Results of an international survey on current trends on surgery for female stress urinary incontinence surgery and pelvic organ prolapse

Introduction and aim of the study: This worldwide survey was aimed to assess the current approach on female stress urinary incontinence (SUI) surgery, on combined surgery in women with SUI and pelvic organ prolapse (POP), and on the use of prosthetic material.Materials and methods: This was an online worldwide survey on current trends in female SUI surgery, combined surgery for associated SUI and POP, use of mesh and tape in urogynaecology (April–September 2021). Mean social media and emails were used to collect data. Demographic respondents data, use of pelvic floor muscle training in SUI patients, type of SUI surgery, performing of combined surgery for associated SUI and POP, use of prosthetic materials were investigated. In some questions more than one answer was possible.Results: Survey was completed by 504 respondents: urologists 83.1%, gynaecologists 16.8%. A fellowship in female urology/urogynaecology was completed by 49.8%. Age and geographical location of respondents is reported in table 1. Female urology/urogynaecology was practised<10 years by 64.3%. Routinely pelvic floor muscle training as first step for SUI was reported by 72%. Preferred surgical treatments for uncomplicated SUI are listed in table 2, while table 3 shows reasons for not performing combination surgery. Combined surgery for associated SUI and POP is performed by 54.5%. Autologous fascia sling (43.2%), bulking agents (27.6%), abdominal colposuspension (24.8%) were the substitutes in case of no MUS availability. The routine use of transvaginal mesh was reported by 44.8%, while the use only in the recurrent POP was in 13.5%.Table 4 reports the use of MESH After April 2019 FDA ban.Interpretation of results: MUS was still the preferred surgical procedure for uncomplicated SUI. In case of no more MUS availability a more invasive treatment such as autologous fascia sling was preferred respect to bulking agents due to the consolidated data on long term success rate. Respondents were quite divided on the use of combined surgery for associated SUI and POP. This data confirmed that this topic is still debated. Surprisingly, even after the FDA ban, still about 40% of respondents used mesh for transvaginal POP repair.Conclusions: This survey confirmed that MUS was the preferred SUI surgery and that urogynecologists are still divided in the one step treatment of SUI associated to POP. The use of mesh was still larger than supposed, considering the mesh ban in several countries