed during the years 2001 to 2009 were identified by searching an exhaustive list of CPT4 codes. Since more than 90% of all SUI procedures found were either submucosal injections or sling operations, further analyses focused on these two procedures.

During the study period, there were approximately 37,000 sling operations performed and approximately 9,000 submucosal injections. Graphing of the data by study year showed a linear increase in the annual number of sling operations and no change in the number of submucosal injections. Results from a multilevel mixed model adjusting for various demographic and regional characteristics also showed that the likelihood of having a sling over an injection continued to increase each year.

"There have been a number of changes in ambulatory surgery for SUI in the past several years, with the introduction of midurethral slings in 1994 being the most important," said Dr. Suskind, who worked on the study with Brent K. Hollenbeck, MD, MS, and colleagues. "While slings promised to be less invasive, easy to perform, have high success rates, and be completely ambulatory, our study suggests they have augmented the armamentarium of outpatient surgical procedures for SUI rather than supplanted alternative treatments."

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