Structural health care reality in the surgical treatment of male stress incontinence in Germany

Abstract

Stress urinary incontinence in men is predominantly iatrogenic after radical prostatectomy or transurethral interventions. Current studies show that there is adeficit in the availability of surgical therapy not only in Germany. The aim of this study is to investigate in more detail the structural health care situation of surgical treatment of male stress incontinence in Germany. The evaluation of the surgical therapy of male stress incontinence in Germany is based on the OPS (Operationen- und Prozedurenschlüssel-German procedural classification) codes from hospital quality reports from 2011-2019. From 2012-2019, the number of male incontinence surgeries declined from 2191 to 1445. The number of departments performing incontinence surgeries decreased from 275 to 244. In the multivariate analysis, ahigh number (≥ 50) of radical prostatectomies/year (RPE/year) is an independent predictor of ahigh-volume centre (≥ 10procedures/year; odds ratio [OR] 6.4 [2.3-17.6]; p < 0.001). The most significant decrease was in sling surgery (from 1091 to 410; p < 0.001). Here, the number of cases decreased especially in departments that implanted ahigh number of slings (≥ 10slings/year; -69%; -62.4 ± 15.5 surgeries/year; p = 0.007). In addition, the number of departments implanting slings decreased over the investigated time period (from 34to 10; p < 0.001). This particularly affected departments that also had alow number of RPE/year (from 9to 0; -100%). The situation of surgical treatment of male stress urinary incontinence in Germany shows aclear decline in sling implantation, especially in small departments. On the one hand, this reflects the increasingly differentiated indications for sling implantation. On the other hand, it raises the suspicion that agap in care has developed, as the decline was not compensated for by other surgical therapies.