Abstract

Introduction and hypothesisThe objectives were to explore the views of women with recurrent stress incontinence (SUI) with regard to treatment preferences and the acceptability of randomisation to a future trial, and to survey the views of UK specialists on treatment preferences and equipoise regarding different treatment alternatives.MethodsAn online survey of the British Society of Urogynaecology (BSUG) and British Society of Urological Surgeons (BAUS) was carried out. Qualitative semi-structured interviews with a purposive sample of surgeons and women suffering from recurrent SUI from three UK centres.ResultsTwo hundred fifty-six survey replies were received (176 gynaecology; 80 urology). Comparing the treatments offered, urogynaecologists were more likely to offer pelvic floor exercises (p < 0.05), and repeat midurethral tape (MUT) (p < 0.001). From the Surgical Equipoise Scale (SES) responses, “no preference” was rarely the commonest response. Marked differences for several options existed; midurethral tape dominated responses whenever it appeared. Twenty-one clinicians were interviewed. Treatment preferences were complex, influenced by a range of factors (reason for failure, patient comorbidity, investigations, personal experience, training). A future trial was regarded as important. Eleven women were interviewed. Most had considered more than one option, but felt that decision-making was more a process of elimination rather than a positive process. Randomisation to a study was regarded as unacceptable by most.ConclusionsNo consensus exists among surgeons about preferred treatment options for recurrent SUI, and personal experience and training dominate decision-making. For patients, choices were usually based on an elimination of options, including that of a repeat failed procedure. This contrasts with surgeons, who mostly preferred a repeat MUT above other options. Any future comparative study will be challenging.

Highlights

  • Introduction and hypothesisThe objectives were to explore the views of women with recurrent stress incontinence (SUI) with regard to treatment preferences and the acceptability of randomisation to a future trial, and to survey the views of UK specialists on treatment preferences and equipoise regarding different treatment alternatives

  • No consensus exists among surgeons about preferred treatment options for recurrent Stress urinary incontinence (SUI), and personal experience and training dominate decision-making

  • This contrasts with surgeons, who mostly preferred a repeat midurethral tape (MUT) above other options

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Summary

Introduction

The objectives were to explore the views of women with recurrent stress incontinence (SUI) with regard to treatment preferences and the acceptability of randomisation to a future trial, and to survey the views of UK specialists on treatment preferences and equipoise regarding different treatment alternatives. Urinary incontinence (UI) in women is a major issue for the NHS and for society. The prevalence and cost of treatment pose a significant healthcare burden with an ageing population. The Leicestershire MRC Incontinence Study reported that over a third of community-dwelling women aged 40 and over had significant urinary symptoms, with 12% experiencing UI weekly [1]. Stress urinary incontinence (SUI) is a common cause of urinary incontinence and surgery is a highly effective option. The placement of a midurethral tape (MUT; retropubic, transobturator route, or singleincision) to support the urethra is the procedure of choice for primary surgery among most clinicians.

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