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Surgery for recurrent stress urinary incontinence: the views of surgeons and women

Lookup NU author(s): Paul Hilton



This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).


© 2017 The Author(s) Introduction and hypothesis: 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. Methods: An 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. Results: Two 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. Conclusions: No 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.

Publication metadata

Author(s): Tincello DG, Armstrong N, Hilton P, Buckley B, Mayne C

Publication type: Article

Publication status: Published

Journal: International Urogynecology Journal

Year: 2018

Volume: 29

Issue: 1

Pages: 45-54

Print publication date: 01/01/2018

Online publication date: 02/06/2017

Acceptance date: 11/05/2017

Date deposited: 19/06/2017

ISSN (print): 0937-3462

ISSN (electronic): 1433-3023

Publisher: Springer London


DOI: 10.1007/s00192-017-3376-6


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