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Geographical variation in rates of surgical treatment for female stress urinary incontinence in England: a national cohort study.

ABSTRACT: OBJECTIVE:To examine geographic variation in use of surgery for female stress urinary incontinence (SUI), mainly midurethral mesh tape insertions, in the English National Health Service (NHS). DESIGN:National cohort study. SETTING:NHS hospitals. PARTICIPANTS:27?997 women aged 20 years or older who had a first SUI surgery in an English NHS Hospital between April 2013 and March 2016 and a diagnosis of SUI at the same time as the procedure. METHODS:Multilevel Poisson regression was used to adjust for geographic differences in age, ethnicity, prevalence of long-term illness and socioeconomic deprivation. PRIMARY OUTCOME MEASURE:Rate of surgery for SUI per 100?000 women/year at two geographic levels: Clinical Commissioning Group (CCG; n=209) and Sustainability and Transformation Partnership (STP; n=44). RESULTS:The rate of surgery for SUI was 40 procedures per 100?000 women/year. Risk-adjusted rates ranged from 20 to 106 procedures per 100?000 women/year across CCGs and 24 to 69 procedures per 100?000 women/year across the STP areas. These regional differences were only partially explained by demographic characteristics as adjustment reduced variance of surgery rates by 16% among the CCGs and 35% among the STPs. CONCLUSIONS:Substantial geographic variation exists in the use of surgery for female SUI in the English NHS, suggesting that women in some areas are more likely to be treated compared with women with the same condition in other areas. The variation reflects differences in how national guidelines are being interpreted in the context of the ongoing debate about the safety of SUI surgery.

SUBMITTER: Mamza JB

PROVIDER: S-EPMC6720135 | biostudies-literature | 2019 Aug

REPOSITORIES: biostudies-literature

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Geographical variation in rates of surgical treatment for female stress urinary incontinence in England: a national cohort study.

Mamza Jil B JB Geary Rebecca S RS El-Hamamsy Dina D Cromwell David A DA Duckett Jonathan J Monga Ash A Toozs-Hobson Philip P Mahmood Tahir T Wilson Andrew A Tincello Douglas G DG van der Meulen Jan H JH Gurol Urganci Ipek I

BMJ open 20190828 8

<h4>Objective</h4>To examine geographic variation in use of surgery for female stress urinary incontinence (SUI), mainly midurethral mesh tape insertions, in the English National Health Service (NHS).<h4>Design</h4>National cohort study.<h4>Setting</h4>NHS hospitals.<h4>Participants</h4>27 997 women aged 20 years or older who had a first SUI surgery in an English NHS Hospital between April 2013 and March 2016 and a diagnosis of SUI at the same time as the procedure.<h4>Methods</h4>Multilevel Poi ...[more]

PMID: 31462480

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Project description:Introduction and hypothesisMany adult women have resident urinary bacteria (urinary microbiome/microbiota). In adult women affected by urinary urgency incontinence (UUI), the etiologic and/or therapeutic role of the urinary microbiome/microbiota remains unknown. We hypothesized that microbiome/microbiota characteristics would relate to clinically relevant treatment response to UUI medication per os.MethodsAdult women initiating medication treatment orally for UUI and a comparator group of unaffected women were recruited in a tertiary care health-care system. All participants provided baseline clinical data and urine samples. Women with UUI were given 5 mg solifenacin, with potential dose escalation to 10 mg for inadequate UUI symptom control at 4 weeks. Additional data and urine samples were collected from women with UUI at 4 and 12 weeks. The samples were assessed using 16S ribosomal RNA (rRNA) gene sequencing and enhanced quantitative urine culturing. The primary outcome was treatment response as measured by the validated Patient Global Symptom Control (PGSC) questionnaire. Clinically relevant UUI symptom control was defined as a 4 or 5 score on the PGSC.ResultsDiversity and composition of the urinary microbiome/microbiota of women with and without UUI differed at baseline. Women with UUI had more bacteria and a more diverse microbiome/microbiota. The clinical response to solifenacin in UUI participants was related to baseline microbiome/microbiota, with responders more likely to have fewer bacteria and a less diverse community at baseline. Nonresponders had a more diverse community that often included bacteria not typically found in responders.ConclusionsKnowledge of an individual's urinary microbiome/microbiota may help refine UUI treatment. Complementary tools, DNA sequencing, and expanded urine culture provide information about bacteria that appear to be related to UUI incontinence status and treatment response in this population of adult women.

Dataset Information

Geographical variation in rates of surgical treatment for female stress urinary incontinence in England: a national cohort study.

Publications

Geographical variation in rates of surgical treatment for female stress urinary incontinence in England: a national cohort study.

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