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. 2025 May 9;17(5):e83815.
doi: 10.7759/cureus.83815. eCollection 2025 May.

Evaluating Surgical Trends and Outcomes in Stress Urinary Incontinence: A Clinical Audit at a District General Hospital

Tarang Preet Kaur  1 , Kimberly Lim Xinyi  2 , Chloe Barnes  2 , Shatha Attarbashi  3 , Naweed Shahid  3
Affiliations

Evaluating Surgical Trends and Outcomes in Stress Urinary Incontinence: A Clinical Audit at a District General Hospital

Tarang Preet Kaur et al. Cureus. .

Abstract

Stress urinary incontinence (SUI) significantly impairs quality of life. This retrospective audit aimed to evaluate surgical treatment patterns and outcomes for SUI at a district general hospital between 2018 and 2023 and to compare them with national benchmarks from the third British Society of Urogynaecology (BSUG) report in 2020-21. Data from 99 patients were collected from the BSUG database and hospital electronic records, following clinical audit department approval. The mean age of patients undergoing surgery was 50 years. In 2018, mid-urethral tape was the most commonly performed procedure (46.2%); however, following the UK-wide suspension of vaginal mesh procedures that year, there was a notable shift towards alternative surgeries. Bladder neck injections (BNIs), colposuspension (open and laparoscopic), and autologous fascial sling (AFS) procedures all increased in frequency, mirroring national trends. BNIs became the predominant procedure, accounting for 76.8% of cases, with over 80% performed on an outpatient basis. Reported cure rates, when compared to national figures, were AFS (100% vs. 94%), laparoscopic colposuspension (71.4% vs. 84%), BNIs (66% vs. 60%), and open colposuspension (33.3% vs. 81%). Bladder injuries occurred in 17.3% of colposuspension cases, significantly higher than the national average of 2.7%. Additionally, prolonged catheterisation (>10 days) was noted in 29% of colposuspension cases, compared to 7.1% nationally. These elevated complication rates may reflect the procedural learning curve, as laparoscopic colposuspension was only recently introduced at the center. The audit highlights evolving surgical trends and outcomes in the management of SUI following the national mesh pause, with a shift toward non-mesh alternatives. Further audits with long-term follow-up and larger sample sizes are recommended to assess the safety, efficacy, and patient-reported outcomes of these procedures.

Keywords: autologous fascial sling; bladder neck injection; colposuspension; mesh pause; stress urinary incontinence; surgical outcomes; urogynaecology audit.

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Conflict of interest statement

Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Clinical Audit and Effectiveness Department, Wrightington, Wigan and Leigh NHS Foundation Trust issued approval Not applicable. This audit was registered and approved by the NHS Trust's Quality Improvement and Audit Department. A review by the Trust's Research Committee and further confirmation via the “Is My Study Research?” tool (hra-decisiontools.org.uk) indicated that formal NHS Research Ethics Committee approval was unnecessary. Informed written consent was not required because data entry into the BSUG system is part of standard practice and consent for data recording is routinely obtained at the time of care. All data were entered into a password-protected Excel spreadsheet on a secure Trust computer. The only patient identifier used was the hospital number, which was necessary for tracking follow-up and readmissions. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Percentage distribution of SUI surgeries (2018-23)
SUI: Stress urinary incontinence; TVT: transvaginal tape; TOT: transobturator tape
Figure 2
Figure 2. Run diagram showing a trend of continence surgeries (2018-23) in this study
SUI: Stress urinary incontinence; MUT: mid-urethral tape; AFS: autologous fascial sling; BNI: bladder neck injection
Figure 3
Figure 3. Run diagram showing the trend of continence surgeries (2018-23) in the BSUG report (2020-21)
SUI: Stress urinary incontinence; MUT: mid-urethral tape; AFS: autologous fascial sling; BNI: bladder neck injection; BSUG: British Society of Urogynaecology
See this image and copyright information in PMC

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