Trends in the surgical management of stress urinary incontinence among female Medicare beneficiaries, 2002-2007

Rogo- u!ta ", "itwin M#, #aigal $#, %nger &T' (rologic )iseases in %merica Pro*ect+ )a,id (#%+ effen #chool of Medicine, (ni,ersity of $alifornia, "os %ngeles, $%,

Oleh Bambang Purwono

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uidelines recommend that women with stress urinary incontinence /#(-0 who fail conser,ati,e management should be considered for all acce!table surgical o!tions+ %(%, %$O , 1%( guidelines consider sling, la!arosco!ic sus!ensions and in*ectable bul2ing agents as acce!table treatment o!tions+ The !ast decade, sling !rocedures is dominant for management of #(-n 3442, urethro!e5y /Burch, Marshall-Marchetti-6rant70 was the most commonly !erformed !rocedure But in 2003 the sling and the suburethral bul2ing !rocedures was most commonly

Objective
To describe trends in the surgical management of female stress urinary incontinence /#(-0 in the (nited #tates from 2002 to 2007

 %naly7ed data from a 89 national random sam!le of female Medicare beneficiaries aged :8 and older+ )ata were obtained from the $enters for Medicare and Medicaid #er,ices carrier and out!atient files from 2002 to 2007+ #ub*ect diagnosed with urinary incontinence identified by the /-$)-40 diagnosis codes Treatment for #(- was identified (sing $urrent Procedural Terminology /$PT-;0 !rocedure codes were included in the analysis+ Trends were analy7ed o,er the :-year !eriod+

Methode

Results

 The total of 243,3<0 !rosedure for #(- were identified during the study !eriod the total number of surgical !rocedures stable during the study !eriod, from ;4,=;0 in 2002 to ;4,400 in 2007+ #lings the most common !rocedure across all years, which increased from 28,<;0 !rocedures in 2002 to ==,<<0 !rocedures in 2007+ -n*ectable bul2ing agents second most common !rocedure, which accounted for 3;,300 !rocedures in 2002 but decreased to 33,=20 in 2007+ Procedures !erformed in ambulatory surgery centers and !hysician offices increased, although those !erformed in in!atient settings declined+ >os!ital out!atient !rocedures remained stable

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#ling ha,e become the most widely !erformed surgical !rocedure for #(- ? good long-term durability "ong term data on retro!ubic tension-free-,aginal ta!e /T@T' gynecare, somer,ile, .&0 uncom!licated suggest 77-4=9 of !atient remain cured 30 years after sling !alcement % decline in surgical !rocedures !erformed in the hos!ital in!atient setting has been demontrated for #(? !el,ic organ !rola!s

$onclusions
The surgical management of women with #(- shifted toward a dominance of !rocedures !erformed in ambulatory surgery centers from 2002 to 2007 #lings remained the dominant surgical !rocedure, followed by in*ectable bul2ing agents, both of which are easily !erformed in out!atient settings+

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