OBJECTIVE: To quantify changes in surgical practice in the treatment of stress, urge and post prostatectomy incontinence in England, using the Hospital Episode Statistics (HES) database.
PATIENTS AND METHODS: The Hospital Episode Statistics (HES) database is an administrative dataset recording all hospital admissions and procedures in England. Public domain information from this database was interrogated for evidence of change in the utilisation of various operative procedures for urinary incontinence from 2000 to 2012.
RESULTS: In the treatment of stress incontinence, a general increase in the use of synthetic mid urethral tapes such as TVT and TVTO was observed. A significant decrease in colposuspension procedures is seen over the same period. Procedures to remove TVT and TVTO have also increased in recent years. In the treatment of overactive bladder and urge urinary incontinence, a significant increase in the use of botulinum toxin-A and neuromodulation has been observed in recent years. This has coincided with a steady decline in the recorded use of clam ileocystoplasty. A steady increase is observed in the insertion of artificial urinary sphincters in men, related to post prostatectomy incontinence.
CONCLUSIONS: Mid-urethral synthetic tapes now represent the mainstream treatment of stress incontinence in women but tape-related complications have led to an increase in procedures to remove these devices. The uptake of botulinum toxin-A and sacral neuromodulation has led to fewer clam ileocystoplasty procedures being performed. The steady increase in insertions of artificial urinary sphincters in men is unsurprising and reflects the widespread uptake of radical prostatectomy in recent years. This study demonstrates that administrative data can be used to demonstrate trends in continence surgery, a method that could be applied in any healthcare setting internationally, that collects such data routinely.
Written by:
Withington J, Hirji S, Sahai A. Are you the author?
Guy's and St Thomas' NHS Hospitals' Trust.
Reference: BJU Int. 2014 Feb 7. Epub ahead of print.
doi: 10.1111/bju.12650
PubMed Abstract
PMID: 24512557
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