Are older women more likely to receive surgical treatment for stress urinary incontinence since the introduction of the mid-urethral sling? An examination of Hospital Episode Statistics data.

OBJECTIVE: To examine the trends in surgical treatment of stress urinary incontinence (SUI) in older women since the introduction of the mid-urethral sling.
DESIGN: Analysis of data from Hospital Episode Statistics (HES) between 2000 and 2012. SETTING AND POPULATION: All surgical procedures for SUI in the National Health Service (NHS) in England.
METHODS: Retrospective cohort analysis of Hospital Episode Statistics for England from 2000 to 2012. MAIN OUTCOME MEASURES: Number of invasive, less invasive, and urethral bulking procedures performed in women in three age groups.
RESULTS: There was a 90% fall in the number of invasive surgical treatments for SUI and a four-fold increase in the number of mid-urethral slings over this time. The total number of surgical procedures for SUI increased from 8458 to 13 219. However, the rise in the number of procedures in women aged over 75 was more modest-a three-fold increase from a low start of 187-and these women now make up a smaller proportion of all women receiving a mid-urethral sling (MUS).
CONCLUSIONS: Despite the development and wide availability of a less invasive, safe and effective operation for stress urinary incontinence in older women, they do not appear to have benefitted. The reasons for this require prospective investigation.