Trends in surgical management of stress urinary incontinence among female Medicare beneficiaries

Abstract

Objectives: To identify patterns in the surgical treatment of women with stress urinary incontinence in the United States from 1992 to 2001.

Methods: As a part of the Urologic Diseases in America Project, we analyzed data from a 5% national random sample of female Medicare beneficiaries aged > or =65 years. The data were obtained from the Centers for Medicare and Medicaid Services carrier and outpatient files from 1992, 1995, 1998, and 2001. Women in the sample with a diagnosis of urinary incontinence were identified using the International Classification of Diseases, 9th edition, codes. Surgical procedures were identified using the Current Procedural Terminology, 4th edition, codes. The patterns of care were then analyzed during the 10-year period.

Results: The overall number of surgical procedures increased from 18 820 to 32 480 during the 10-year period, likely owing to the growing population of Medicare beneficiaries. Needle suspension was the most commonly performed incontinence procedure in 1992 and 1995. Collagen injections gained rapid popularity and became the most common procedure by 1998. A drastic increase in the numbers and rates of sling placements occurred from 1995 to 2001.

Conclusions: A rapid shift occurred in the surgical management of stress urinary incontinence in the 1990s. The rapid increase in the use of sling procedures corresponded with a decrease in the use of the many other available anti-incontinence procedures. As in previous years, we identified a trend toward minimally invasive approaches to surgery, without the presence of randomized controlled clinical trials to support these trends. We anticipate that the analysis of Medicare claims from 2004 onward will demonstrate an additional increase in the use of sling procedures.