National Trends in the Surgical Management of Urinary Incontinence Among Insured Adult Women, 2004-2013: The Urologic Diseases in America Project.

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The objective of this study was to examine national trends in the surgical management of urinary incontinence (UI) among women in the United States from 2004-2013.We analyzed the Optum© de-identified Clinformatics® Data Mart (CDM) Database for women 18-64 years of age and the Medicare 5% Sample (CMS) for women 65+ years of age. We created annual cross-sectional cohorts and assessed trends in annual prevalence of UI-related surgical procedures, overall and by age, race/ethnicity, and geographic region.We observed a decline in the percentage of women with UI undergoing surgical treatment (CMS: 4.7% in 2004 to 2.7% in 2013; CDM: 12.5% in 2004 to 9.1% in 2013). This trend persisted independent of age, race/ethnicity, and geographic region. Slings were the most common procedure but started to decline in 2011, ultimately declining by about 50% over the study period. Compared to other groups, prevalence of UI-related surgical procedures, including slings, was highest among women ages 35-54 years and White women, and lowest among women residing in the Northeast. These sociodemographic patterns persisted over time. During the study period, injection procedures remained stable, sacral neuromodulation increased slightly but remained uncommon, and suspensions declined to nearly 0% of all anti-incontinence procedures.The surgical management of female UI experienced several shifts from 2004-2013, including a decline in sling procedures. Age, racial/ethnic, and regional differences in treatment persisted over time. Improved understanding regarding drivers of these trends may help direct future development of treatments for pelvic floor disorders.

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