Abstract
Introduction and hypothesisThis was an observational study aiming to determine factors which influence women’s choice of surgery for primary stress urinary incontinence (SUI).MethodsTwo hundred twelve women undergoing a primary SUI procedure were recruited to this study from 12 hospitals in the north of England. After choosing a procedure, women were asked to complete a standardized semi-structured questionnaire about their health, demographics and a free text box to record factors important to them when choosing their procedure. Statistical analysis was performed to determine the impact of demographic, lifestyle or healthcare factors on women’s decision-making. Thematic analysis of the free text data was performed to identify factors important for women when choosing a surgical procedure.ResultsSixty-four percent of women chose urethral bulking. There was no significant difference among age, BMI, smoking status or previous laparotomy between women choosing the four types of surgery. Women were less likely to choose urethral bulking if seen in a tertiary centre compared with a secondary centre (p < 001). Major themes in decision-making were efficacy, invasiveness, recovery, risk of complications, use of mesh, the clinician, the media, hierarchy of treatments and type of anaesthetic. Some women expressed a hierarchical approach to treatment.ConclusionsOur findings suggest decision-making is not influenced by patient factors such as age, BMI, smoking status or previous laparotomies. Women’s choices are a complex mix of factors and not simply related to efficacy.
Highlights
Introduction and hypothesisThis was an observational study aiming to determine factors which influence women’s choice of surgery for primary stress urinary incontinence (SUI)
The inclusion criteria required that women were having their first procedure for SUI, had stress predominant mixed urinary incontinence, no evidence of detrusor over-activity or voiding difficulties and were deemed suitable by the surgeon for at least two of four surgical options
The analysis of 212 women found 64% opted for urethral bulking (n = 135), 23% a mid-urethral sling (n = 48), 12% colposuspension (n = 25) and 2% a fascial sling (n = 4)
Summary
This was an observational study aiming to determine factors which influence women’s choice of surgery for primary stress urinary incontinence (SUI). Methods Two hundred twelve women undergoing a primary SUI procedure were recruited to this study from 12 hospitals in the north of England. Statistical analysis was performed to determine the impact of demographic, lifestyle or healthcare factors on women’s decision-making. Thematic analysis of the free text data was performed to identify factors important for women when choosing a surgical procedure. There was no significant difference among age, BMI, smoking status or previous laparotomy between women choosing the four types of surgery. Continence surgery has been the subject of controversy in the UK, and there have been several government inquiries and reviews of safety, primarily in relation to mesh. Until the 2018 pause on MUS in England, MUS were by far the most common procedure performed, with 84 tapes for every one non-tape procedure [1]
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